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Yabalak A, Ögün MN, Önalan A, Yılmaz M, Tokmak H, Ersoy S, Bilgili F, Bakkal T. Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome. Arq Neuropsiquiatr 2024; 82:1-7. [PMID: 38438069 PMCID: PMC10911890 DOI: 10.1055/s-0044-1779268] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/11/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies. OBJECTIVE In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used. METHODS Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated. RESULTS Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis. CONCLUSION mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.
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Affiliation(s)
- Ahmet Yabalak
- Duzce University, Faculty of Medicine, Department of Neurology, Duzce, Türkiye.
| | - Muhammed Nur Ögün
- Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.
| | - Ayşenur Önalan
- Kartal Lutfi Kırdar City Hospital, Department of Neurology, Istanbul, Türkiye.
| | - Murat Yılmaz
- Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.
| | - Hilmiye Tokmak
- Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.
| | - Sadettin Ersoy
- Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.
| | - Fatma Bilgili
- Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.
| | - Tahsin Bakkal
- Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.
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Mota Telles JP, Rosi Junior J, Yamaki VN, Rabelo NN, Teixeira MJ, Figueiredo EG. Homocysteine serum levels in patients with ruptured and unruptured intracranial aneurysms: a case-control study. Arq Neuropsiquiatr 2024; 82:1-6. [PMID: 38325387 PMCID: PMC10849822 DOI: 10.1055/s-0044-1779270] [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] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/21/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND There is very few data regarding homocysteine's influence on the formation and rupture of intracranial aneurysms. OBJECTIVE To compare homocysteine levels between patients with ruptured and unruptured intracranial aneurysms, and to evaluate possible influences of this molecule on vasospasm and functional outcomes. METHODS This is a retrospective, case-control study. We evaluated homocysteinemia differences between patients with ruptured and unruptured aneurysms; and the association of homocysteine levels with vasospasm and functional outcomes. Logistic regressions were performed. RESULTS A total of 348 participants were included: 114 (32.8%) with previous aneurysm rupture and 234 (67.2%) with unruptured aneurysms. Median homocysteine was 10.75µmol/L (IQR = 4.59) in patients with ruptured aneurysms and 11.5µmol/L (IQR = 5.84) in patients with unruptured aneurysms. No significant association was detected between homocysteine levels and rupture status (OR = 0.99, 95% CI = 0.96-1.04). Neither mild (>15µmol/L; OR = 1.25, 95% CI 0.32-4.12) nor moderate (>30µmol/L; OR = 1.0, 95% CI = 0.54-1.81) hyperhomocysteinemia demonstrated significant correlations with ruptured aneurysms. Neither univariate (OR = 0.86; 95% CI 0.71-1.0) nor multivariable age-adjusted (OR = 0.91; 95% CI = 0.75-1.05) models evidenced an association between homocysteine levels and vasospasm. Homocysteinemia did not influence excellent functional outcomes at 6 months (mRS≤1) (OR = 1.04; 95% CI = 0.94-1.16). CONCLUSION There were no differences regarding homocysteinemia between patients with ruptured and unruptured intracranial aneurysms. In patients with ruptured aneurysms, homocysteinemia was not associated with vasospasm or functional outcomes.
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Affiliation(s)
- João Paulo Mota Telles
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Jefferson Rosi Junior
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
| | - Vitor Nagai Yamaki
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
| | - Nicollas Nunes Rabelo
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
| | - Manoel Jacobsen Teixeira
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
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Oliveira NKD, Santos LHCGD, Reis GCD, Pereira ND. Reliability and validity of remote Life Space Assessment: LSA in persons with chronic stroke. Arq Neuropsiquiatr 2024; 82:1-6. [PMID: 38325388 PMCID: PMC10849820 DOI: 10.1055/s-0044-1779297] [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] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND StepWatch Activity Monitor (SAM) is used to measure the mobility of chronic hemiparetic patients and the Life Space Assessment (LSA) scale was developed to assess the displacement of hemiparetic patients in different contexts through self-reporting. Studies that apply the LSA remotely and correlate it with the number of steps measured by the SAM were not found. OBJECTIVE To evaluate the measurement properties of the LSA applied remotely and to evaluate the correlation between the LSA scale score and the number of steps measured by the SAM in post-stroke chronic hemiparetic patients. METHODS Nineteen patients participated in the study. The LSA scale was applied remotely and later, face to face. The SAM measured the steps taken by the participants over a period of three consecutive days. The correlation between the LSA and the SAM was performed using Pearson's correlation. The measurement properties calculated of remote LSA were the intraclass correlation coefficient (ICC), Cronbrach's alpha, standard error of measurement (SEM), and smallest real difference (SRD). RESULTS The reproducibility of the LSA scale between remote and face-to-face applications was considered excellent with ICC = 0.85 (IC 95% 0.62-0.94); SEM = 8.4; SRD = 23.2, and Cronbach's alpha = 0.85. The correlation between SAM and LSA was positive, considered moderate (r = 0.51) and significant (p = 0.025). CONCLUSION The LSA is a reproducible measure for post-stroke chronic hemiparetic patients even if applied remotely and can be used as a remote measurement for mobility in a real-world environment for people with chronic hemiparesis after stroke.
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Martins SCO, Pontes-Neto OM, Pille A, Secchi TL, Miranda Alves MAD, Rebello LC, Oliveira-Filho J, Lange MC, de Freitas GR, de Andrade JBC, Rocha LJDA, Bezerra DDC, Souza ACD, Carbonera LA, Nogueira RG, Silva GS. Reperfusion therapy for acute ischemic stroke: where are we in 2023? Arq Neuropsiquiatr 2023; 81:1030-1039. [PMID: 38157871 PMCID: PMC10756810 DOI: 10.1055/s-0043-1777721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.
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Affiliation(s)
- Sheila Cristina Ouriques Martins
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
- Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
| | | | - Arthur Pille
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
- Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
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Sahbaz T, Medin-Ceylan C. Stroke severity to determine musculoskeletal symptoms in family caregivers. Rev Lat Am Enfermagem 2023; 31:e4004. [PMID: 37820216 PMCID: PMC10561800 DOI: 10.1590/1518-8345.6725.4004] [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: 02/28/2023] [Accepted: 07/12/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE the objective of this study is to examine the relationship between the musculoskeletal problems experienced by the family members who care for stroke patients, physical health and disability levels. METHOD the subjects included in the study were patients and family caregivers admitted to the Kanuni Sultan Suleyman Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with a stroke diagnosis between May 30 th, 2019, and May 30 th, 2021. The caregivers were assessed using the Extended Nordic Musculoskeletal Questionnaire. Validated scales were employed to evaluate stroke patients' physical health and disability level. RESULTS a total of 104 stroke patients and 104 caregivers who met our inclusion criteria took part in this study. Low back complaints in the last month were associated with the patients' Functional Ambulation Score (FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) and Brunnstrom scores. Neck pain was the second musculoskeletal complaint, but was not statistically associated with patient-related factors. Upper limb problems were associated with FAS, FIM, SIS, Brunnstrom and the Modified Ashworth Scale scores. CONCLUSION according to our findings, the low back is the body area most affected by musculoskeletal complaints in family caregivers of stroke patients, closely related to the patients' functional capacity and disability levels. CLINICAL TRIALS NUMBER NCT04901637 (1) Stroke survivors highly depend on informal caregivers for daily living. (2) Family caregivers are at an increased risk of experiencing musculoskeletal problems. (3) The caregivers' musculoskeletal symptoms are related to the level of the patient disability. (4) Preventive medicine should become a part of nursing education for family caregivers.
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Affiliation(s)
- Tugba Sahbaz
- Beykent University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Cansın Medin-Ceylan
- University of Health Sciences, Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
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de Lima JN, Lima LR, Cavalcante EGR, Quirino GDS, Pinheiro WR. Nursing theories in the care of stroke patients: a scoping review. Rev Bras Enferm 2023; 76:e20220791. [PMID: 37820129 PMCID: PMC10561425 DOI: 10.1590/0034-7167-2022-0791] [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: 01/22/2023] [Accepted: 04/20/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES to map and synthesize nursing theories and conceptual frameworks that have been applied in the practice of nursing care for stroke patients in hospital settings. METHODS a scoping review was conducted in October 2022 using the MEDLINE (accessed via PubMed), CINAHL, Scielo, and Web of Science databases, following The Joanna Briggs Institute guidelines. RESULTS nine studies incorporated six nursing theories and three conceptual frameworks, which were employed to enhance stroke patient care. The objective of these theories and conceptual frameworks was to facilitate the identification of the patient's psychobiological, psychosocial, and psychospiritual needs, elucidate the nurse's role and expand their perspective on rehabilitation, and acknowledge the survivor's process of transition. FINAL CONSIDERATIONS this mapping exercise identified major nursing theories, middle-range theories, and conceptual frameworks applied to the care of stroke patients.
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Dias FA, Zotin MCZ, Alessio-Alves FF, Martins Filho RKDV, Barreira CMA, Vincenzi OC, Venturelli PM, Boulouis G, Goldstein JN, Pontes-Neto OM. Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage. Arq Neuropsiquiatr 2023; 81:861-867. [PMID: 37939718 PMCID: PMC10631847 DOI: 10.1055/s-0043-1775885] [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] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context. OBJECTIVE We evaluated whether dilated optic nerve sheath diameter (ONSD) depicted by optic nerve ultrasound (ONUS) at hospital admission has prognostic value as a predictor of mortality at 90 days. METHODS Prospective multicenter study of acute supratentorial primary ICH patients consecutively recruited from two tertiary stroke centers. Optic nerve ultrasound and cranial computed tomography (CT) scans were performed at hospital admission and blindly reviewed. The primary outcome was mortality at 90-days. Multivariate logistic regression, ROC curve, and C-statistics were used to identify independent predictors of mortality. RESULTS Between July 2014 and July 2016, 57 patients were evaluated. Among those, 13 were excluded and 44 were recruited into the trial. Their mean age was 62.3 ± 13.1 years and 12 (27.3%) were female. On univariate analysis, ICH volume on cranial CT scan, ICH ipsilateral ONSD, Glasgow coma scale, National Institute of Health Stroke Scale (NIHSS) and glucose on admission, and also diabetes mellitus and current nonsmoking were predictors of mortality. After multivariate analysis, ipsilateral ONSD (odds ratio [OR]: 6.24; 95% confidence interval [CI]: 1.18-33.01; p = 0.03) was an independent predictor of mortality, even after adjustment for other relevant prognostic factors. The best ipsilateral ONSD cutoff was 5.6mm (sensitivity 72% and specificity 83%) with an AUC of 0.71 (p = 0.02) for predicting mortality at 90 days. CONCLUSION Optic nerve ultrasound is a noninvasive, bedside, low-cost technique that can be used to identify increased ICP in acute supratentorial primary ICH patients. Among these patients, dilated ONSD is an independent predictor of mortality at 90 days.
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Affiliation(s)
- Francisco Antunes Dias
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Maria Clara Zanon Zotin
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Medicina Interna, Divisão de Radiologia, Ribeirão Preto SP, Brazil.
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.
| | - Frederico Fernandes Alessio-Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Rui Kleber do Vale Martins Filho
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Clara Monteiro Antunes Barreira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Otavio Costa Vincenzi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Paula Muñoz Venturelli
- Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina, Centro de Estudios Clínicos, Santiago, Chile.
| | - Gregoire Boulouis
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.
| | | | - Octavio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
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Rodrigues de Oliveira LF, Camilo MR, Franciscatto L, Podolsky-Gondim GG, Alves FFA, Filho RKDVM, Dias FA, Tanaka K, Colli BO, Pontes-Neto OM. Outcomes of decompressive craniectomy for malignant middle cerebral artery stroke in an academic hospital in Brazil. Arq Neuropsiquiatr 2023; 81:778-784. [PMID: 37793399 PMCID: PMC10550345 DOI: 10.1055/s-0043-1772602] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/02/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Ischemic stroke is an important cause of death in the world. The malignant middle cerebral artery infarction (MMCAI) has mortality as high as 80% when clinically treated. In this setting, decompressive craniectomy is a life-saving measure, in spite of high morbidity among survivors. OBJECTIVE To evaluate the outcomes of patients with MMCAI treated with decompressive craniectomy in a Brazilian academic tertiary stroke center. METHODS A prospective stroke database was retrospectively evaluated, and all patients treated with decompressive craniectomy for MMCAI between January 2014 and December 2017 were included. The demographics and clinical characteristics were evaluated. The functional outcome, measured by the modified Rankin Scale (mRS), was assessed at hospital discharge, after 3-months and 1-year of follow-up. RESULTS We included 53 patients on the final analysis. The mean age was 54.6 ± 11.6 years and 64.2% were males. The median time from symptoms to admission was 4.8 (3-9.7) hours and the mean time from symptoms to surgery was 36 ± 17 hours. The left hemisphere was the affected in 39.6%. The median NIHSS at admission was 20 (16-24). The in-hospital mortality was 30.2%. After a median of 337 [157-393] days, 47.1% of patients had achieved favorable outcome (mRS ≤ 4) and 39.6% had died. CONCLUSION Decompressive craniectomy is a life-saving measure in the setting of MMCAI, and its effects remains important in the scenario of a middle-income country in real-world situations.
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Affiliation(s)
- Luiz Fernando Rodrigues de Oliveira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Millene Rodrigues Camilo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Luisa Franciscatto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Guilherme Gozzoli Podolsky-Gondim
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
| | - Frederico Fernandes Alessio Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Rui Kleber do Vale Martins Filho
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Francisco Antunes Dias
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Koji Tanaka
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
| | - Benedicto Oscar Colli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
| | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
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Muniz LS, Moraes MDA, Sales RS, Ribeiro LS, Cunha BS, de Jesus PAP, Sampaio EES, Baccin CRA, Teles CADS, Mussi FC. Factors associated with decision time to seek care in the face of ischemic stroke. Rev Esc Enferm USP 2023; 57:e20230075. [PMID: 37624382 PMCID: PMC10461728 DOI: 10.1590/1980-220x-reeusp-2023-0075en] [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: 03/27/2023] [Accepted: 06/29/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To verify the association between sociodemographic, clinical, environmental, cognitive, and emotional factors and the decision time of people with ischemic stroke to seek a health service after the onset of symptoms or wake up stroke. METHOD Cross-sectional study carried out from March to October 2019, with 304 patients, in a public hospital, a reference in neurology. Data obtained through interview and from medical records. Decision time was analyzed as a geometric mean. In the bivariate and multivariate analyses, linear regression was used and the Akaike Information Criterion was used to select the best model. Statistical significance of 5% was adopted. RESULTS The geometric mean of decision time was 0.30h (95% CI 0.23-0.39). The final model explained this time in 41%, showing an increase of 0.5 min for people with arterial hypertension; 10.8 min for those who waited for symptoms to improve; 1.4 min for those who were alone at the onset of symptoms; 3.9 min for those at home; 3.2 min for the ones at work; and 2.1 for those on the street/public space. CONCLUSION The mean decision time for seeking a health service was high and influenced by clinical, environmental, cognitive, and emotional variables. The results guide nurses regarding health education.
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Affiliation(s)
- Ludimila Santos Muniz
- Empresa Brasileira de Serviços Hospitalares, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil
| | | | - Rilary Silva Sales
- Universidade Federal da Bahia, Faculdade de Enfermagem, Salvador, BA, Brazil
| | - Laís Silva Ribeiro
- Universidade Federal da Bahia, Faculdade de Enfermagem, Salvador, BA, Brazil
| | - Brenda Silva Cunha
- Universidade Federal da Bahia, Faculdade de Enfermagem, Salvador, BA, Brazil
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Vasconcelos BF, Vilhena DDA, Vasconcelos LF, Corrêa PMMG, da Costa MCP, Santos JN, Machado TPG. Content validity of the Post-Stroke Guidance and Follow-up Booklet. Rev Bras Enferm 2023; 76:e20220532. [PMID: 37556694 PMCID: PMC10405396 DOI: 10.1590/0034-7167-2022-0532] [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: 05/09/2022] [Accepted: 07/02/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES to provide sources of content validity evidence for the Post-Stroke Guidance and Follow-up Booklet. METHODS a quantitative-qualitative approach, using two Delphi method and content analysis rounds. The Educational Content Validation Instrument in Health was sent to 53 independent judges. A Content Validity Index above 0.90 was considered. RESULTS of the 14 nurses who participated, 64.3% have experience with stroke care, 35.7% with primary care and 64.3% with educational material production. In content analysis, judges' suggestions were stratified into four categories: material conformation, objectivity, accuracy and perception. Spelling changes were made to the images, addition of functionality scale, adequacy of technical terms and language. The Content Validity Index in the second round showed a concordance of 0.97. CONCLUSIONS the booklet presented satisfactory content validity sources of evidence.
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Affiliation(s)
| | | | | | | | | | - Juliana Nunes Santos
- Universidade Federal dos Vales do Jequitinhonha e Mucuri. Diamantina, Minas Gerais, Brazil
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Rangel DM, Feitosa AKN, Araújo FM, Pinheiro MCDS, Cidrão AADL. The effects of the healthcare line in a stroke unit: three years' experience of a center in the Northeast of Brazil. Arq Neuropsiquiatr 2023; 81:707-711. [PMID: 37647904 PMCID: PMC10468246 DOI: 10.1055/s-0043-1770350] [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] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/16/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Treatment at an organized stroke unit center (SUC) improves survival after stroke. Stroke mortality has decreased worldwide in recent decades. OBJECTIVE This study shows the experience of a SUC in the Northeast of Brazil, comparing its first, second, and third years. METHODS We compared data on the SUC prospectively collected from 31 July 2018 to 31 July 2019 (year 1), August 1st, 2019, to July 31st, 2020 (year 2), and August 1st to July 31st, 2021 (year 3). RESULTS There was an expertise evolution through the years, with good outcomes in spite of the coronavirus disease 2019 pandemic in the 3rd year. Also, in the 1st year, the median (interquartile range) door-to-needle time was 39.5 (29.5-60.8) minutes evolving to 22 (17-30) minutes, and then to 17 (14-22) minutes in the last year. CONCLUSION This was the first report on a SUC's outcome in the Brazil's Central Arid Northeast countryside, and it shows the improvement in care for patients with stroke through an effective healthcare line.
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Affiliation(s)
| | - Anna Karuza Nogueira Feitosa
- Instituto de Saúde e Gestão Hospitalar, Hospital Regional do Sertão Central, Serviço de AVC, Quixeramobim CE, Brazil.
| | - Flaviane Melo Araújo
- Instituto de Saúde e Gestão Hospitalar, Hospital Regional do Sertão Central, Serviço de AVC, Quixeramobim CE, Brazil.
| | | | - Alan Alves de Lima Cidrão
- Instituto de Saúde e Gestão Hospitalar, Hospital Regional do Sertão Central, Serviço de AVC, Quixeramobim CE, Brazil.
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12
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Le Goff L, Demuth S, Fickl A, Muresan L. Ischemic stroke risk factors not included in the CHADS-VASC score in patients with non-valvular atrial fibrillation. Arq Neuropsiquiatr 2023; 81:712-719. [PMID: 37567570 PMCID: PMC10468251 DOI: 10.1055/s-0043-1771167] [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] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/09/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND In patients with atrial fibrillation, the CHA2DS2-VASC score guides stroke prevention using anticoagulants, but it is an imperfect score. Other potential risk factors such as renal failure, the type of atrial fibrillation, active smoking, cancer, sleep apnea or systemic inflammation have less well been investigated. OBJECTIVE To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation. METHODS On a population of 248 patients (124 patients with acute ischemic stroke and 124 controls), we performed a logistic regression to assess the impact of multiple non-classic risk factors for the prediction of acute ischemic stroke. Their impact on mortality was assessed by performing a survival analysis. RESULTS A high CHA2DS2-VASc score (OR 1.75; 95% CI 1.13-2.70; p = 0.032), treatment with anticoagulants (OR 0.19; 95% CI 0.07-0.51; p < 0.001) and permanent atrial fibrillation (OR 6.31; 95% CI 2.46-16.19; p < 0.001) were independently associated with acute ischemic stroke. Renal failure and chronic obstructive pulmonary disease predicted a higher mortality. After adjusting for age, sex, the CHA2DS2-VASc score and the use of anticoagulants, the only risk factor predictive for acute ischemic stroke was the permanent type of AF (OR: 8.0 [95% CI 2.5-25.5], p < 0.001). CONCLUSIONS The CHA2DS2-VASc score, the absence of anticoagulants and the permanent type of atrial fibrillation were the main predictive factors for the occurrence of acute ischemic stroke. Larger studies are necessary for conclusive results about other factors.
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Affiliation(s)
- Laurine Le Goff
- “Emile Muller” Hospital, Department of Cardiology, Mulhouse, France.
| | - Stanislas Demuth
- Strasbourg University Hospital, Department of Neurology, France.
| | - Andreas Fickl
- “Emile Muller” Hospital, Department of Neurology, Mulhouse, France.
| | - Lucian Muresan
- “Emile Muller” Hospital, Department of Cardiology, Mulhouse, France.
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13
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Alexandre A, Roque C, Sá I, Silveira J, Torres S. An Atypical Non-Cardiac Presentation of Hypertrophic Cardiomyopathy. Arq Bras Cardiol 2023; 120:e20220933. [PMID: 37377257 PMCID: PMC10344080 DOI: 10.36660/abc.20220933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 06/29/2023] Open
Affiliation(s)
- André Alexandre
- Centro Hospitalar Universitário do Porto EPEPortoPortugalCentro Hospitalar Universitário do Porto EPE, Porto – Portugal
- Universidade do PortoInstituto de Ciências Biomédicas Abel SalazarPortoPortugalUniversidade do Porto – Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto – Portugal
| | - Carla Roque
- Centro Hospitalar Universitário do Porto EPEPortoPortugalCentro Hospitalar Universitário do Porto EPE, Porto – Portugal
- Universidade do PortoInstituto de Ciências Biomédicas Abel SalazarPortoPortugalUniversidade do Porto – Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto – Portugal
| | - Isabel Sá
- Centro Hospitalar Universitário do Porto EPEPortoPortugalCentro Hospitalar Universitário do Porto EPE, Porto – Portugal
- Universidade do PortoInstituto de Ciências Biomédicas Abel SalazarPortoPortugalUniversidade do Porto – Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto – Portugal
| | - João Silveira
- Centro Hospitalar Universitário do Porto EPEPortoPortugalCentro Hospitalar Universitário do Porto EPE, Porto – Portugal
- Universidade do PortoInstituto de Ciências Biomédicas Abel SalazarPortoPortugalUniversidade do Porto – Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto – Portugal
| | - Severo Torres
- Centro Hospitalar Universitário do Porto EPEPortoPortugalCentro Hospitalar Universitário do Porto EPE, Porto – Portugal
- Universidade do PortoInstituto de Ciências Biomédicas Abel SalazarPortoPortugalUniversidade do Porto – Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto – Portugal
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14
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Pimentel BN, dos Santos VAV. Influence of visual symptoms on posturographic performance after stroke. Codas 2023; 35:e20200262. [PMID: 36629550 PMCID: PMC10010430 DOI: 10.1590/2317-1782/20212020262] [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: 08/21/2020] [Accepted: 03/20/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE to verify the occurrence of visual symptoms in subjects with dizziness after stroke, to compare the posturographic results and to correlate their clinical aspects with the characteristics of the stroke. METHODS This is an observational, cross-sectional study with quantitative analysis. The inclusion criteria for the sample composition were to report dizziness after ischemic or hemorrhagic stroke and at least 18 years old. We evaluated 50 patients through clinical anamnesis and Dynamic Foam-Laser Posturography. Anteroposterior deviations were calculated with the measures of each SOT. The preferences of the functions were analyzed according to the means of the Sensory Organization Test. RESULTS twenty-eight subjects had stroke-related visual symptoms. The prevalent kind of dizziness was imbalance and the most frequent stroke was ischemic, mainly in the carotid territory. The values of tests were below the standard; there was a relationship between older subjects and proprioceptive system, and between visual preference and presence of visual symptoms, as well as the location of the posterior stroke. CONCLUSION there was a high frequency of visual symptoms among subjects with stroke sequelae and these have significant relationship with the worst values in visual preference system.
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Affiliation(s)
- Bianca Nunes Pimentel
- Programa de Pós-graduação em Distúrbios da Comunicação Humana - UFSM - Santa Maria (RS), Brasil.
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15
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Rosa CT, Zonta MB, Lange MC, Zétola VDHF. Quality of life: predictors and outcomes after stroke in a Brazilian public hospital. Arq Neuropsiquiatr 2023; 81:2-8. [PMID: 36918001 PMCID: PMC10014206 DOI: 10.1055/s-0042-1758364] [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] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND Some scales are applied after stroke to measure functional independence but qualify of life (QoL) is sometimes neglected in this scenario. OBJECTIVE To analyze predictors and outcomes of QoL after stroke using a validated scale in our population. METHODS Our study included patients who had their first ischemic stroke and were followed in the outpatient clinic for at least 6 months from stroke index. Disability status was assessed using the modified Rankin scale (mRS), the Barthel index (BI), and the Lawton and Brody scale. Quality of life was assessed by a stroke-specific QoL (SSQoL) scale. Statistical significance was accepted for p < 0.05. The estimated measure of association was the odds ratio (OR) for which 95% confidence intervals (95%Cis) were presented. RESULTS Of 196 patients studied, the median age was 60.4 (±13.4) years, and 89 (45.40%) of the patients were female. In a stepwise model considering risk factors, basic activities of daily living scales, satisfaction with life, and outcomes, we found four independent variables related to a poor QoL after stroke, namely hypertension, non-regular rehabilitation, not returning to work, and medical complications. The National Institutes of Health stroke scale (NIHSS) score at admission ≥ 9 was also an independent clinical marker. Approximately 30% of all participants had a negative score under 147 points in the SSQoL. CONCLUSIONS Our results showed that QoL after stroke in a developing country did not seem to differ from those of other countries, although there is a gap in rehabilitation programs in our public system. The functional scales are important tools, but they have failed to predict QoL, in some patients, when compared with specific scales.
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Affiliation(s)
- Camila Thieime Rosa
- Universidade Federal do Paraná, Hospital de Clínicas, Unidade de AVC, Departamento de Clínica Médica, Curitiba PR, Brazil
| | - Marise Bueno Zonta
- Universidade Federal do Paraná, Hospital de Clínicas, Unidade de AVC, Departamento de Clínica Médica, Curitiba PR, Brazil
| | - Marcos Christiano Lange
- Universidade Federal do Paraná, Hospital de Clínicas, Unidade de AVC, Departamento de Clínica Médica, Curitiba PR, Brazil
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16
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Bierhals CCBK, Dal Pizzol FLF, Low G, Day CB, dos Santos NO, Paskulin LMG. Quality of life in caregivers of aged stroke survivors in southern Brazil: Arandomized clinical trial. Rev Lat Am Enfermagem 2023; 31:e3657. [PMID: 36722630 PMCID: PMC9886075 DOI: 10.1590/1518-8345.5935.3657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/15/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE to evaluate the effect of nursing home care interventions on the quality of life in family caregivers of aged stroke survivors. METHOD a Randomized Clinical Trial, blinded for outcome evaluation. Forty-eighty family caregivers of aged stroke survivors participated in the study. The Intervention Group received three home visits by nurses one month after hospital discharge to provide stroke-related education (i.e., how to access health services and perform care activities) and emotional support. The Control Group received the usual guidance from the health services. Quality of life was assessed using the World Health Organization Quality of Life Assessment (WHOQOL-BREF) instrument and the Old Module(WHOQOL-OLD) 1 week, 2 months, and 1 year after discharge. RESULTS the caregivers were mainly women, children, or spouses. The caregivers in the Intervention Group and Control Group did not significantly differ in terms of their Overall Quality of Life at baseline. There was no interaction effect between group allocation and Overall Quality of Life(p=0.625) over time. However, there was an interaction effect for Social Relations(p=0.019) and Autonomy (p=0.004). CONCLUSION the intervention exerted a statistically significant effect on the quality of life of family caregivers with respect to social relationships and autonomy. TRIAL REGISTRATION NCT02807012.
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Affiliation(s)
| | | | - Gail Low
- University of Alberta, Faculty of Nursing, Edmonton, AB, Canada.
| | - Carolina Baltar Day
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Porto Alegre, RS, Brazil. , Grupo Hospitalar Conceição, Hospital Fêmina, Porto Alegre, RS, Brazil.
| | | | - Lisiane Manganelli Girardi Paskulin
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. , Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. , Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.
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17
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Silva LAS, Amaral MMD, Grassi V, Palmeira ALR. Chronic insomnia disorder as risk factor for stroke: a systematic review. Arq Neuropsiquiatr 2022; 80:1159-1166. [PMID: 36577416 PMCID: PMC9797278 DOI: 10.1055/s-0042-1755227] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Stroke is one of the main causes of mortality worldwide. Nonetheless, there are still risk factors that have not been fully elucidated, such as chronic insomnia disorder. OBJECTIVE To evaluate the association between chronic insomnia disorder and the risk of stroke in adults, through a systematic review. METHODS Multiple studies available in the Embase, Lilacs, and Medline platforms were evaluated in English, Spanish, French, and Portuguese. The selection of papers was restricted to those that had investigated the association between chronic insomnia disorder and stroke in adults, regardless of gender or nationality, without a previous history of stroke. The data was extracted with the Cochrane Effective Practice and Organization of Care (EPOC) form. The risk of bias was evaluated by the EPOC Risk of bias tool. RESULTS A total of 138 articles were identified. After a detailed evaluation with the eligibility criteria, four articles were included in the present systematic review. Three of them recognized the association between chronic insomnia disorder and stroke. The comparative analysis was limited, since the studies used distinct insomnia classifications. Regarding the risk of bias, the analysis displayed an important risk in the selection and allocation of participants, besides the use of own insomnia diagnosis criteria, disrespecting chronology and factors indicated by already established classifications. CONCLUSIONS There is not enough data to determine that chronic insomnia disorder is a risk factor for stroke. The present study points out the existence of a possible relationship between insomnia disorder and stroke, suggesting that further studies adopt standardized criteria and instruments.
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Affiliation(s)
| | - Mateus Molin do Amaral
- Universidade do Vale do Taquari, Centro de Ciências Médicas, Lajeado, Brazil.,Address for correspondence Mateus Molin do Amaral
| | - Vanise Grassi
- Universidade do Vale do Taquari, Centro de Ciências Médicas, Lajeado, Brazil.
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18
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Ducci RDP, Tessaro CL, Fontes DP, Fraga GSD, Cirino RHD, Neto FDNL, Zetola VDHF, Lange MC. Stroke-related mortality analysis in Paraná, Brazil, over 10 years. Arq Neuropsiquiatr 2022; 80:1083-1089. [PMID: 36577406 PMCID: PMC9797268 DOI: 10.1055/s-0042-1758398] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Stroke is the second leading cause of death and disability around the world. OBJECTIVE The purpose of this study is to evaluate the age- and sex-specific mortality rates related to stroke in the state of Paraná, Brazil, between 2007 and 2016. METHODS In this cross-sectional study, residents in the state of Paraná were selected by death certificates (from 2007-2016); the basic cause of death was stroke. A descriptive analysis was performed, and mortality rates were calculated with a 95% confidence interval (95% CI) for each year. RESULTS From 2007 to 2016, there were 62,607 deaths in the state of Paraná due to stroke. Most individuals had medical assistance before death (85.7% in 2007 versus 83.9% in 2016), and most of these deaths occurred in hospitals (73.6% in 2007 versus 74.8% in 2016). Death rates due to stroke increased from 138 (95% CI 135-142) to 163 (95% CI 159-166) per 100,000 inhabitants. This raise occurred mainly in those over 79 years old. For the ages groups of 34 to 44 and 44 to 54 years, mortality rate decreased. CONCLUSIONS In the past 15 years, despite the advances in the diagnosis and treatment of stroke, there has been an increase in mortality due to stroke in the state of Paraná. This fact is possibly associated with the aging of the population because there was a more pronounced increase in the group over 79 years old. Thus, new health strategies are necessary to improve the survival and quality of life of poststroke individuals.
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Affiliation(s)
- Renata Dal-Prá Ducci
- Universidade Federal do Paraná, Hospital de Clínicas, Divisão de Neurologia, Divisão de Neurologia, Curitiba PR, Brazil.,Address for correspondence Renata Dal-Prá Ducci
| | | | | | - Gabriel Schier de Fraga
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Divisão de Cardiologia, Curitiba PR, Brazil.
| | - Raphael Henrique Déa Cirino
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Divisão de Cardiologia, Curitiba PR, Brazil.
| | | | | | - Marcos Christiano Lange
- Universidade Federal do Paraná, Hospital de Clínicas, Divisão de Neurologia, Divisão de Neurologia, Curitiba PR, Brazil.
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19
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Cacho RDO, Moro CHC, Bazan R, Guarda SNFD, Pinto EB, Andrade SMMDS, Valler L, Almeida KJ, Ribeiro TS, Jucá RVBDM, Minelli C, Piemonte MEP, Paschoal EHA, Pedatella MTA, Pontes-Neto OM, Fontana AP, Pagnussat ADS, Conforto AB. Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol. Arq Neuropsiquiatr 2022; 80:1067-1074. [PMID: 36535291 PMCID: PMC9770079 DOI: 10.1055/s-0042-1758558] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most of the Brazilian population relies on public healthcare and stroke is a major cause of disability in this country of continental dimensions. There is limited information about access to rehabilitation after stroke in Brazil. OBJECTIVE To provide comprehensive information about Access to Rehabilitation After discharge from public hospitals in Brazil (AReA study), up to 6 months after stroke. METHODS The present study intends to collect information from 17 public health centers in 16 Brazilian cities in the 5 macroregions of the country. Each center will include 36 participants (n = 612). The inclusion criteria are: age ≥ 18 years old; ischemic or hemorrhagic stroke, from 6 months to 1 year prior to the interview; admission to a public hospital in the acute phase after stroke; any neurological impairment poststroke; patient or caregiver able to provide informed consent and answer the survey. Patients can only be recruited in public neurology or internal medicine outpatient clinics. Outcomes will be assessed by a standard questionnaire about rehabilitation referrals, the rehabilitation program (current status, duration in months, number of sessions per week) and instructions received. In addition, patients will be asked about preferences for locations of rehabilitation (hospitals, clinics, or at home). TRIAL STATUS The study is ongoing. Recruitment started on January 31st, 2020 and is planned to continue until June 2022. CONCLUSION The AReA study will fill a gap in knowledge about access to stroke rehabilitation in the public health system in different Brazilian regions.
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Affiliation(s)
- Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil.,Address for correspondence Roberta de Oliveira Cacho
| | | | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, São Paulo SP, Brazil.
| | | | - Elen Beatriz Pinto
- Escola Bahiana de Medicina e Saúde Pública, Fundação para o Desenvolvimento das Ciências, Salvador BA, Brazil.
| | | | - Lenise Valler
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas SP, Brazil.
| | - Kelson James Almeida
- Universidade Federal do Piauí, Centro Universitário UniFacid, Departamento de Medicina Especializada em Neurologia, Teresina PI, Brazil.
| | - Tatiana Souza Ribeiro
- Universidade Federal do Rio Grande do Norte, Departamento de Fisioterapia, Natal RN, Brazil.
| | | | - Cesar Minelli
- Hospital Carlos Fernando Malzoni, Instituto “Você sem AVC”, Matão SP, Brazil.,Universidade de São Paulo, Departamento de Neurociências e Ciências Comportamentais, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil.
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.
| | | | | | | | - Ana Paula Fontana
- Universidade Federal do Rio de Janeiro, Faculdade de Fisioterapia, Laboratório Pesquisa em Recuperação Funcional Após AVC, Rio de Janeiro RJ, Brazil.
| | - Aline de Souza Pagnussat
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Fisioterapia, Porto Alegre RS, Brazil.
| | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital de Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
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20
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Ristow AVON, Santos M, Vescovi A, Massière B, Demier B, Sartori P, Niemeyer Filho P. Determinants of success in treating acute ischemic cerebral and ocular ischemia through carotid revascularization. An observational study of a case series. Rev Col Bras Cir 2022; 49:e20223400. [PMID: 36449945 PMCID: PMC10578794 DOI: 10.1590/0100-6991e-20223400-en] [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: 06/20/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE stroke etiology is ischemia in 85%, and in circa 25% of these, the source is the extracranial carotid. Recurrence is frequent and usually more severe. Carotid revascularization prevents new ischemic strokes. The sooner the treatment is undertaken, complete recovery chances are greater with less recurrences. But, historically, intervention in the acute setting was catastrophic. Objective: Identify determinants of success when carotid revascularization after a recent cerebral ischemic event is performed. MATERIALS AND METHODS A cohort of 50 subjects underwent carotid revascularization after ischemic symptoms, within a period of 71 months. The currently diagnostic tools were used, and the symptoms stratified by the Rankin scale. The extension of the cerebral lesion and the source location the source of the event was analyzed. RESULTS indications were based on the Rankin Scale (R0: 35.4%; R1: 45.8%; R2:18.8% and R3: zero), on the location of the source and the absence of ischemic areas greater than 15mm. An early surgical approach was adopted in all patients. Extreme care was applied to control arterial pressure. At discharge, no additional deficits were observed. CONCLUSIONS carotid revascularization after ischemic events can be achieved without additional morbidity and no recurrences, using the most appropriate therapy in the shortest time, in patients with Rankin Scale up to 2, absence of intracranial hemorrhage and single or multiple ischemic intracerebral areas, with 15mm or less in their greater dimension.
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Affiliation(s)
- Arno VON Ristow
- - Pontifícia Universidade Católica do Rio de Janeiro, Pós-graduação de cirurgia vascular e endovascular - Rio de Janeiro - RJ - Brasil
| | - Marcos Santos
- - Universidade Federal do Rio de Janeiro, Instituto de Ciências Biomédicas, Laboratório de Morfogênese Celular - Rio de Janeiro - RJ - Brasil
| | - Alberto Vescovi
- - Instituto Estadual do Cérebro Paulo Niemeyer - Rio de Janeiro - RJ - Brasil
| | - Bernardo Massière
- - Pontifícia Universidade Católica do Rio de Janeiro, Pós-graduação de cirurgia vascular e endovascular - Rio de Janeiro - RJ - Brasil
| | - Bruno Demier
- - Pontifícia Universidade Católica do Rio de Janeiro, Pós-graduação de cirurgia vascular e endovascular - Rio de Janeiro - RJ - Brasil
| | - Pedro Sartori
- - Pontifícia Universidade Católica do Rio de Janeiro, Pós-graduação de cirurgia vascular e endovascular - Rio de Janeiro - RJ - Brasil
| | - Paulo Niemeyer Filho
- - Universidade Federal do Rio de Janeiro, Instituto de Ciências Biomédicas, Laboratório de Morfogênese Celular - Rio de Janeiro - RJ - Brasil
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Carbonera LA, Souza ACD, Rodrigues MDS, Mottin MD, Nogueira RG, Martins SCO. FAST-ED scale for prehospital triage of large vessel occlusion: results in the field. Arq Neuropsiquiatr 2022; 80:885-892. [PMID: 36261126 PMCID: PMC9770065 DOI: 10.1055/s-0042-1755536] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acute ischemic stroke (AIS) is an extremely time-sensitive condition. The field triage of stroke patients should consider a careful balance between the best destination for the timely delivery of intravenous and/or endovascular reperfusion therapies. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale has been shown to have an accuracy comparable to that of the National Institutes of Health Stroke Scale (NIHSS). However, it has not been tested in the field. OBJECTIVE To evaluate the accuracy of the FAST-ED scale in the detection of AIS due to large vessel occlusion (LVO) in the prehospital setting. METHODS A cross-sectional study of consecutive prospective data collected from February 2017 to May 2019 in the city of Porto Alegre, state of Rio Grande do Sul, Southern Brazil, correlating the prehospital FAST-ED scale scores with the hospital diagnosis of LVO. Area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS In total, 74 patients were included in the analysis. As compared with the diagnosis of LVO upon hospital discharge, the prehospital FAST-ED scale applied by paramedics had a sensitivity of 80%, a specificity of 47.7%, a PPV of 51.1%, an NPV of 77.8%, and an AUC of 0.68 (95% confidence interval [95%CI]: 0.55-0.80). Among the patients with a final diagnosis of AIS, the accuracy was higher, with an AUC of 0.75 (95%CI: 0.60-0.89), a sensitivity of 80%, a specificity of 60%, a PPV of 80%, and an NPV of 60%. CONCLUSIONS In the present study, the FAST-ED scale, which was applied by paramedics in the field, demonstrated moderate accuracy but high sensitivity and NPV, which are essential attributes for a triage scale. While larger studies are still needed, these findings further support the use of the FAST-ED in stroke triage.
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Affiliation(s)
- Leonardo Augusto Carbonera
- Hospital de Clínicas de Porto Alegre, Grupo de Pesquisa em Neurologia Vascular, Departamento de Neurologia, Porto Alegre RS, Brazil.,Hospital Moinhos de Vento, Departamento de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil.,Address for correspondence Leonardo Augusto Carbonera
| | - Ana Claudia de Souza
- Hospital de Clínicas de Porto Alegre, Grupo de Pesquisa em Neurologia Vascular, Departamento de Neurologia, Porto Alegre RS, Brazil.,Hospital Moinhos de Vento, Departamento de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil.
| | | | | | - Raul Gomes Nogueira
- Emory University School of Medicine, Neurology Department, Atlanta, United States.
| | - Sheila Cristina Ouriques Martins
- Hospital de Clínicas de Porto Alegre, Grupo de Pesquisa em Neurologia Vascular, Departamento de Neurologia, Porto Alegre RS, Brazil.,Hospital Moinhos de Vento, Departamento de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil.,Universidade Federal do Rio Grande do Sul, Departamento de Medicina Interna, Porto Alegre RS, Brazil.
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22
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Santos IS, Lotufo PA, Goulart AC, Brant LCC, Pinto MM, Pereira AC, Barreto SM, Ribeiro ALP, Thomas GN, Lip GYH, Bensenor IM. Cardiovascular Health and Atrial Fibrillation or Flutter: A Cross-Sectional Study from ELSA-Brasil. Arq Bras Cardiol 2022; 119:S0066-782X2022005016205. [PMID: 36169453 PMCID: PMC9750207 DOI: 10.36660/abc.20210970] [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: 11/21/2021] [Revised: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. OBJECTIVE To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05. RESULTS The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15-0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19-2.98; p=0.007) profiles were significantly associated with AFF diagnosis. CONCLUSIONS No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.
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Affiliation(s)
- Itamar S. Santos
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Paulo A. Lotufo
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Alessandra C. Goulart
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Luisa C. C. Brant
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Marcelo M Pinto
- Programa de Pós-Graduação em Infectologia e Medicina TropicalFaculdade de MedicinaUniversidade Federal de Minas Gerais,Belo HorizonteMGBrasil Programa de Pós-Graduação em Infectologia e Medicina Tropical da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte , MG – Brasil
| | - Alexandre C. Pereira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Laboratório de Genética e Cardiologia Molecular do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Sandhi M. Barreto
- Departamento de Medicina Preventiva e SocialFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Medicina Preventiva e Social da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Antonio L. P. Ribeiro
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - G Neil Thomas
- Institute of Applied Health ResearchCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamReino Unido Institute of Applied Health Research , College of Medical and Dental Sciences , University of Birmingham , Birmingham – Reino Unido
| | - Gregory Y. H. Lip
- Chest Hospital and Aalborg Thrombosis Research UnitDepartment of Clinical MedicineAalborg UniversityLiverpoolReino Unido Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital and Aalborg Thrombosis Research Unit , Department of Clinical Medicine , Aalborg University , Liverpool – Reino Unido
| | - Isabela M. Bensenor
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
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Fernandes A, Fraga-Maia H, Maso I, Matos IG, Gomes L, Matos M, Santana A, Oliveira-Filho J, de Jesus PA, Pinto EB. Predictors of functional communication in people with aphasia after stroke. Arq Neuropsiquiatr 2022; 80:681-688. [PMID: 36254440 PMCID: PMC9685830 DOI: 10.1055/s-0042-1755267] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Aphasia, the most common language disorder secondary to stroke, has been associated with increased mortality, longer hospitalization and rehabilitation times, worse performance in daily activities, increased financial burden, and short- and long-term complications. Aphasia can negatively impact functional communication skills, including social networks, social activities, relationships with other people and social support. OBJECTIVE To evaluate patients with poststroke aphasia in their respective residences to investigate potential predictors of functional communication. METHODS The prospective cohort included patients with poststroke aphasia aged 18 years or older who resided in the city of Salvador, Northeastern Brazil. Following discharge from the Stroke Unit (SU), the individuals themselves, or their guardians, were contacted by telephone to schedule a home visit no less than three months after discharge. At baseline, sociodemographic and clinical data were collected, in addition to the scores on the National Institutes of Health Stroke Scale (NIHSS) and modified Barthel Index (mBI). The American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) was applied at the patients' homes. Multivariate linear regression was employed using the total score on the ASHA FACS as the outcome of interest. RESULTS A multivariate analysis of the associated factors identified using the linear regression revealed that only functional capacity (as assessed by the mBI) upon discharge from the SU remained as an independent predictor of functional communication performance (β = 0.042; 95% confidence interval [95%CI] = 0.013-0.071; p = 0.002). CONCLUSION The functional capacity to perform daily activities, evaluated upon discharge from a stroke unit, was identified as a potential predictor of functional communication performance, regardless of the time elapsed after the stroke.
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Affiliation(s)
- Adriana Fernandes
- Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa em Neurorreabilitação e Comportamento Motor, Salvador BA, Brazil
| | | | - Iara Maso
- Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa em Neurorreabilitação e Comportamento Motor, Salvador BA, Brazil
- Hospital Geral Roberto Santos, Unidade de AVC, Salvador BA, Brazil
| | - Isabela Guimarães Matos
- Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa em Neurorreabilitação e Comportamento Motor, Salvador BA, Brazil
| | - Lene Gomes
- Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa em Neurorreabilitação e Comportamento Motor, Salvador BA, Brazil
| | - Matheus Matos
- Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa em Neurorreabilitação e Comportamento Motor, Salvador BA, Brazil
| | - Andressa Santana
- Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa em Neurorreabilitação e Comportamento Motor, Salvador BA, Brazil
| | | | - Pedro Antônio de Jesus
- Hospital Geral Roberto Santos, Unidade de AVC, Salvador BA, Brazil
- Universidade Federal da Bahia, Departamento de Biomorfologia, Salvador BA, Brazil
| | - Elen Beatriz Pinto
- Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa em Neurorreabilitação e Comportamento Motor, Salvador BA, Brazil
- Universidade do Estado da Bahia, Salvador BA, Brazil
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24
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Minelli C, Luvizutto GJ, Cacho RDO, Neves LDO, Magalhães SCSA, Pedatella MTA, de Mendonça LIZ, Ortiz KZ, Lange MC, Ribeiro PW, de Souza LAPS, Milani C, da Cruz DMC, da Costa RDM, Conforto AB, Carvalho FMM, Ciarlini BS, Frota NAF, Almeida KJ, Schochat E, Oliveira TDP, Miranda C, Piemonte MEP, Lopes LCG, Lopes CG, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Castro SS, de Andrade JBC, Silva GS, Pontes-Neto OM, de Carvalho JJF, Martins SCO, Bazan R. Brazilian practice guidelines for stroke rehabilitation: Part II. Arq Neuropsiquiatr 2022; 80:741-758. [PMID: 36254447 PMCID: PMC9685826 DOI: 10.1055/s-0042-1757692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 10/14/2022]
Abstract
The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
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Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
- Instituto Você sem AVC, Matão SP, Brazil
| | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | | | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Estadual Geral de Goiânia Dr. Alberto Rassi, Goiânia GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia, GO, Brazil
| | - Lucia Iracema Zanotto de Mendonça
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, São Paulo SP, Brazil
- Pontíficia Universidade Católica de São Paulo, Faculdade de Ciências Humanas e da Saúde, São Paulo SP, Brazil
| | - Karin Zazo Ortiz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Fala, Linguagem e Ciências Auditivas, São Paulo SP, Brazil
| | | | | | | | - Cristiano Milani
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Serviço de Neurologia Vascular e Emergências Neurológicas, Ribeirão Preto SP, Brazil
| | | | | | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil
| | | | - Bruna Silva Ciarlini
- Universidade de Fortaleza, Programa de Pos-Graduação em Ciências Médicas, Fortaleza CE, Brazil
| | | | | | - Eliane Schochat
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Tatiana de Paula Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Camila Miranda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Laura Cardia Gomes Lopes
- Universidade Estadual de São Paulo, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Departamento de Neurologia, Psicologia e Psiquiatria, São Paulo SP, Brazil
| | | | | | | | | | | | | | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | - Sheila C. Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
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Minelli C, Bazan R, Pedatella MTA, Neves LDO, Cacho RDO, Magalhães SCSA, Luvizutto GJ, Moro CHC, Lange MC, Modolo GP, Lopes BC, Pinheiro EL, de Souza JT, Rodrigues GR, Fabio SRC, do Prado GF, Carlos K, Teixeira JJM, Barreira CMA, Castro RDS, Quinan TDL, Damasceno E, Almeida KJ, Pontes-Neto OM, Dalio MTRP, Camilo MR, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Carvalho JJF, Martins SCO. Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I. Arq Neuropsiquiatr 2022; 80:634-652. [PMID: 35946713 PMCID: PMC9387194 DOI: 10.1590/0004-282x-anp-2021-0354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/21/2021] [Accepted: 01/18/2022] [Indexed: 06/15/2023]
Abstract
The Guidelines for Stroke Rehabilitation are the result of a joint effort by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology aiming to guide professionals involved in the rehabilitation process to reduce functional disability and increase individual autonomy. Members of the group participated in web discussion forums with predefined themes, followed by videoconference meetings in which issues were discussed, leading to a consensus. These guidelines, divided into two parts, focus on the implications of recent clinical trials, systematic reviews, and meta-analyses in stroke rehabilitation literature. The main objective was to guide physicians, physiotherapists, speech therapists, occupational therapists, nurses, nutritionists, and other professionals involved in post-stroke care. Recommendations and levels of evidence were adapted according to the currently available literature. Part I discusses topics on rehabilitation in the acute phase, as well as prevention and management of frequent conditions and comorbidities after stroke.
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Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
| | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Geral de Goiânia, Goiania GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia GO, Brazil
| | | | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Carla Heloísa Cabral Moro
- Neurológica Joinville, Joinville SC, Brazil
- Hospital Municipal de Joinville, Joinville SC, Brazil
- Associação Brasil AVC, Joinville SC, Brazil
| | | | | | | | | | - Juli Thomaz de Souza
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
| | - Guilherme Riccioppo Rodrigues
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | | | - Karla Carlos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil
| | | | | | - Rodrigo de Souza Castro
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
| | | | - Eduardo Damasceno
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Geral de Goiânia, Goiania GO, Brazil
- Hospital Orion, Goiania GO, Brazil
| | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Marina Teixeira Ramalho Pereira Dalio
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Centro de Cirurgia de Epilepsia de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Millene Rodrigues Camilo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | | | | | | | - Sheila Cristina Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
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Rocha LJDA, Silva KAD, Chagas ADL, Veras ADO, Souto VGL, Valente MCMB, Baggio JADO. Stroke in the state of Alagoas, Brazil: a descriptive analysis of a northeastern scenario. Arq Neuropsiquiatr 2022; 80:550-556. [PMID: 35946709 PMCID: PMC9387186 DOI: 10.1590/0004-282x-anp-2021-0194] [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] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/26/2021] [Accepted: 08/06/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is little information available on stroke epidemiology in the northeast of Brazil. OBJECTIVE Our objective was to investigate the prevalence of the stroke subtypes, prevalence of cerebrovascular risk factors and patterns of management in a public neurovascular outpatient referral service, in Alagoas. METHODS Data were prospectively collected from consecutive patients with stroke who were treated in a specialized neurovascular clinic between November 2016 and June 2018. Recurrence was evaluated by telephone 12 months after patients had been included in the study. RESULTS We evaluated 190 patients (mean age, 60.22 ( 13.29 years; 60.5% males). Ischemic stroke was the most frequent subtype (85.2%). Sedentary lifestyle was the most common risk factor (71.6%), followed by hypertension (62.6%) and stroke family history (41.1%). Only 21.5% of the patients were transported by ambulance to the hospital, and 42.6% received medical support in hospital units or emergency units with no imaging support. The median NIHSS was 2.5 (IQR, 1-5) and mRS was 2 (IQR, 1-3). We found a high rate of undetermined stroke (35.8%), and few patients completed the etiological investigation. One year after inclusion in the study, 12 patients (6.3%) had died and 14 (7.3%) had had another stroke. CONCLUSIONS The prevalence of cerebrovascular risk factors and clinical presentation were similar to what had been seen in previous series. A notable number of patients received medical support in institutions with no imaging equipment. The high number of cases of undetermined stroke etiology shows the difficulty in accessing healthcare services in Alagoas.
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Bichuette LD, Lottenberg MP, Cardozo FAM, Calderaro D. Atherosclerosis risk factor management - what's new for the neurologist? Arq Neuropsiquiatr 2022; 80:88-93. [PMID: 35976292 PMCID: PMC9491406 DOI: 10.1590/0004-282x-anp-2022-s102] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Stroke is the second leading cause of death worldwide and the vast majority can be attributed to modifiable risk factors, mainly behavioral and metabolic. The top six risk factors responsible for cardiovascular mortality in Brazil in 2019 were high systolic blood pressure, inadequate dietary exposure, high body mass index, high LDL cholesterol, high fasting blood glucose levels, and tobacco. We intend to discuss in this paper the evidence and recommendations in the approach of three essential risk factors for patients with a history of stroke: dyslipidemia, hypertension and diabetes.
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Affiliation(s)
- Luciana Dornfeld Bichuette
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Coração, São Paulo SP, Brazil
| | - Marcos Pita Lottenberg
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Coração, São Paulo SP, Brazil
| | | | - Daniela Calderaro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Coração, São Paulo SP, Brazil
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Pellegrino MP, Guerra FBD, Perissinotti IN. Decision-making strategies for reperfusion therapies: navigating through stroke trials gaps. Arq Neuropsiquiatr 2022; 80:60-71. [PMID: 35976313 PMCID: PMC9491414 DOI: 10.1590/0004-282x-anp-2022-s123] [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] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Despite there being a robust amount of literature and numerous randomized clinical trials regarding acute ischemic stroke treatment, the trials have not included some frequent controversial situations for which decision-making strategies are an urgent and unmet need in clinical practice. This article tries to summarize the current evidence about some selected situations (mechanical thrombectomy in low ASPECTS, low NIHSS with proximal occlusion, acute basilar occlusion, distal and medium vessel occlusion, among others), make suggestions on how to approach them in clinical practice and show what to expect in acute stroke research in the near future.
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Affiliation(s)
- Mateus Paquesse Pellegrino
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo, SP, Brazil
| | | | - Iago Navas Perissinotti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto Central, Departamento de Neurologia, São Paulo, SP, Brazil
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Pagliarin KC, Fernandes EG, Muller MD, Portalete CR, Fonseca RP, Altmann RF. Clustering and switching in verbal fluency: a comparison between control and individuals with brain damage. Codas 2021; 34:e20200365. [PMID: 34816946 PMCID: PMC9769432 DOI: 10.1590/2317-1782/20212020365] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/02/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study is to analyze and compare the performance and strategies used by control subjects and patients with unilateral brain damage on phonemic and semantic Verbal Fluency tasks. METHODS The sample consisted of 104 participants divided into four groups (26 with left hemisphere damage and aphasia- LHDa, 28 with left hemisphere damage and no aphasia- LHDna, 25 with right hemisphere damage- RHD and 25 neurologically healthy control subjects). All participants were administered the phonemic ("M" letter-based) and semantic (animals) verbal fluency tasks from the Montreal-Toulouse Language Assessment Battery (MTL-BR). RESULTS Patients in the LHDa group showed the worst performance (fewer words produced, fewer clusters and switches) in both types of fluency task. RHD group showed fewer switching productions when compared with controls and LHDna had fewer words productions than controls in the first 30 seconds block. CONCLUSION Our findings suggest that the LHDa group obtained lower scores in most measures of SVF and PVF when compared to the other groups.
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Affiliation(s)
- Karina Carlesso Pagliarin
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria – UFSM, Santa Maria (RS), Brasil.
| | - Eduarda Giovelli Fernandes
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria – UFSM, Santa Maria (RS), Brasil.
| | - Maryndia Diehl Muller
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria – UFSM, Santa Maria (RS), Brasil.
| | - Caroline Rodrigues Portalete
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria – UFSM, Santa Maria (RS), Brasil.
| | - Rochele Paz Fonseca
- Programa de Pós-Graduação em Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul – PUCRS, Porto Alegre (RS), Brasil.
| | - Raira Fernanda Altmann
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria – UFSM, Santa Maria (RS), Brasil.
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Huyut MA. Comparison of the Outcomes between Coronary No-Reflow and Slow-Flow Phenomenon in Non-STEMI Patients. Arq Bras Cardiol 2021; 116:856-864. [PMID: 34008803 PMCID: PMC8121461 DOI: 10.36660/abc.20190905] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Coronary slow-flow phenomenon (CSFP) and coronary no-reflow phenomenon (CNP) are associated with increased risk of major cardiovascular adverse events (MACE). OBJECTIVES This study aimed to evaluate and compare the one-year clinical follow-up outcomes among patients with CNP and CSFP who underwent percutaneous coronary interventions (PCI) in non-ST elevation myocardial infarction (NSTEMI). METHODS This study included a total of 858 patients who were diagnosed with NSTEMI and underwent PCI within 24 h of symptom onset. The patients were divided into two groups, the CSFP group (n=221) and the CNP group (n=25), regarding the angiographic characteristics of thrombolysis in myocardial infarction (TIMI) flow of the infarct-related artery. Patients were followed for one-year. A p-value of <0.05 was considered significant. RESULTS CNP was observed in 2.91%, and CSFP was observed in 25.75% of the patients. Clinical endpoints analyzed that stroke was significantly higher in the CNP group than in the CSFP group (6 (24%) vs. 6 (2.70%), p<0.001) and MACE was significantly higher in the CNP group than in the CSFP group (11 (44%) vs. 51 (23.10%), p=0.022). Forward conditional logistic regression analysis demonstrated that body mass index (BMI) (OR=1.11, 95%CI: 1.00-1.24, p=0.038) and baseline heart rate (HR) (OR=0.923, 95%CI: 0.88-0.96, p<0.001) were the independent predictors of CNP in NSTEMI. CONCLUSION CNP patients have worse clinical outcomes and a higher risk of stroke compared with CSFP patients in NSTEMI. (Arq Bras Cardiol. 2021; 116(5):856-864).
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Affiliation(s)
- Mustafa Ahmet Huyut
- Yeni Yuzyil UniversityFaculty of MedicineDepartment of CardiologyIstambulTurquiaYeni Yuzyil University, Faculty of Medicine, Department of Cardiology, Istambul – Turquia.
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Montenegro CEL. In Search of the Perfect Coronary Perfusion. Arq Bras Cardiol 2021; 116:865-866. [PMID: 34008804 PMCID: PMC8121469 DOI: 10.36660/abc.20210228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pedrosa RC. Causing Mechanisms of Embolic Strokes in Chagas Heart Disease: Autonomic Dysfunction, a Working Hypothesis. Arq Bras Cardiol 2020; 115:1080-1081. [PMID: 33470304 PMCID: PMC8133738 DOI: 10.36660/abc.20200481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Roberto Coury Pedrosa
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
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Camilo MR, Pontes-Neto OM. Coronary Calcium Score. Is There a Difference among Ischemic Stroke Subtypes? Arq Bras Cardiol 2020; 115:1152-1153. [PMID: 33470316 PMCID: PMC8133728 DOI: 10.36660/abc.20201192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Millene Rodrigues Camilo
- Departamento de Neurociências e Ciências do ComportamentoFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasilDivisão de Neurologia - Departamento de Neurociências e Ciências do Comportamento - Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | - Octávio Marques Pontes-Neto
- Departamento de Neurociências e Ciências do ComportamentoFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasilDivisão de Neurologia - Departamento de Neurociências e Ciências do Comportamento - Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP - Brasil
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Macedo C, Aras R, de Macedo IS. Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants. Arq Bras Cardiol 2020; 115:31-39. [PMID: 32236323 PMCID: PMC8384326 DOI: 10.36660/abc.20190218] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/17/2019] [Accepted: 07/17/2019] [Indexed: 01/13/2023] Open
Abstract
Background Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol.2020; 115(1):31-39).
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Affiliation(s)
- Cristiano Macedo
- Hospital Universitário Professor Edgard SantosSalvadorBABrasilHospital Universitário Professor Edgard Santos – Cardiologia,Salvador- BA - Brasil
| | - Roque Aras
- Hospital Universitário Professor Edgard SantosSalvadorBABrasilHospital Universitário Professor Edgard Santos – Cardiologia,Salvador- BA - Brasil
| | - Isabella Sales de Macedo
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo - Faculdade de Medicina,São Paulo, SP – Brasil
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Gaspari AP, Cruz EDDA, Batista J, Alpendre FT, Zétola V, Lange MC. Predictors of prolonged hospital stay in a Comprehensive Stroke Unit. Rev Lat Am Enfermagem 2019; 27:e3197. [PMID: 31618390 PMCID: PMC6792336 DOI: 10.1590/1518-8345.3118.3197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/23/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE to analyze the in-hospital complications of prolonged hospital stay in patients with ischemic stroke or transient ischemic attack, admitted to the stroke unit of a tertiary hospital. METHOD this is an evaluative correlational study. All first-ever ischemic stroke or transient ischemic attack patients admitted were retrospectively analyzed. During hospital stay, the predictors of long-term hospitalization considered were: 1) clinical complications (pneumonia, urinary tract infection, pressure damage and deep vein thrombosis), and 2) neurological complications (malignant ischemic stroke and symptomatic hemorrhagic transformation). RESULTS 353 patients were discharged in the study period. Mean age was 64.1±13.7 years old and 186 (52.6%) were men. The mean time of hospital stay was 13.7±14.3 days. Pneumonia (25.3±28.8 days, p<0.001), urinary tract infection (32.9±45.2 days, p<0.001) and malignant stroke (29.1±21.4 days, p<0.001) increased significantly the length of hospital stay compared to patients without any complications (11.2±7.1 days). CONCLUSION this study showed that three complications delayed hospital discharge in patients admitted in a stroke unit, two preventable ones: pneumonia and urinary tract infection. More intense measures to avoid them should be included in the performance indicators to reduce the length of hospital stay in stroke units.
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Affiliation(s)
- Ana Paula Gaspari
- Universidade Federal do Paraná, Complexo Hospitalar de Clínicas,
Curitiba, PR, Brasil
| | | | - Josemar Batista
- Governo do Estado do Paraná, Secretaria do Estado da Educação,
Curitiba, PR, Brasil
| | | | - Viviane Zétola
- Universidade Federal do Paraná, Complexo Hospitalar de Clínicas,
Curitiba, PR, Brasil
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Amancio CT, Nascimento LF. Environmental pollution and deaths due to stroke in a city with low levels of air pollution: ecological time series study. SAO PAULO MED J 2014; 132:353-8. [PMID: 25351756 PMCID: PMC10496774] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/07/2013] [Accepted: 11/18/2013] [Indexed: 04/07/2023] Open
Abstract
CONTEXT AND OBJECTIVE Little has been discussed about the increased risk of stroke after exposure to air pollutants, particularly in Brazil. The mechanisms through which air pollution can influence occurrences of vascular events such as stroke are still poorly understood. The aim of this study was to estimate the association between exposure to some air pollutants and risk of death due to stroke. DESIGN AND SETTING Ecological time series study with data from São José dos Campos, Brazil. METHODS Data on deaths due to stroke among individuals of all ages living in São José dos Campos and on particulate matter, sulfur dioxide and ozone were used. Statistical analysis was performed using a generalized additive model of Poisson regression with the Statistica software, in unipollutant and multipollutant models. The percentage increase in the risk of increased interquartile difference was calculated. RESULTS There were 1,032 deaths due to stroke, ranging from 0 to 5 per day. The statistical significance of the exposure to particulate matter was ascertained in the unipollutant model and the importance of particulate matter and sulfur dioxide, in the multipollutant model. The increases in risk were 10% and 7%, for particulate matter and sulfur dioxide, respectively. CONCLUSION It was possible to identify exposure to air pollutants as a risk factor for death due to stroke, even in a city with low levels of air pollution.
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Affiliation(s)
- Camila Trolez Amancio
- Medical Student. Department of Medicine, Universidade de Taubaté (Unitau), Taubaté, São Paulo, Brazil
| | - Luiz Fernando Nascimento
- PhD. Assistant Professor, Department of Medicine, Universidade de Taubaté (Unitau), Taubaté, São Paulo, Brazil
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Mishra MN, Kalra R, Rohatgi S. Clinical profile, common thrombophilia markers and risk factors in 85 young Indian patients with arterial thrombosis. SAO PAULO MED J 2013; 131:384-8. [PMID: 24346777 PMCID: PMC10871819 DOI: 10.1590/1516-3180.2013.1316369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/16/2012] [Accepted: 03/06/2013] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Arterial thrombosis may occur consequent to hereditary thrombophilia and increased lipoprotein(a) [Lp(a)] and fibrinogen. Our aim was to study the prevalence of common thrombophilia markers in 85 consecutive cases of arterial thrombosis. DESIGN AND SETTING A retrospective study was conducted from 85 consecutive young patients treated as outpatients or admitted due to stroke or myocardial infarction at a tertiary care hospital. METHODS Eighty-five Indian patients (age < 45 years) presenting ischemic stroke (n = 48) or myocardial infarction (n = 37) and 50 controls were studied for seven thrombophilia markers including antithrombin (AT), factor V, protein C, protein S, activated protein C resistance (APC-R), fibrinogen and Lp(a). Functional assays for protein C, protein S, factor V and APC-R were performed using clotting-based methods. Semi-quantitative estimation of fibrinogen was done using Clauss's method and Lp(a) using immunoturbidimetry. Statistical analysis was done using the Epi Info 6 software. RESULTS Thirty-three samples (38.8%) tested positive for one or more thrombophilia markers. The three commonest abnormalities were elevated Lp(a) (20%), fibrinogen (17.6%) and low APC-R (14.2%). Low levels of protein C, protein S and AT were present in 4.7, 9.4 and 7% of the patients, respectively. Overall, the risk factor profile was: smoking (33%), positive family history (15.3%), hyperlipidemia (7%), hypertension, diabetes mellitus and obesity (2.3% each). CONCLUSIONS An association was found between low levels of protein C, protein S and AT and arterial thrombosis, but only elevated fibrinogen levels, smoking, positive family history and hyperlipidemia showed statistical significance.
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Affiliation(s)
- Mahendra Narain Mishra
- MD. Specialist in Pathology and Immunopathology, Department of Pathology, Dr. Lal Path Labs Pvt Ltd., New Delhi, India
| | - Ravi Kalra
- MD, PhD. Department of Cardiology, Indian Naval Hospital Ship Asvini, Colaba, Mumbai, Maharashtra, India
| | - Shalesh Rohatgi
- MD, PhD. Department of Neurology, Command Hospital (WC), Chandimandir, Haryana, India
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Santos MD, Gagliardi RJ, Mac-Kay APMG, Boggio PS, Lianza R, Fregni F. Transcranial direct-current stimulation induced in stroke patients with aphasia: a prospective experimental cohort study. SAO PAULO MED J 2013; 131:422-6. [PMID: 24346782 PMCID: PMC10871813 DOI: 10.1590/1516-3180.2013.1316595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 05/05/2013] [Accepted: 05/28/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Previous animal and human studies have shown that transcranial direct current stimulation can induce significant and lasting neuroplasticity and may improve language recovery in patients with aphasia. The objective of the study was to describe a cohort of patients with aphasia after stroke who were treated with transcranial direct current stimulation. DESIGN AND SETTING Prospective cohort study developed in a public university hospital. METHODS Nineteen patients with chronic aphasia received 10 transcranial direct current stimulation sessions lasting 20 minutes each on consecutive days, using a current of 2 mA. The anode was positioned over the supraorbital area and the cathode over the contralateral motor cortex. The following variables were analyzed before and after the 10 neuromodulation sessions: oral language comprehension, copying, dictation, reading, writing, naming and verbal fluency. RESULTS There were no adverse effects in the study. We found statistically significant differences from before to after stimulation in relation to simple sentence comprehension (P = 0.034), naming (P = 0.041) and verbal fluency for names of animals (P = 0.038). Improved scores for performing these three tasks were seen after stimulation. CONCLUSIONS We observed that excitability of the primary motor cortex through transcranial direct current stimulation was associated with effects on different aspects of language. This can contribute towards future testing in randomized controlled trials.
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Affiliation(s)
- Michele Devido Santos
- BSc, MD, PhD. Professor of Speech Pathology and Audiology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil.
| | - Rubens José Gagliardi
- MD, PhD. Full Professor and Head of Discipline of Neurology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil.
| | - Ana Paula Machado Goyano Mac-Kay
- BSc, PhD. Professor of Speech Pathology and Audiology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil.
| | - Paulo Sergio Boggio
- BSc, PhD. Professor of Cognitive Neuroscience, Cognitive Neuroscience Laboratory, Mackenzie Presbyterian University, São Paulo, Brazil.
| | - Roberta Lianza
- PT. Physiotherapist, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
| | - Felipe Fregni
- MD, PhD. Professor of Neurology, Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School; and Head of Neuromodulation Laboratory, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.
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Abe IM, Goulart AC, Santos WR, Lotufo PA, Benseñor IM. Validation of a stroke symptom questionnaire for epidemiological surveys. SAO PAULO MED J 2010; 128:225-31. [PMID: 21120435 PMCID: PMC10938991 DOI: 10.1590/s1516-31802010000400010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 06/11/2010] [Accepted: 06/18/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Stroke is a relevant issue within public health and requires epidemiological surveillance tools. The aim here was to validate a questionnaire for evaluating individuals with stroke symptoms in the Stroke Morbidity and Mortality Study (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral, EMMA), São Paulo, Brazil. DESIGN AND SETTING This was a cross-sectional study performed among a sample of the inhabitants of Butantã, an area in the western zone of the city of São Paulo. METHODS For all households in the coverage area of a primary healthcare unit, household members over the age of 35 years answered a stroke symptom questionnaire addressing limb weakness, facial weakness, speech problems, sensory disorders and impaired vision. Thirty-six participants were randomly selected for a complete neurological examination (gold standard). RESULTS Considering all the questions in the questionnaire, the sensitivity was 72.2%, specificity was 94.4%, positive predictive value was 92.9% and negative predictive value was 77.3%. The positive likelihood ratio was 12.9, the negative likelihood ratio was 0.29 and the kappa coefficient was 0.67. Limb weakness was the most sensitive symptom, and speech problems were the most specific. CONCLUSIONS The stroke symptom questionnaire is a useful tool and can be applied by trained interviewers with the aim of identifying community-dwelling stroke patients, through the structure of the Family Health Program.
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Affiliation(s)
- Ivana Makita Abe
- PhD. Attending physician, Hospital Universitário (HU), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Alessandra Carvalho Goulart
- PhD. Epidemiologist, Hospital Universitário (HU), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Waldyr Rodrigues Santos
- MD. Neurologist, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Paulo Andrade Lotufo
- PhD. Professor of Clinical Medicine and Epidemiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), and Superintendent of Hospital Universitário (HU), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Isabela Martins Benseñor
- PhD. Attending physician, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), and Hospital Universitário (HU), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
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