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Rangel MFDA, Silva LC, Gonçalves EH, Silva A, Teixeira-Salmela LF, Scianni AA. Presence of Self-Reported Sleep Alterations After Stroke and Their Relationship With Disability: A Longitudinal Study. Neurorehabil Neural Repair 2024; 38:518-526. [PMID: 38708936 DOI: 10.1177/15459683241252826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Sleep disorders have a prevalence of 30% to 70% in post-stroke individuals. The presence of sleep disorders and poor sleep quality after stroke can affect important functions and lead to worse outcomes. However, most studies are restricted to the acute post-stroke stage only. OBJECTIVE To investigate the frequency of self-reported sleep alterations in a sample of chronic stroke individuals and to identify which self-reported sleep alterations were associated with disability. METHODS Prospective exploratory study. Self-reported sleep alterations were measured by the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, and STOP-Bang Questionnaire. The dependent variable was measured 3 years after the first contact by the Modified Rankin Scale (mRS). Step-wise multiple linear regression analysis was employed to identify which sleep alterations were associated with disability. RESULTS Sixty-five individuals with stroke participated. About 67.7% of participants had poor sleep quality, 52.4% reported insomnia symptoms, 33.9% reported excessive daytime sleepiness, and 80.0% were classified as intermediate or high risk for obstructive sleep apnea. Only risk for obstructive sleep apnea was significantly associated with disability and explained 5% of the variance in the mRS scores. CONCLUSION Self-reported sleep alterations had a considerable frequency in a sample of chronic stroke individuals. The risk of obstructive sleep apnea was associated with disability in the chronic stage of stroke. Sleep alterations must be considered and evaluated in the rehabilitation process even after a long period since the stroke onset.
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Affiliation(s)
| | - Leonardo Carvalho Silva
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Estefany Horrany Gonçalves
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Andressa Silva
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Aline Alvim Scianni
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Ovando AC, Dall'Agnol C, Merlyn Luiz J, Andrade Momo R, De Castro SS. The Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) is reliable and valid for chronic stroke survivors. Top Stroke Rehabil 2024; 31:211-220. [PMID: 37120851 DOI: 10.1080/10749357.2023.2207293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Stroke is the leading cause of disability worldwide. Assessing stroke's impact on patients' daily activities and social participation can provide important complementary information to their rehabilitation process. However, no previous study had been conducted on the psychometric properties of the Brazilian version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the stroke population. OBJECTIVES This study aimed to examine the internal consistency, test-retest and inter-rater reliability, convergent validity and floor/ceiling effect of the Brazilian version of the WHODAS 2.0 in individuals after chronic stroke. METHODS Two examiners interviewed 53 chronic stroke individuals who responded to the Brazilian 36-item version of the WHODAS 2.0 three times to analyze test-retest and inter-rater reliabilities. Floor/ceiling effects were calculated as relative frequencies of the lowest or the highest possible WHODAS 2.0 scores. Participants also responded to the Stroke Impact Scale 3.0 (SIS 3.0) and the Functional Independence Measure (FIM) to analyze convergent validity. RESULTS The internal consistency analyses for domains of WHODAS showed a strong correlation among the items of each domain (0.76-0.91) except for the "getting along" domain, which presented a moderate correlation (ρ = 0,62). Total scores of WHODAS 2.0 showed satisfactory internal consistency (α = 0.93), good inter-rater reliability (ICC = 0.85), excellent test-retest reliability (ICC = 0.92) and no significant floor/ceiling effect. Convergent validity indicated moderate to strong correlations (ρ=-0.51 to ρ=-0.88; p < 0.001), with the highest values associated with the correlation with the SIS scale. CONCLUSIONS The Brazilian version of the WHODAS 2.0 instrument presented evidence of reliability and validity for chronic post-stroke individuals.
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Affiliation(s)
- Angélica Cristiane Ovando
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
- Department for Health Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
| | - Catiane Dall'Agnol
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
| | - Jhoanne Merlyn Luiz
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
| | - Renata Andrade Momo
- Department for Health Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
| | - Shamyr Sulyvan De Castro
- Master Program in Physiotherapy and Functioning (PPGFisio), Federal University of Ceará (UFC), Fortaleza, Brazil
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Miranda LA, Luvizutto GJ, Bessornia PAC, Furlan NE, Winckler FC, Ferreira NC, Hamamoto Filho PT, de Souza JT, Martin LC, Zanati Bazan SG, Pinheiro Modolo G, de Freitas CCM, Vidal EIDO, Bazan R. To what extent does frailty mediate the association between age and the outcomes of brain reperfusion following acute ischemic stroke? Front Aging Neurosci 2024; 16:1305803. [PMID: 38333676 PMCID: PMC10850226 DOI: 10.3389/fnagi.2024.1305803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Objective We evaluated the extent to which frailty mediated the association between age, poor functional outcomes, and mortality after acute ischemic stroke when patients were treated with brain reperfusion (thrombolytic therapy and/or thrombectomy). Materials and methods This retrospective cohort study included patients diagnosed with ischemic stroke who had undergone intravenous cerebral reperfusion therapy and/or mechanical thrombectomy. We created a mediation model by analyzing the direct natural effect of an mRS score > 2 and death on age-mediated frailty according to the Frailty Index. Results We enrolled 292 patients with acute ischemic stroke who underwent brain reperfusion. Their mean age was 67.7 ± 13.1 years. Ninety days after the stroke ictus, 54 (18.5%) participants died, and 83 (28.4%) lived with moderate to severe disability (2 < mRS < 6). In the mediation analysis of the composite outcome of disability (mRS score > 2) or death, frailty accounted for 28% of the total effect of age. The models used to test for the interaction between age and frailty did not show statistically significant interactions for either outcome, and the addition of the interaction did not significantly change the direct or indirect effects, nor did it improve model fit. Conclusion Frailty mediated almost one-third of the effect of age on the composite outcome of disability or death after acute ischemic stroke.
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Affiliation(s)
- Luana Aparecida Miranda
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Pedro Augusto Cândido Bessornia
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Natalia Eduarda Furlan
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Fernanda Cristina Winckler
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Natalia Cristina Ferreira
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Juli Thomaz de Souza
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Luis Cuadrado Martin
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Gabriel Pinheiro Modolo
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Carlos Clayton Macedo de Freitas
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | | | - Rodrigo Bazan
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
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Milles LS, Pommeranz D, Chae WH, Kühne Escolà J, Kleinschnitz C, Köhrmann M, Frank B. Validation of a German-language modified Rankin Scale structured telephone interview at 3 months in a real-life stroke cohort. Neurol Res Pract 2023; 5:59. [PMID: 38031129 PMCID: PMC10687899 DOI: 10.1186/s42466-023-00289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The modified Rankin scale (mRS) at 3 months is established as the primary outcome measure in clinical stroke trials. Traditionally, the mRS is assessed through an unstructured face-to-face interview. This approach can be labor-intensive and lead to suboptimal inter-rater reliability. Recently, the Covid-19 pandemic made face-to-face contact even more challenging. To address these issues, we developed and validated a structured German-language questionnaire for mRS testing by telephone. METHODS In this prospective cohort study, we compared the mRS testing results of the standard face-to-face interview with those obtained in a structured interview by telephone using Cohen's Kappa. RESULTS At our tertiary care stroke center, we included 108 patients who underwent both assessments. In 80.6% of cases (87/108) face-to-face and telephone interview reached identical scores. Linear weighted Kappa was 0.82 (p < 0.001). Unweighted Kappa for dichotomized mRS between fair (0-2) and poor (3-6) functional outcome was κ = 0.97 (p < 0.001). CONCLUSIONS Our study validates the use of the German-language structured telephone interview as a reliable instrument for the use in clinical trials. We encourage others to utilize the questionnaire. It is available as an Appendix (Additional file 1) to this publication.
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Affiliation(s)
- Lennart Steffen Milles
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Doreen Pommeranz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Woon Hyung Chae
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Jordi Kühne Escolà
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Benedikt Frank
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Albakr A, Almatar A, AlFajri A, Zafar A, Nazish S, Shahid R, AlJaafari D, Soltan N, Alarfaj Z, Al Ghamdi O, Alfilw S, Abdelhady A, Albaker W. Important Factors to Expect the Outcome After Intracerebral Hemorrhage: An Observational Study From a University Hospital in Saudi Arabia. Neurologist 2023; 28:310-315. [PMID: 37027177 DOI: 10.1097/nrl.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) has worse clinical outcomes than other stroke types. The risk factors contributing to ICH outcomes are not entirely understood, and published literature from Saudi Arabia on ICH outcomes is limited. Our goal was to study the specific clinical and imaging determinants of ICH outcomes. METHODS We retrospectively retrieved all patients with spontaneous ICH (SICH) from a prospective King Fahd Hospital University registry between 2017 and 2019. The clinical characteristics of ICH events and data on clinical outcomes (6 to 12 mo) were recorded. Groups of patients with a favorable modified Rankin Scale of 0 to 2 and nonfavorable outcomes of a modified Rankin Scale of 3 to 6 were investigated. The relationship between the clinical characteristics of the SICH event and its outcomes was assessed using linear and logistic regression analyses. RESULTS A total of 148 patients with a mean age of 60.3 years (±15.2) and a median follow-up of 9 months were included. Unfavorable outcomes were reported in 98 patients (66.2%). The ICH event variables associated with unfavorable outcomes were impaired renal function, Glasgow Coma Score <8, hematoma volume, hematoma expansion, and intraventricular extension (IVE). CONCLUSIONS Our study demonstrated important clinical and radiologic features in patients with ICH that may affect their clinical long-term functional outcomes. A larger multicenter study is required to validate our results and evaluate the methods to improve health care in patients with SICH.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Suad Alfilw
- Department of Neurology, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Ahmed Abdelhady
- Department of critical care, College of Medicine, Alexandria University, Egypt
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Rynkowski CB, Hegele V, Soares PHR, Tonello ML, Petterson L, Gomes FK, Rabinstein AA, Bastos LSL, Turon R, Gonçalves B, Righy C, Bozza FA, Kurtz P. Effects of Tranexamic Acid in Patients with Subarachnoid Hemorrhage in Brazil: A Prospective Observational Study with Propensity Score Analysis. Neurocrit Care 2023; 39:191-197. [PMID: 37131089 DOI: 10.1007/s12028-023-01732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Rebleeding from a ruptured aneurysm increases the risk of unfavorable outcomes after subarachnoid hemorrhage (SAH) and is prevented by early aneurysm occlusion. The role of antifibrinolytics before aneurysm obliteration remains controversial. We investigated the effects of tranexamic acid on long-term functional outcomes of patients with aneurysmal SAH (aSAH). METHODS This was a single-center, prospective, observational study conducted in a high-volume tertiary hospital in a middle-income country from December 2016 to February 2020. We included all consecutive patients with aSAH who either received or did not receive tranexamic acid (TXA) treatment. Multivariate logistic regression analysis using propensity score was used to evaluate the association of TXA use with long-term functional outcomes, measured by the modified Rankin Scale (mRS) at 6 months. RESULTS A total of 230 patients with aSAH were analyzed. The median (interquartile range) age was 55 (46-63) years, 72% were women, 75% presented with good clinical grade (World Federation of Neurological Surgeons grade 1-3), and 83% had a Fisher scale of 3 or 4. Around 80% of patients were admitted up to 72 h from ictus. The aneurysm occlusion method was surgical clipping in 80% of the patients. A total of 129 patients (56%) received TXA. In multivariable logistic regression using inverse probability treatment weighting, the long-term rate of unfavorable outcomes (modified Rankin scale 4-6) was the same in the TXA and non-TXA groups (61 [48%] in TXA group vs. 33 [33%] in non-TXA group; odds ratio [OR] 1.39, 95% confidence interval [CI] 0.67-2.92; p = 0.377). The TXA group had higher in-hospital mortality (33 vs. 11% in non-TXA group; OR 4.13, 95% CI 1.55-12.53, p = 0.007). There were no differences between the groups concerning intensive care unit length of stay (16 ± 11.22 days in TXA group vs. 14 ± 9.24 days in non-TXA group; p = 0.2) or hospital (23 ± 13.35 days in TXA group vs. 22 ± 13.36 days in non-TXA group; p = 0.9). There was no difference in the rates of rebleeding (7.8% in TXA group vs. 8.9% in non-TXA group; p = 0.31) or delayed cerebral ischemia (27% in TXA group vs. 19% in non-TXA group; p = 0.14). For the propensity-matched analysis, 128 individuals were selected (64 in TXA group and 64 in non-TXA group), and the rates of unfavorable outcomes at 6 months were also similar between groups (45% in TXA group and 36% in non-TXA group; OR 1.22, 95% CI 0.51-2.89; p = 0.655). CONCLUSIONS Our findings in a cohort with delayed aneurysm treatment reinforce previous data that TXA use before aneurysm occlusion does not improve functional outcomes in aSAH.
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Affiliation(s)
- Carla B Rynkowski
- Intensive Care Unit, Cristo Redentor Hospital, Porto Alegre, Brazil
- Intensive Care Unit, Ernesto Dornelles Hospital, Porto Alegre, Brazil
| | - Vanessa Hegele
- Pharmacy Department, Cristo Redentor Hospital, Porto Alegre, Brazil
| | | | | | | | | | | | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Ricardo Turon
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Bruno Gonçalves
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Cassia Righy
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
- D ́Or Institute for Research and Education, Rua Diniz Cordeiro 30, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Pedro Kurtz
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
- D ́Or Institute for Research and Education, Rua Diniz Cordeiro 30, Rio de Janeiro, RJ, 22281-100, Brazil.
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil.
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Rivera R, Amudio C, Cruz JP, Brunetti E, Catalan P, Sordo JG, Echeverria D, Badilla L, Chamorro A, Gonzalez C, Ojeda H, Rodriguez C, Rogers N, Bravo L, Bravo F, Carrasco A, Gonzalez W, Lopez S, Orellana ML, Oportus M, Salazar A, Palacios G, Nguyen PT. The impact of a two-year long COVID-19 public health restriction program on mechanical thrombectomy outcomes in a stroke network. J Stroke Cerebrovasc Dis 2023; 32:107138. [PMID: 37087772 PMCID: PMC10106818 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the impact of COVID-19 pandemic public health restrictions on our drip and ship mechanical thrombectomy program in Santiago Chile. MATERIALS AND METHODS This was a retrospective analysis of a prospectively collected database comparing two cohorts, one during a two-year period before COVID-19 and the second during the two years of the pandemic at our metropolitan stroke program. RESULTS A total of 100 patients were included in the pre COVID-19 cohort (cohort 1) and 121 in the COVID-19 cohort (cohort 2). There was a significant difference between cohorts, with older patients, different occlusion sites and higher door to arterial puncture time during the COVID-19 period. A non-significant trend for worse 90-day outcomes and higher mortality was present in cohort 2. There were no statistical differences in safety treatment parameters. CONCLUSIONS COVID-19 pandemic has had a measurable impact on our mechanical thrombectomy program. Results showed similarities to other reported Latin American series, where less robust health systems could adapt less efficiently compared to developed countries. After two years of public health restrictions, there were changes in the treatment population characteristics, delay in some internal management metrics and a non-significant trend to worse 90-day outcomes and higher mortality.
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Affiliation(s)
- Rodrigo Rivera
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile.
| | - Cristian Amudio
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Juan Pablo Cruz
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Enzo Brunetti
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Pascual Catalan
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Juan Gabriel Sordo
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Daniel Echeverria
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Lautaro Badilla
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Alex Chamorro
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Christian Gonzalez
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Héctor Ojeda
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Cristian Rodriguez
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Nicole Rogers
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Loreto Bravo
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Fabian Bravo
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Alejandra Carrasco
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Walter Gonzalez
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Sofia Lopez
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Maria Luisa Orellana
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Monica Oportus
- Anesthesia Unit, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Alejandro Salazar
- Anesthesia Unit, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Gerardo Palacios
- Anesthesia Unit, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Prof Thanh Nguyen
- Interventional neurology/ neuroradiology at Boston Medical Center (BMC), Boston MA - USA
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8
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Diegoli H, Magalhães PSC, Makdisse MRP, Moro CHC, França PHC, Lange MC, Longo AL. Real-World Populational-Based Quality of Life and Functional Status After Stroke. Value Health Reg Issues 2023; 36:76-82. [PMID: 37054502 DOI: 10.1016/j.vhri.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/24/2022] [Accepted: 02/14/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES This study aimed to describe health-related quality of life (HRQoL) 3 months and 1 year after stroke, compare HRQoL between dependent (modified Rankin scale [mRS] 3-5) and independent (mRS 0-2) patients, and identify factors predictive of poor HRQoL. METHODS Patients with a first ischemic stroke or intraparenchymal hemorrhage from the Joinville Stroke Registry were analyzed retrospectively. Using the 5-level version of the EuroQol-5D questionnaire, HRQoL was calculated for all patients 3 months and 1 year after stroke, stratified by mRS score (0-2 or 3-5). One-year HRQoL predictors were examined using univariate and multivariate analyses. RESULTS Three months after a stroke, data from 884 patients were analyzed; 72.8% were categorized as mRS 0-2 and 27.2% as mRS 3-5, and the mean HRQoL was 0.670 ± 0.256. At 1-year follow-up, 705 patients were evaluated; 75% were classified as mRS 0-2 and 25% as mRS 3-5, and the mean HRQoL was 0.71 ± 0.249. An increase in HRQoL was observed between 3 months and 1 year (mean difference 0.024, P < .0001), both in patients with 3-month mRS 0-2 (0.013, P = .027) and mRS 3-5 (0.052, P < .0001). Increasing age, female sex, hypertension, diabetes, and a high mRS were associated with poor HRQoL at 1 year. CONCLUSIONS This study described the HRQoL after a stroke in a Brazilian population. This analysis shows that the mRS was highly associated with HRQoL after stroke. Age, sex, diabetes, and hypertension were also associated with HRQoL, although not independently of mRS.
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Affiliation(s)
| | | | | | - Carla H C Moro
- Joinville Stroke Registry, City Hall of Joinville, Joinville, SC, Brazil
| | - Paulo H C França
- Post-Graduation Program in Health and Environment, University of the Region of Joinville, Joinville, SC, Brazil
| | - Marcos C Lange
- Federal University of Paraná, Clinical Hospital, Curitiba, PR, Brazil
| | - Alexandre L Longo
- Joinville Stroke Registry, City Hall of Joinville, Joinville, SC, Brazil
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9
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Gonçalves B, Rynkowski C, Turon R, Charris N, Miranda F, de Caro V, Prazeres M, Santos T, Greer DM, Sharshar T, Guillaume T, Bozza FA, Righy C, Kurtz P. Clinical Characteristics and Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Multicenter Study in a Middle-Income Country. Neurocrit Care 2023; 38:378-387. [PMID: 36324005 DOI: 10.1007/s12028-022-01629-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/03/2022] [Indexed: 04/13/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality and long-term functional impairment. Data on clinical management and functional outcomes from developing countries are scarce. We aimed to define patient profiles and clinical practices and evaluate long-term outcomes after SAH in a middle-income country. METHODS This was a prospective study including consecutive adult patients admitted with SAH to two reference centers in Brazil from January 2016 to February 2020. The primary outcome was functional status at 6 months using the modified Rankin Scale. Mixed multivariable analysis was performed to determine the relationship between clinical variables and functional outcomes. RESULTS From 471patients analyzed, the median time from symptom onset to arrival at a study center was 4 days (interquartile range 0-9). Median age was 55 years (interquartile range 46-62) and 353 (75%) patients were women. A total of 426 patients (90%) were transferred from nonspecialized general hospitals, initial computed tomography revealed thick hemorrhage in 73% of patients (modified Fisher score of 3 or 4), and 136 (29%) had poor clinical grade (World Federation of Neurological Surgeons score of 4 or 5). A total of 312 (66%) patients underwent surgical clipping, and 119 (25%) underwent endovascular coiling. Only 34 patients (7%) underwent withdrawal or withholding of life-sustaining therapy during their hospital stay, and in-hospital mortality was 24%. A total of 187 (40%) patients had an unfavorable long-term functional outcome (modified Rankin Scale score of 4 to 6). Factors associated with unfavorable outcome were age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.03-1.08), hypertension (adjusted OR 1.81, 95% CI 1.04-3.16), poor clinical grade (adjusted OR 4.92, 95% CI 2.85-8.48), external ventricular drain (adjusted OR 3.8, 95% CI 2.31-6.24), postoperative deterioration (adjusted OR 2.33, 95% CI 1.32-4.13), cerebral infarction (adjusted OR 3.16, 95% CI 1.81-5.52), rebleeding (adjusted OR 2.95, 95% CI 1.13-7.69), and sepsis (adjusted OR 2.68, 95% CI 1.42-5.05). CONCLUSIONS Our study demonstrated that SAH management in a middle-income country diverges significantly from published cohorts and current guidelines, despite comparable clinical profiles on presentation and admission to high-volume referral centers. Earlier aneurysm occlusion and increased use of endovascular therapy could potentially reduce modifiable in-hospital complications and improve functional outcomes in Brazil.
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Affiliation(s)
- Bruno Gonçalves
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Carla Rynkowski
- Department of Intensive Care Medicine, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Ricardo Turon
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Nestor Charris
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Fabio Miranda
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil
| | - Vanessa de Caro
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Marco Prazeres
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Thayana Santos
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Tarek Sharshar
- Department of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France
| | - Turc Guillaume
- GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris Cité, Paris, France
- INSERM, Paris, France
- FHU NeuroVasc, Paris, France
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, CEP 22281-100, Brazil
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Cassia Righy
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Pedro Kurtz
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil.
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, CEP 22281-100, Brazil.
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Telephone-based assessment of the fear of falling in older people and factors associated. Int J Rehabil Res 2023; 46:98-102. [PMID: 36727964 DOI: 10.1097/mrr.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to validate the telephone-based application of the Falls Efficacy Scale-International (FES-I) for the assessment of the fear of falling in older people, and to investigate, among personal and environmental factors, which ones can explain this fear in this population. Participants answered the FES-I on two randomized occasions, face-to-face and by telephone. Intraclass correlation coefficient (ICC 3,1 ) was used to investigate the levels of agreement between the two occasions. The possible factors associated were sex, age, previous history of falls, family arrangement, practice of physical activity, presence of orthopedic pathologies, use of walking aids, presence of visual impairment, and presence of stairs in the home environment. Linear regression analysis was applied to investigate which of these factors could explain the fear of falling in older people. One hundred twenty-two individuals were included. There was no significant difference in the mean difference obtained between the two applications of the FES-I (1 point; 95% confidence interval, -4 to 6), with a high level of agreement (ICC = 0.88). Sex and presence of orthopedic pathologies explained 14% of the model. The FES-I showed to be a reliable scale to be applied for telephone assessments of fear of falling in older people. In addition, women with orthopedic pathologies are the profile of older people with most afraid of falling.
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11
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Brito SAFD, Scianni AA, Peniche PDC, Faria CDCDM. Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review using COSMIN checklist. Clin Rehabil 2023; 37:415-435. [PMID: 36448251 DOI: 10.1177/02692155221129834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To summarize the measurement properties (reliability, validity, and responsiveness) and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions. DESIGN Systematic review. SUBJECTS Individuals with neurological conditions. INTERVENTION Not applicable. MAIN MEASURES The methodological quality of the studies using the COSMIN Risk of Bias Checklist, the quality of the measurement properties using the criteria for good measurement properties, and the clinical utility of the measurements using the Tyson & Connell scale. RESULTS From the 22,188 identified studies, 47 were included. Forty-three measurement tools were identified. The main modes of administration were telephone and videoconference. Studies involved mostly individuals with stroke, multiple sclerosis, and Alzheimer's disease. Criterion validity and reliability were the most investigated measurement properties. None of the tools had their responsiveness investigated. Twenty-two measurement tools have at least one measurement property evaluated as "sufficient" in a study with appropriate methodological quality ("very good" or "adequate"). Nineteen measurement tools showed adequate clinical utility. Eight measurement tools, investigated in individuals with stroke, spinal cord injury or Alzheimer's disease, all administered by telephone, were recommended. CONCLUSION The present results can be used to assist in choosing appropriate measurement tools, both in research and clinical practice, during telerehabilitation in individuals with neurological conditions. Measurement error, content validity, structural validity, and responsiveness need to be further investigated. In addition, the measurement properties of tools used in telerehabilitation in other neurological conditions, such as Huntington's disease, should also be investigated. REGISTRATION NUMBER CRD42021257662.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paula da Cruz Peniche
- Department of Physical Therapy, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Moraes MDA, Jesus PAPD, Muniz LS, Costa GA, Pereira LV, Nascimento LM, Teles CADS, Baccin CA, Mussi FC. Ischemic stroke mortality and time for hospital arrival: analysis of the first 90 days. Rev Esc Enferm USP 2023; 57:e20220309. [PMID: 37058593 PMCID: PMC10112237 DOI: 10.1590/1980-220x-reeusp-2022-0309en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/30/2023] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVE To analyze the association between time of arrival at a reference hospital and mortality of people with ischemic stroke. METHOD Descriptive and inferential statistics were used. Modifying and confounding variables between time of arrival and mortality were observed in the multivariate analysis. The Akaike Information Criterion was used to choose the model. Statistical significance of 5% and risk correction using the Poisson Model were adopted. RESULTS Most participants arrived within 4.5 hours of symptom onset or wake up stroke to the referral hospital and 19.4% died. The score of the National Institute of Health Stroke Scale was a modifier. In the multivariate model stratified by scale score ≥14, arrival time >4.5h was associated with lower mortality; and age ≥60 years and having Atrial Fibrillation, to higher mortality. In the model stratified by score ≤13, previous Rankin ≥3, and presence of atrial fibrillation were predictors of mortality. CONCLUSION The relationship between time of arrival and mortality up to 90 days was modified by the National Institute of Health Stroke Scale. Prior Rankin ≥3, atrial fibrillation, time to arrival ≤4.5h, and age ≥60 years contributed to higher mortality.
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Affiliation(s)
| | | | | | - Greice Alves Costa
- Universidade Federal da Bahia, Escola de Enfermagem, Salvador, BA, Brazil
| | | | | | - Carlos Antônio de Souza Teles
- Fiocruz, Instituto Gonçalo Muniz, Salvador, BA, Brazil
- Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil
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Oliveira ASD, Dantas MC, de Jesus PAP, Farias DS, de Almeida BM, Santos CSDO, Santos CSLA, Blumetti CR, de Faria CD, Costa CDC, Fernandes DP, Nogueira EDB, Fonseca GDQ, Pinto JPM, Oliveira IJW, Barcelos LS, Velloso LUF, Lucio MJP, Pimenta MD, Leopoldino OCS, de Medeiros RC, Junior TMDL, Santana TA, Lacerda VR, Alcantara YDFV, Oliveira-Filho J. Development of a new non invasive prognostic stroke scale (NIPSS) including triage elements for sleep apnea and peripheral artery disease. J Stroke Cerebrovasc Dis 2023; 32:106864. [PMID: 36434859 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although sleep apnea and peripheral artery disease are prognostic factors for stroke, their added benefit in the acute stage to further prognosticate strokes has not been evaluated. OBJECTIVES We tested the accuracy in the acute stroke stage of a novel score called the Non-Invasive Prognostic Stroke Scale (NIPSS). PATIENTS AND METHODS Prospective cohort with imaging-confirmed ischemic stroke. Clinical data, sleep apnea risk score (STOPBANG) and blood pressure measures were collected at baseline. Primary outcome was the 90-day modified Rankin Scale (mRS), with poor outcome defined as mRS 3-6. Area under the ROC curve (AUC) was calculated for NIPSS and compared to six other stroke prognostic scores in our cohort: SPAN-100 index, S-SMART, SOAR, ASTRAL, THRIVE, and Dutch Stroke scores. RESULTS We enrolled 386 participants. After 90 days, there were 56% with poor outcome, more frequently older, female predominant and with higher admission National Institute of Health Stroke Scale (NIHSS). Four variables remained significantly associated with primary endpoint in the multivariable model: age (OR 1.87), NIHSS (OR 7.08), STOPBANG category (OR 1.61), and ankle-braquial index (OR 2.11). NIPSS AUC was 0.86 (0.82-0.89); 0.83 (0.79-0.87) with bootstrapping. When compared to the other scores, NIPSS, ASTRAL, S-SMART and DUTCH scores had good abilities in predicting poor outcome, with AUC of 0.86, 0.86, 0.83 and 0.82, respectively. THRIVE, SOAR and SPAN-100 scores were fairly predictive. DISCUSSION AND CONCLUSIONS Non-invasive and easily acquired emergency room data can predict clinical outcome after stroke. NIPSS performed equal to or better than other prognostic stroke scales.
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Affiliation(s)
- Alice Silva de Oliveira
- Post-Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Brazil (UFBA), Neurology Service, Hospital Universitario Professor Edgard Santos, UFBA, Sala 421, Rua Reitor Miguel Calmón, Sem Número, Bairro Canela, Salvador 40110-100, Brazil.
| | - Moises Correia Dantas
- Post-Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Brazil (UFBA), Neurology Service, Hospital Universitario Professor Edgard Santos, UFBA, Sala 421, Rua Reitor Miguel Calmón, Sem Número, Bairro Canela, Salvador 40110-100, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jamary Oliveira-Filho
- Post-Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Brazil (UFBA), Neurology Service, Hospital Universitario Professor Edgard Santos, UFBA, Sala 421, Rua Reitor Miguel Calmón, Sem Número, Bairro Canela, Salvador 40110-100, Brazil.
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Moraes MDA, Jesus PAD, Muniz LS, Baccin CA, Barreto ABM, Sales RS, Pires CGDS, Teles CADS, Mussi FC. Arrival time at a referral hospital and functional disability of people with stroke: a cohort study. SAO PAULO MED J 2023; 141:e2022510. [PMID: 37194766 DOI: 10.1590/1516-3180.2022.0510.r1.27022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/27/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Stroke is a major cause of death and functional disability worldwide. Knowledge of the associated factors is essential for defining education, management, and healthcare strategies. OBJECTIVE To analyze the association between arrival time at a neurology referral hospital (ATRH) and functional disability in patients with ischemic stroke 90 days after the event. DESIGN AND SETTING Prospective cohort study conducted at a public institution of higher education in Brazil. METHODS This study included 241 people aged ≥ 18 years who presented ischemic stroke. The exclusion criteria were death, inability to communicate without companions who could answer the research questions, and > 10 days since ictus. Disability was assessed using the Rankin score (mR). Variables for which associations showed a P value ≤ 0.20 in bivariate analysis were tested as modifiers between ATRH and disability. Significant interaction terms were used for multivariate analysis. Multivariate logistic regression analysis was performed with all variables, arriving at the complete model and adjusted beta measures. The confounding variables were included in the robust logistic regression model, and Akaike's Information Criterion was adopted to choose the final model. The Poisson model assumes a statistical significance of 5% and risk correction. RESULTS Most participants (56.0%) arrived at the hospital within 4.5 hours of symptom onset, and 51.7% presented with mRs of 3 to 5 after 90 days of ictus. In the multivariate model, ATRH ≥ 4.5 hours and females were associated with more significant disability. CONCLUSIONS Arrival at the referral hospital 4.5 hours after the onset of symptoms or wake-up stroke was an independent predictor of a high degree of functional disability.
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Affiliation(s)
- Mariana de Almeida Moraes
- MSc, PhD. Nurse and Adjunct Professor, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Pedro Antônio de Jesus
- MD, MSc, PhD. Adjunct Professor, Institute of Health Science, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Ludimila Santos Muniz
- MSc. Nurse, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Camila Antunes Baccin
- MSc, PhD. Nurse, Laboratório de Produção, Inovação e Pesquisa em Tecnologias e Informática em Saúde e Enfermagem (LAPETEC/GIATE), Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | | | - Rilary Silva Sales
- Graduate Student, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | | | | | - Fernanda Carneiro Mussi
- MSc, PhD. Nurse and Full Professor, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
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15
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Miranda LA, Luvizutto GJ, Stephan BCM, Souza JTD, Silva TRD, Winckler FC, Ferreira NC, Antunes LCDO, Bessornia PAC, Bazan SGZ, Fukushima FB, Costa RDMD, Modolo GP, Minicucci MF, Bazan R, Vidal EIDO. Evaluating the performance of the PRISMA-7 frailty criteria for predicting disability and death after acute ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31:106837. [PMID: 36283237 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
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Yi K, Nakajima M, Ikeda T, Yoshigai M, Ueda M. Modified Rankin scale assessment by telephone using a simple questionnaire. J Stroke Cerebrovasc Dis 2022; 31:106695. [PMID: 36054972 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The modified Rankin Scale (mRS) is widely used as a measure of post-stroke physical disability in clinical stroke trials; however, it is affected by inter-rater discrepancies. A Japanese version of the simplified mRS questionnaire (J-RASQ) has the potential to overcome the inter-rater discrepancies and might be feasible for clinical surveys. We aimed to determine the reliability of J-RASQ in a telephone survey administered by non-medical staff. METHODS We recruited 103 patients (age = 73 ± 11 years; 57% males) with a history of ischemic stroke who visited the outpatient clinic of the department of neurology at our hospital between March and May, 2021. After obtaining informed consent for participation in the study, a stroke neurologist assessed the mRS score during the visit using the Japanese version of mRS. On the same day, a clerk telephoned the patient or his/her family members to administer the J-RASQ. The percentage of agreement between mRS and J-RASQ scores was evaluated using the kappa coefficient and weighted kappa coefficient. RESULTS The median time for the telephone survey was 85 s (interquartile range = 70-135 s). The mRS and J-RASQ scores had an agreement of 63.1%, with a kappa statistic of 0.51 (95% confidence interval [CI] = 0.39-0.63). The weighted kappa statistic, which takes into account the extent of disagreement, was 0.81 (95% CI = 0.75-0.88). CONCLUSION J-RASQ is easy to administer and reliable for assessment in telephone-based surveys performed by non-medical staff.
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Affiliation(s)
- Kenichiro Yi
- Department of Neurology, Minamata City Hospital and Medical Center, Minamata, Japan.
| | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | - Tomoaki Ikeda
- Department of Neurology, Minamata City Hospital and Medical Center, Minamata, Japan
| | - Mineko Yoshigai
- Department of Neurology, Minamata City Hospital and Medical Center, Minamata, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
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Jitpratoom P, Boonyasiri A. Clinical and laboratory features in patients with positive syphilis serology presenting with acute ischemic stroke or transient ischemic attack: a prospective cohort study. BMC Infect Dis 2022; 22:717. [PMID: 36042411 PMCID: PMC9429294 DOI: 10.1186/s12879-022-07700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neurosyphilis (NS) can lead to acute ischemic stroke (AIS) or transient ischemic attack (TIA). We compared the clinical characteristics and laboratory features among AIS and TIA patients who were syphilis-seronegative (control group) or had latent syphilis (LS) or NS to evaluate their stroke outcome. Methods This prospective cohort study was conducted on patients who had recently suffered AIS or TIA. After serological syphilis screening, clinical and laboratory data were collected, and brain imaging and spinal tap (serologically syphilis-positive patients only) were performed. Stroke outcome was re-evaluated approximately three months later. Results The 344 enrolled patients were divided into three groups: control group (83.7%), LS (13.1%), and NS (3.2%). A multivariate analysis revealed: 1) age of ≥ 70 years, generalized brain atrophy via imaging, and alopecia (adjusted odds ratio [AOR] = 2.635, 2.415, and 13.264, respectively) were significantly associated with LS vs controls; 2) age of ≥ 70 years (AOR = 14.633) was significantly associated with NS vs controls; and 3) the proportion of patients with dysarthria was significantly lower (AOR = 0.154) in the NS group than in the LS group. Regarding the NS patient cerebrospinal fluid (CSF) profile, only 2/11 cases had positive CSF-Venereal Disease Research Laboratory (VDRL) test results; the other nine cases were diagnosed from elevated white blood cell counts or protein levels combined with positive CSF fluorescent treponemal antibody absorption (FTA-ABS) test results. Regarding disability, the initial modified Rankin scale (mRS) score was lower in the control group than in the NS group (p = 0.022). At 3 months post-stroke, the mRS score had significantly decreased in the control (p < 0.001) and LS (p = 0.001) groups. Regarding activities of daily living, the 3-month Barthel Index (BI) score was significantly higher in control patients than in LS (p = 0.030) or NS (p = 0.002) patients. Additionally, the 3-month BI score was significantly increased in the control (p < 0.001) and LS (p = 0.001) groups. Conclusions Because syphilis was detected in many AIS and TIA patients, especially those aged ≥ 70 years, routine serological syphilis screening may be warranted in this population. Patients with syphilitic infection had worse stroke outcomes compared with NS patients.
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Affiliation(s)
| | - Adhiratha Boonyasiri
- Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Fernández Sanz A, Ruiz Serrano J, Tejada Meza H, Marta Moreno J. Validation of the Spanish-language version of the simplified modified Rankin Scale telephone questionnaire. Neurologia 2022; 37:271-276. [PMID: 31153685 DOI: 10.1016/j.nrl.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/09/2019] [Accepted: 03/03/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The modified Rankin Scale (mRS) is the main functional assessment tool used after stroke. The simplified mRS questionnaire (smRSq) has recently been validated in English, and represents a simpler, reliable scale with an excellent reproducibility via telephone. The present study aims to validate a Spanish-language version of the telephone smRSq. METHOD We conducted a prospective cohort study, assessing 50 patients 3 months after they presented an ischaemic stroke. We assessed the Spanish-language smRSq by telephone and in person, the mRS with a structured interview, the Spanish-language smRSq, and the Stroke Impact Scale-16. Inter-rater reliability, test-retest reliability, construct validity, and criterion validity were assessed. RESULTS Inter-rater reliability showed strong agreement (k=0.810); test-retest reliability and criterion validity showed moderate agreement (k=0.639 and k=0.759, respectively), and construct validity showed moderate agreement (Spearman correlation coefficient=-0.728). CONCLUSIONS The Spanish-language telephone smRSq is reliable and simple, and saves time in the functional assessment after a stroke.
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Affiliation(s)
- A Fernández Sanz
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - J Ruiz Serrano
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Miguel Servet, Zaragoza, España
| | - H Tejada Meza
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Marta Moreno
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
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Moraes MDA, Mussi FC, Muniz LS, Sampaio EES, Leitão TDS, Santos CADST, Jesus PAPD. Clinical characterization, disability, and mortality in people with strokes during 90 days. Rev Bras Enferm 2021; 75:e20201383. [PMID: 34705991 DOI: 10.1590/0034-7167-2020-1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to describe clinical characteristics and mortality of people with ischemic cerebrovascular accidents (strokes); to compare disability before the event and 90 days after. METHODS longitudinal study with 308 people hospitalized in Salvador-BA. Data collection took place from 03/2019 to 01/2020. Descriptive and inferential statistics were used. RESULTS mean age was 64.8 years, and National Institute of Health Stroke Scale score was 10.7. The median length of stay in the hospital was 11 days. Afro-descendants predominated (84%), elementary educational level (68.4%), income up to three minimum wages (89.1%), arrival within 4.5 hours of symptoms (57.9%) and admission to a specialized unit (71.8%). Prevalence of thrombolysis: 26%. The asymptomatic before the event category predominated (85.3%) as did the moderate/severe disability (41.5%) after 90 days. 19.7% of the sample evolved to death. Conclusions: the high mortality and disability generated by the event have implications for health management and care.
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Lehmann ALCF, Alfieri DF, de Araújo MCM, Trevisani ER, Nagao MR, Pesente FS, Gelinski JR, de Freitas LB, Flauzino T, Lehmann MF, Lozovoy MAB, Breganó JW, Simão ANC, Maes M, Reiche EMV. Carotid intima media thickness measurements coupled with stroke severity strongly predict short-term outcome in patients with acute ischemic stroke: a machine learning study. Metab Brain Dis 2021; 36:1747-1761. [PMID: 34347209 DOI: 10.1007/s11011-021-00784-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 06/14/2021] [Indexed: 12/24/2022]
Abstract
Acute ischemic stroke (IS) is one of the leading causes of morbidity, functional disability and mortality worldwide. The objective was to evaluate IS risk factors and imaging variables as predictors of short-term disability and mortality in IS. Consecutive 106 IS patients were enrolled. We examined the accuracy of IS severity using the National Institutes of Health Stroke Scale (NIHSS), carotid intima-media thickness (cIMT) and carotid stenosis (both assessed using ultrasonography with doppler) predicting IS outcome assessed with the modified Rankin scale (mRS) three months after hospital admission. Poor prognosis (mRS ≥ 3) at three months was predicted by carotid stenosis (≥ 50%), type 2 diabetes mellitus and NIHSS with an accuracy of 85.2% (sensitivity: 90.2%; specificity: 81.8%). The mRS score at three months was strongly predicted by NIHSS (β = 0.709, p < 0.001). Short-term mortality was strongly predicted using a neural network model with cIMT (≥ 1.0 mm versus < 1.0 mm), NIHSS and age, yielding an area under the receiving operator characteristic curve of 0.977 and an accuracy of 94.7% (sensitivity: 100.0%; specificity: 90.9%). High NIHSS (≥ 15) and cIMT (≥ 1.0 mm) increased the probability of dying with hazard ratios of 7.62 and 3.23, respectively. Baseline NIHSS was significantly predicted by the combined effects of age, large artery atherosclerosis stroke, sex, cIMT, body mass index, and smoking. In conclusion, high values of cIMT and NIHSS at admission strongly predict short-term functional impairment as well as mortality three months after IS, underscoring the importance of those measurements to predict clinical IS outcome.
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Affiliation(s)
- Ana Lucia Cruz Fürstenberger Lehmann
- Department of Clinical Medicine, Health Sciences Center and Radiology Service, The University Hospital, State University of Londrina, Paraná, Brazil
| | - Daniela Frizon Alfieri
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil
| | | | - Emanuelle Roberto Trevisani
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil
| | - Maisa Rocha Nagao
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil
| | | | - Jair Roberto Gelinski
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil
| | - Leonardo Bodner de Freitas
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil
| | - Tamires Flauzino
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil
| | - Márcio Francisco Lehmann
- Department of Clinical Surgery, Health Sciences Center, Neurosurgery Service of the University Hospital, State University of Londrina, Paraná, Brazil
| | - Marcell Alysson Batisti Lozovoy
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, Paraná, CEP 86.038-440, Brazil
| | - José Wander Breganó
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, Paraná, CEP 86.038-440, Brazil
| | - Andréa Name Colado Simão
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, Paraná, CEP 86.038-440, Brazil
| | - Michael Maes
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Chulalongkorn, Bangkok, Thailand
| | - Edna Maria Vissoci Reiche
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil.
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, Paraná, CEP 86.038-440, Brazil.
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Menezes KKP, Avelino PR, Costa GA, Viana JB, Gomes WL, Nascimento LR. Telephone-based assessment of walking confidence in older people. Int J Rehabil Res 2021; 44:282-284. [PMID: 34034288 DOI: 10.1097/mrr.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To validate the telephone-based application of the modified Gait Efficacy Scale (mGES) for the assessment of walking confidence in older people. Participants answered the mGES-Brazil on two randomized occasions, face-to-face and by telephone. The mean difference (MD) between the interviews was reported. Intraclass correlation coefficient (ICC3,1) was used to investigate the levels of agreement between the two occasions for total mGES-Brazil scores and for the individual items. A total of 78 individuals were included. There was no significant difference in the MD obtained between applications of the mGES (1 point, 95% confidence interval -6 to 7). A very high level of agreement was found between the mGES total scores during face-to-face and telephone applications (ICC = 0.98; 95% CI 0.97-0.99). All items, except one (item 3), had a very high agreement between the two applications. The mGES showed to be reliable to be applied for telephone assessments of walking confidence in older people.
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Affiliation(s)
- Kênia K P Menezes
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
- Department of Physical Therapy, Fundação Comunitária de Ensino Superior de Itabira, Itabira
| | - Patrick R Avelino
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
- Department of Physical Therapy, Faculdade de Santa Luzia, Santa Luzia, Brazil
| | - Gabriela Azevedo Costa
- Department of Physical Therapy, Fundação Comunitária de Ensino Superior de Itabira, Itabira
| | | | - Wanda Lucia Gomes
- Department of Physical Therapy, Fundação Comunitária de Ensino Superior de Itabira, Itabira
| | - Lucas R Nascimento
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
- Center of Health Sciences, Department of Physical Therapy, Universidade Federal do Espírito Santo, Vitória
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22
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Coelho TS, Bitencourt ACS, Bazan R, de Souza LAPS, Luvizutto GJ. Hip abduction with ankle dorsiflexion (HAAD) score and trunk seating control within 72 h after stroke predicts long-term disability: A cohort study. J Bodyw Mov Ther 2021; 27:710-716. [PMID: 34391311 DOI: 10.1016/j.jbmt.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/20/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to determine whether muscle strength of the lower limb and trunk during the acute phase after stroke are predictors of motor function and disability 90 days after hospital discharge. METHODS This prospective study used a nonconcurrent design to evaluate stroke patients at two time points: a) first 72 h: hip abduction and ankle dorsiflexion (HAAD) score, trunk sitting control, clinical evaluation, demographic profile, and stroke severity using the National Institutes of Health Stroke Scale (NIHSS); b) 90 days after hospital discharge: modified Rankin scale (mRS). The participants were divided into two groups: good outcome (mRS 0-2) and worse outcome (mRS>2), and the differences between them were assessed statistically. Clinical and demographic variables were included in the multiple logistic regression analysis. The ROC curve was used to illustrate the clinical sensitivity and specificity of the HAAD score cutoff for the outcomes. RESULTS Thirty-seven patients were included: 16 with mRS≤2 and 21 with mRS>2. Patients in the worse outcome group were older (p = 0.02) and presented with higher NIHSS scores (p = 0.002), lower HAAD scores (p < 0.001), higher pain sensation (p = 0.04), greater altered perception (p = 0.008), and no trunk control in the sitting position (p = 0.004). A lower HAAD score (OR = 0.09; 95%CI: 0.14-0.53; p < 0.001) and the absence of trunk control in the sitting position (OR = 0.55; 95%CI:0.54-0.95; p < 0.001) were associated with unsatisfactory outcomes. CONCLUSION A HAAD score <6 and the absence of trunk control while sitting during the first 72 h are predictors of worse long-term disability in stroke patients.
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Affiliation(s)
| | | | - Rodrigo Bazan
- Botucatu Medical School (UNESP), Botucatu, São Paulo, Brazil
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23
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Fernández Sanz A, Ruíz Serrano J, Tejada Meza H, Marta Moreno J. Validation of the Spanish-language version of the simplified modified Rankin Scale telephone questionnaire. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:271-276. [DOI: 10.1016/j.nrleng.2019.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/03/2019] [Indexed: 10/21/2022] Open
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24
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Fialho Silva IT, Assis Lopes P, Timotio Almeida T, Ramos SC, Caliman Fontes AT, Guimarães Silva D, Martins Soares C, Oliveira Carneiro L, Souza IFB, Ferreira Abreu F, Nascimento Silva G, Mascarenhas de Souza L, Brito Pinheiro T, de Souza E Silva FN, de Santana JP, Kelly Silva B, Almeida Souza D, Silva Macedo S, Almeida Ismael LS, Pereira de Jesus PA. Impact of Delirium and Its Motor Subtypes on Stroke Outcomes. Stroke 2021; 52:1322-1329. [PMID: 33719516 DOI: 10.1161/strokeaha.120.026425] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Delirium is an acute and fluctuating impairment of attention, cognition, and behavior. Although common in stroke, studies that associate the clinical subtypes of delirium with functional outcome and death are lacking. We aimed to evaluate the influence of delirium occurrence and its different motor subtypes over stroke patients' prognosis. METHODS Prospective cohort of stroke patients with symptom onset within 72 hours before research admission. Delirium was diagnosed by Confusion Assessment Method for the Intensive Care Unit, and its motor subtypes were defined according to the Richmond Agitation-Sedation Scale. The main outcome was functional dependence or death (modified Rankin Scale>2) at 90 days comparing: delirium versus no delirium patients; and between motor subtypes. Secondary outcomes included modified Rankin Scale score >2 at 30 days and 90-day-mortality. RESULTS Two hundred twenty-seven patients were enrolled. Delirium occurred in 71 patients (31.3%), with the hypoactive subtype as the most frequent, in 41 subjects (57.8%). Delirium was associated with increased risk of death and functional dependence at 30 and 90 days and higher 90-day mortality. Multivariate analysis showed delirium (odds ratio, 3.28 [95% CI, 1.17-9.22]) as independent predictor of modified Rankin Scale >2 at 90 days. CONCLUSIONS Delirium is frequent in stroke patients in the acute phase. Its occurrence-specifically in mixed and hypoactive subtypes-seems to predict worse outcomes in this population. To our knowledge, this is the first study to prospectively investigate differences between delirium motor subtypes over functional outcome three months poststroke. Larger studies are needed to elucidate the relationship between motor subtypes of delirium and functional outcomes in the context of acute stroke.
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Affiliation(s)
- Ivã Taiuan Fialho Silva
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Pedro Assis Lopes
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Tiago Timotio Almeida
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Saint Clair Ramos
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Ana Teresa Caliman Fontes
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Daniel Guimarães Silva
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Camila Martins Soares
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Lays Oliveira Carneiro
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Ian Felipe Barbosa Souza
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Fernanda Ferreira Abreu
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Gabriel Nascimento Silva
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Letícia Mascarenhas de Souza
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Thiago Brito Pinheiro
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Filipe Nolasco de Souza E Silva
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - João Pedro de Santana
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Beatriz Kelly Silva
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Danilo Almeida Souza
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
| | - Silvana Silva Macedo
- Federal University of Bahia, Stroke Clinic, Salvador, Brazil (I.T.F.S., P.A.L., T.T.A., A.T.C.F., D.G.S., L.O.C., F.F.A., G.N.S., L.M.d.S., S.C.R., C.M.S., I.F.B.S., T.B.P., F.N.d.S.e.S., J.P.d.S., B.K.S., D.A.S., S.S.M.)
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Avelino PR, Nascimento LR, Menezes KKP, Tenório RA, Cândido GN, Christovão IS, Teixeira-Salmela LF. Validation of the telephone-based assessment of locomotion ability after stroke. Int J Rehabil Res 2021; 44:88-91. [PMID: 33234843 DOI: 10.1097/mrr.0000000000000447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The aim of the study was to validate the telephone-based application of the ABILOCO questionnaire for the assessment of locomotion ability after stroke. Individuals after stroke answered the ABILOCO-Brazil questionnaire on two randomized occasions, face-to-face and by telephone, 5-7 days apart. The mean difference between the interviews was reported. Intraclass correlation coefficient (ICC) was calculated to investigate the agreement between the total scores, and weighted-Kappa statistics to investigate the agreement between the individual items. A total of 92 individuals were included. There was no significant difference in the mean scores between face-to-face and telephone-based applications of the ABILOCO [mean difference 0.17 logits; 95% confidence interval (CI), -0.88 to 0.54]. A high level of agreement was found between the ABILOCO total scores obtained between both applications (ICC = 0.90; 95% CI, 0.84-0.93), and most of the individual items had, on average, moderate agreement. The ABILOCO showed to be a reliable questionnaire for telephone assessment of locomotion ability after stroke.
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Affiliation(s)
- Patrick R Avelino
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
| | - Lucas R Nascimento
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
- Discipline of Physical Therapy, Center of Health Sciences, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Kênia K P Menezes
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
| | - Ruani A Tenório
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
| | - Gabriela N Cândido
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
| | - Isabela S Christovão
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
| | - Luci F Teixeira-Salmela
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
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26
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Rivera R, Amudio C, Brunetti E, Catalan P, Sordo JG, Badilla L, Echeverria D, Cruz JP, Ojeda H, Bravo L, Bravo F, Gonzalez W, Orellana ML, Pinto C, Merino-Osorio C, Oportus M, Salazar A, Nogueira RG. Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile. Interv Neuroradiol 2021; 27:114-118. [PMID: 32873104 PMCID: PMC7903558 DOI: 10.1177/1591019920956405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mechanical Thrombectomy (MT) is the standard of care for treatment of large vessel occlusion stroke. Until the beginning of 2020 MT was not funded nor widely implemented at the public healthcare level in Chile. OBJECTIVE To describe the results of a pilot program created to provide access to public MT in Santiago - Chile. METHODS Analysis from a prospectively collected database of MT cases performed between September 2017 and September 2019 in one center. A stroke network was developed with a single MT capable stroke center and five primary stroke centers. The primary efficacy endpoint was the rate of functional independence (mRS 0-2) at 90 days. Successful reperfusion was defined as 2 b-3 according to the thrombolysis in cerebral infarction scale. Safety outcomes include the rates of symptomatic intracranial hemorrhage and 90-day mortality. RESULTS A total of 100 patients were treated over the study period. Their mean age was 62.8 ± 11.8 years and median baseline National Institute of Health Stroke Scale (NIHSS) measurement was 17. Seventy-seven percent of the patients received intra venous thrombolysis. Successful reperfusion was achieved in 95% of the cases. NIHSS at 24 hours showed a median drop of 7 points from baseline (p < 0.00001) and 50% of the follow-up patients were functionally independent at 90 days. Symptomatic Intracerebral hemorrhage occurred in 5% of the patients and 90-day all case mortality was 11%. CONCLUSIONS We demonstrated the feasibility of a publicly funded MT program in Chile, with similar results as other international randomized control trials.
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Affiliation(s)
- Rodrigo Rivera
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Cristian Amudio
- Critical Care Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Enzo Brunetti
- Critical Care Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Pascual Catalan
- Critical Care Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Juan Gabriel Sordo
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Lautaro Badilla
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Daniel Echeverria
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Juan Pablo Cruz
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Hector Ojeda
- Critical Care Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Loreto Bravo
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Fabian Bravo
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Walter Gonzalez
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Maria Luisa Orellana
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | - Camila Pinto
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo,
Santiago, Chile
| | | | - Monica Oportus
- Anesthesia Unit, Instituto de Neurocirugia Dr. Asenjo, Santiago,
Chile
| | - Alejandro Salazar
- Anesthesia Unit, Instituto de Neurocirugia Dr. Asenjo, Santiago,
Chile
| | - Raul G Nogueira
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital
and Department of Neurology, Emory University School of Medicine, Atlanta, GA,
USA
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Silva LC, Silva A, Rangel MFDA, Caetano LCG, Teixeira-Salmela LF, Scianni AA. Depressive symptoms and functional status are associated with sleep quality after stroke. Top Stroke Rehabil 2020; 28:573-580. [DOI: 10.1080/10749357.2020.1864964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Leonardo Carvalho Silva
- Graduate Program in Rehabilitation Sciences, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Andressa Silva
- Graduate Program in Rehabilitation Sciences, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Aline Alvim Scianni
- Graduate Program in Rehabilitation Sciences, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
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28
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Validation of the Telephone-Based Application of the ABILHAND for Assessment of Manual Ability After Stroke. J Neurol Phys Ther 2020; 44:256-260. [DOI: 10.1097/npt.0000000000000326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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29
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Dysphagia and tube feeding after stroke are associated with poorer functional and mortality outcomes. Clin Nutr 2020; 39:2786-2792. [DOI: 10.1016/j.clnu.2019.11.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 10/24/2019] [Accepted: 11/27/2019] [Indexed: 01/24/2023]
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Nasi LA, Martins SCO, Gus M, Weiss G, de Almeida AG, Brondani R, Rebello LC, DalPizzol A, Fuchs FD, Valença MJM, Wirth LF, Nunes G, Anderson CS. Early Manipulation of Arterial Blood Pressure in Acute Ischemic Stroke (MAPAS): Results of a Randomized Controlled Trial. Neurocrit Care 2020; 30:372-379. [PMID: 30460598 DOI: 10.1007/s12028-018-0642-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION There is uncertainty over the optimal level of systolic blood pressure (SBP) in the setting of acute ischemic stroke (AIS). The aim of this study was to determine the efficacy of the early manipulation of SBP in non-thrombolised patients. The key hypothesis under investigation was that clinical outcomes vary across ranges of SBP in AIS. METHODS 218 patients were randomized within 12 h of AIS to maintain the SBP during 24 h within three ranges: Group 1 140-160 mmHg, Group 2 161-180 mmHg or Group 3 181-200 mmHg. Vasoactive drugs and fluids were used to achieve these targets. Good outcome was defined as a modified Rankin score 0-2 at 90-days. RESULTS The median SBP in the three groups in 24 h was: 153 mmHg, 163 mmHg, and 178 mmHg, respectively, P < 0.0001. Good clinical outcome did not differ among the different groups (51% vs 52% vs 39%, P = 0.27). Symptomatic intracranial hemorrhage (SICH) was more frequent in the higher SBP range (1% vs 2.7% vs 9.1%, P = 0.048) with similar mortality rates. No patient had acute neurological deterioration related to the SBP reduction in the first 24 h. In our logistic regression analysis, the odds of having good clinical outcome was higher in Group 2 (OR 2.83) after adjusting for important confounders. Regardless of the assigned group, the probability of good outcome was 47% in patients who were manipulated to increase the BP, 42% to decrease and 62% in non-manipulated (P = 0.1). Adverse effects were limited to Group 2 (4%) and Group 3 (7.6%) and were associated with the use of norepinephrine (P = 0.05). CONCLUSIONS Good outcome in 90 days was not significantly different among the 3 blood pressure ranges. After logistic regression analysis, the odds of having good outcome was greater in Group 2 (SBP 161-180 mmHg). SICH occurred more frequently in Group 3 (181-200 mmHg).
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Affiliation(s)
- Luiz Antonio Nasi
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil.
| | - Sheila Cristina Ouriques Martins
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil.,Stroke Division, Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Miguel Gus
- Hypertension Group, Cardiology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Weiss
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil.,Stroke Division, Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrea Garcia de Almeida
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil.,Stroke Division, Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rosane Brondani
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil.,Stroke Division, Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Letícia Costa Rebello
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil.,Stroke Division, Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angélica DalPizzol
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil.,Stroke Division, Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávio Danni Fuchs
- Hypertension Group, Cardiology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Júlia Monteiro Valença
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil.,Stroke Division, Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Letícia F Wirth
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil
| | - Gerson Nunes
- Vascular Unit, Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS, CEP 90 035-903, Brazil
| | - Craig S Anderson
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of New South Wales, Sydney, Australia
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Nogueira RG, Lima FO, Pontes-Neto OM, S Silva G, José Mont'Alverne F, Abud DG, Frudit M, Passos P, Haussen DC, Dabus G, de Freitas GR, Oliveira-Filho J, Bezerra DC, Liebeskind DS, Wagner MB, Passos JE, Molina CA, Broderick J, Saver JL, Martins SO. Randomization of endovascular treatment with stent-retriever and/or thromboaspiration versus best medical therapy in acute ischemic stroke due to large vessel occlusion trial: Rationale and design. Int J Stroke 2019; 16:100-109. [PMID: 31793395 DOI: 10.1177/1747493019890700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND RESILIENT is a prospective, multicenter, randomized phase III trial to test the safety, efficacy, and cost-effectiveness of mechanical thrombectomy as compared to medical treatment alone in patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country. METHODS Subjects must fulfill the following main inclusion criteria: symptom onset ≤8 h, age ≥18 years, baseline NIHSS ≥8, evidence of intracranial ICA or proximal MCA (M1 segment) occlusion, ASPECTS ≥6 on CT or >5 on DWI-MRI and be either ineligible for or unresponsive to intravenous alteplase. The primary end-point is the distribution of disability levels (on the modified Rankin Scale, mRS) at 90 days under the intention-to-treat principle. RANDOMIZATION Randomization is performed under a minimization process using age, baseline NIHSS, intravenous alteplase use, occlusion site and center. DESIGN The trial is designed with an expectation of a 10% difference in the proportion of favorable outcome (mRS 0-2 at 90 days) common odds ratio of 1.615. PRIMARY OUTCOME Projected sample size is 690 subjects with pre-planned interim analyses at 174, 346, and 518 subjects. SECONDARY OUTCOMES Secondary end-points include: 90-day functional independence (mRS ≤2), mRS shift stratified for treatment with IV rt-PA at 90 days, infarct volume on 24 h CT or MRI, early dramatic response (NIHSS 0-2 or improvement ≥8 points) at 24 h, vessel recanalization evaluated by CTA or MRA at 24 h, and the post-procedure rate of successful reperfusion (defined as a modified Treatment in Cerebral Infarction 2b or greater). Safety variables are mortality at 90 days, symptomatic intracranial hemorrhage at 24 h and procedure-related complications.
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Affiliation(s)
- Raul G Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Fabricio O Lima
- Neurology Service, 365090Hospital Geral de Fortaleza, Fortaleza-CE, Brazil.,Department of Neurology, 28128Universidade de Fortaleza, Fortaleza-CE, Brazil
| | - Octávio M Pontes-Neto
- Stroke Service-Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gisele S Silva
- Neurology and Neurosurgery Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Academic Research Organization, 37896Hospital Israelita Albert Einstein São Paulo, São Paulo, Brazil
| | | | - Daniel G Abud
- Department of Internal Medicine, Radiology Division, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Michel Frudit
- Neurointerventional Radiology Service, Federal University of São Paulo, São Paulo, Brazil
| | - Paulo Passos
- 156417Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Diogo C Haussen
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Guilherme Dabus
- Miami Cardiac and Vascular Institute and Baptist Neuroscience Center, Miami, FL, USA
| | - Gabriel R de Freitas
- 519983D'Or Institute for Research and Education, 28110Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Jamary Oliveira-Filho
- Postgraduate Program in Health Sciences, 28111Federal University of Bahia School of Medicine, Salvador, BA, Brazil
| | - Daniel C Bezerra
- Department of Neurology, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil
| | - David S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, 8783University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mario B Wagner
- School of Medicine, 28124Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - José Ef Passos
- Administrative Director of the National Council of Municipal Health Secretariats, Bauru, São Paulo
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Joseph Broderick
- Department of Neurology and Rehabilitation Medicine, 12303University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, 8783University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Sheila O Martins
- 156417Hospital Moinhos de Vento, Porto Alegre, Brazil.,Neurology Service, Hospital de Clínicas de Porto Alegre, 28124Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Liebeskind DS, Derdeyn CP, Wechsler LR. STAIR X: Emerging Considerations in Developing and Evaluating New Stroke Therapies. Stroke 2019; 49:2241-2247. [PMID: 30355006 DOI: 10.1161/strokeaha.118.021424] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- David S Liebeskind
- From the Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California, Los Angeles (D.S.L.)
| | - Colin P Derdeyn
- Departments of Radiology and Neurology, University of Iowa Hospitals and Clinics (C.P.D.)
| | - Lawrence R Wechsler
- Department of Neurology, University of Pittsburgh Medical Center, PA (L.R.W.)
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Incidence and impact of sepsis on long-term outcomes after subarachnoid hemorrhage: a prospective observational study. Ann Intensive Care 2019; 9:94. [PMID: 31432283 PMCID: PMC6702247 DOI: 10.1186/s13613-019-0562-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
Background Aneurysmal subarachnoid hemorrhage (SAH) is an acute cerebrovascular disease associated with high mortality and long-term functional impairment among survivors. Systemic inflammatory responses after acute injury and nosocomial infections are frequent complications, making the management of these patients challenging. Here, we hypothesized that sepsis might be associated with early and long-term mortality and functional outcomes. Our objective was to define the incidence of sepsis, diagnosed prospectively with the Sepsis-3 criteria, and to determine its impact on mortality and functional outcomes of patients with SAH. Methods We prospectively included all adult patients with aneurysmal SAH admitted to the intensive care unit (ICU) of a reference center between April 2016 and May 2018. Daily clinical and laboratory follow-up data were analyzed during the first 14 days, with data collected on sepsis according to the Sepsis-3 criteria. The main outcome was the functional outcome using the Modified Rankin Scale (mRS), which was assessed at hospital discharge and 3, 6 and 12 months post-discharge. Results In total, 149 patients were enrolled. The incidence of sepsis was 28%. Multivariable logistic regression analysis revealed that death or functional dependence (defined as an mRS score of 4 to 6) at hospital discharge was independently associated with sepsis (OR 3.4, 95% CI 1.16–9.96, p = 0.026) even after controlling for World Federation of Neurological Surgeons (WFNS) Scale (OR 4.66, 95% CI 1.69–12.88, p = 0.003), hydrocephalus (OR 4.55, 95% CI 1.61–12.85, p = 0.004) and DCI (OR 3.86, 95% CI 1.39–10.74, p = 0.01). Long-term follow-up mortality rates were significantly different in the septic and nonseptic groups (log-rank test p < 0.0001). The mortality rate of septic patients was 52.5%, and that of nonseptic patients was 16%. Conclusion Sepsis plays a significant role in the outcomes of patients with SAH, affecting both mortality and long-term functional outcomes. Combining high-level neurocritical care management of neurological complications and the optimal diagnosis and management of sepsis may effectively reduce secondary brain injury and improve patients’ outcomes after SAH.
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Nascimento LR, Scianni AA, Ada L, Fantauzzi MO, Hirochi TL, Teixeira-Salmela LF. Predictors of return to work after stroke: a prospective, observational cohort study with 6 months follow-up. Disabil Rehabil 2019; 43:525-529. [PMID: 31242399 DOI: 10.1080/09638288.2019.1631396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine, in Brazil, the proportion of individuals who return to a paid work after stroke, and the factors which predict this. MATERIALS AND METHODS A prospective observational cohort study was carried out for six months. Participants were recruited early after stroke from four public hospitals. The outcome of interest was return to work, and the following predictors were investigated: age, sex, education, marital status, contribution to household income, type of work, independence, and depression. Logistic regression was used to identify multivariate predictors of return to work. RESULTS Of the 117 included participants, 52 (44%) had returned to work by 6 months. Contribution to household income (OR 2.4; 95% CI 1.0 to 5.9), being a white-collar worker (OR 4.0; 95% CI 1.8 to 8.6) and being independent in daily activities at 3 months (OR 10.6; 95% CI 2.9 to 38.3), in combination, positively predicted return to work. CONCLUSIONS Less than 50% of stroke survivors returned to work six months after stroke. Among predictors, only the level of dependence in daily activities is a modifiable factor. Interventions aimed at reducing disability after stroke might increase rates of return to work.Implications for rehabilitationIn Brazil, less than 50% of stroke survivors returned to work six months after stroke.Clinicians may collect information regarding household income, type of work and dependence in daily activities to estimate chances of returning to work, in developing countries.Being independent at 3 months was the strongest predictor of return to work; therefore, interventions aimed at reducing disability after stroke may increase rates of return to work.
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Affiliation(s)
- Lucas R Nascimento
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Center of Health Sciences, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Aline A Scianni
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Marcela O Fantauzzi
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tânia L Hirochi
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Silva SM, Brandão TCP, Silva FPD, Buchalla CM. Identification of categories of the International Classification of Functioning, Disability and Health in functional assessment measures for stroke survivors: a systematic review. Disabil Rehabil 2018; 42:156-162. [PMID: 30451028 DOI: 10.1080/09638288.2018.1496149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Perform a systematic review to identify the categories of the International Classification of Functioning, Disability and Health linked to the concepts measured by functional assessment tools validated for Brazilian Portuguese: Timed Up and Go test, Functional Independence Measure, Barthel Index, and Rivermead Mobility Index and Modified Rankin Scale.Methods: The Medline, Embase and CINAHL databases were consulted using a standardized search strategy. The studies were summarized using a pre-established set of specific criteria for the adequate linkage between the concepts identified in the assessment measures and the International Classification of Functioning, Disability and Health categories. Two independent reviewers performed the selection of the studies, data extraction and evaluation of the results.Results: The search of the databanks led to the retrieval of 99 studies. However, only six articles were included in the present review. The linkage results of the studies included in the review were divergent, likely due to the taxonomic complexity of the International Classification of Functioning, Disability and Health, the difficulty in clearly relating the concepts of the assessment measures to the classifications and the fact that not all linkage rules were followed. "Activities and participation" was the most evaluated component, with mobility the most frequently covered category in the measures, followed by self-care. Among the measures analyzed, the Functional Independence Measure addresses a greater number of categories and therefore has the most concepts related to the International Classification of Functioning, Disability and Health, followed by the Barthel Index, Modified Rankin Scale, Rivermead Mobility Index and Timed Up and Go test. The Modified Rankin Scale was the assessment tool that most evaluated categories related to environmental factors.Conclusion: The Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health, since it addresses a greater number of categories. These findings can help guide health professionals in the selection of assessment tools for the evaluation of post-stroke functioning, making viable the use of the International Classification of Functioning, Disability and Health categories in clinical practice and public health services.Implications for rehabilitationThis study standardized identification of the International Classification of Functioning, Disability and Health categories in the main outcome measures used to assess post-stroke functional capacity.Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health compared to other functional assessment instruments.Findings can enable physiotherapists and researchers choose the most appropriate measure that best corresponds to their field of interest.These results facilitate the implementation of the International Classification of Functioning, Disability and Health in clinical practice.Use of International Classification of Functioning, Disability and Health categories can standardize information on functional health.
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Affiliation(s)
- Soraia Micaela Silva
- Postgraduate program in Rehabilitation Sciences, University Nove de Julho (UNINOVE), São Paulo, SP, Brazil.,Postgraduate program in Public Health, School of Public Health, University of Sao Paulo, Brazil
| | | | - Felipe Pereira Da Silva
- Postgraduate program in Rehabilitation Sciences, University Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Cassia Maria Buchalla
- Postgraduate program in Public Health, School of Public Health, University of Sao Paulo, Brazil
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Cabral NL, Nagel V, Conforto AB, Magalhaes PSC, Venancio VG, Safanelli J, Ibiapina F, Mazin S, França P, Liberato RM, Longo A, Zetola VF. High five-year mortality rates of ischemic stroke subtypes: A prospective cohort study in Brazil. Int J Stroke 2018; 14:491-499. [DOI: 10.1177/1747493018806197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Studies regarding long-term outcomes of ischemic stroke subtypes are scarce in low- and middle-income countries. We aimed to measure the five-year prognosis of ischemic stroke subtypes in Joinville, Brazil. Methods All first-ever ischemic strokes that occurred in Joinville in 2010 were followed-up for five years. Results We included 334 ischemic stroke patients. Over five years, 156 died, 51 had a recurrent stroke, and 128 were free of recurrent stroke. The overall cumulative risk of death was 17% (95% CI, 13% to 22%) at 30 days and 47% (95% CI, 41% to 52%) after five years. Undetermined with incomplete investigation ischemic stroke had a significantly worse survival probability (β −4.91; 95% CI, −6.31 to −3.50; p < 0.001), followed by cardioembolic ischemic stroke (β −3.07; 95% CI, −4.32 to −1.83; p < 0.001) and large artery disease ischemic stroke (β −1.95; 95% CI, −3.30 to −0.60; p = 0.005). The survival probability of undetermined with negative investigation or cryptogenic ischemic stroke did not differ significantly from small artery disease ischemic stroke (β −1.022; 95% CI, −3.37 to −1.43; p = 0.414). The five-year mortality for small artery disease ischemic stroke was 30% (95% CI, 22% to 39%) and 47% (95% CI, 35% to 60%) for large artery ischemic stroke. The risk of stroke recurrence was 2% in the first year and 5% in the second year. The proportion of disability among survivors in the first month ranged from 8% (95% CI, 3–15) for small artery disease ischemic stroke to 40% (95% CI, 30–52) for cardioembolic ischemic stroke patients. Conclusions Cardioembolic and undetermined with incomplete investigation ischemic stroke sub-types have a poor long-term prognosis. An alarming finding was that our patients with both small and large artery ischemic stroke had higher five-year mortality rates compared with subjects from high-income countries.
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Affiliation(s)
- Norberto Luiz Cabral
- Joinville Stroke Registry, Joinville, Brazil
- University of Joinville Region, Joinville, Brazil
| | | | - Adriana B Conforto
- Neurology Clinical Division, Hospital das Clínicas/Sao Paulo University, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | - Suleimy Mazin
- Department of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Viviane F Zetola
- Neurology Department, Paraná Federal University, Curitiba, Brazil
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Purandare M, Ehlert AN, Vaitkevicius H, Dworetzky BA, Lee JW. The role of cEEG as a predictor of patient outcome and survival in patients with intraparenchymal hemorrhages. Seizure 2018; 61:122-127. [PMID: 30138824 PMCID: PMC6168397 DOI: 10.1016/j.seizure.2018.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The objective of this study was to determine if continuous electroencephalography (cEEG) results are associated with functional outcome and survival in critically ill patients with intraparenchymal hemorrhages (IPH). METHODS Patients diagnosed with IPH were selected using a Critical Care EEG Monitoring Consortium Database at Brigham and Women's Hospital in Boston. Functional Outcome in Patients with Primary Intracerebral Hemorrhage (FUNC) scores and Intracerebral Hemorrhage (ICH) scores were calculated as covariates. Outcomes of interest were functional outcome (modified Rankin scale [mRS] <3 vs ≥3) and mortality at hospital discharge. cEEG features, as defined by the American Clinical Neurophysiology Society standard terminology, were assessed for association with outcome after accounting for known clinical covariates. RESULTS A total of 94 patients admitted between March 2013 and December 2015 were selected. Multivariate regression analysis revealed that the presence of Stage II Sleep is independently associated with good functional outcome at discharge after correcting for FUNC (p = 0.0080) and ICH (p = 0.0088). The absence of anteroposterior (AP) gradient in an EEG is associated with increased likelihood of mortality at discharge after correcting for FUNC (p = 0.013) and ICH (p = 0.019) scores. CONCLUSIONS cEEG measures were significantly associated with functional and mortality outcome measures in patients with IPH even after accounting for known clinical and radiological covariates. Further research is needed to determine whether prediction models are improved by inclusion of cEEG features.
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Affiliation(s)
- Mallika Purandare
- The Edward B. Bromfield Epilepsy Program, Department of Neurology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, United States
| | - Alexa N Ehlert
- Harvard T.H. Chan School of Public Health, Harvard Medical School, Boston, MA 02115, United States
| | - Henri Vaitkevicius
- Division of Neurocritical Care, Department of Neurology, Brigham and Women's Hospital / Harvard Medical School, Boston, MA 02115, United States
| | - Barbara A Dworetzky
- The Edward B. Bromfield Epilepsy Program, Department of Neurology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, United States
| | - Jong Woo Lee
- The Edward B. Bromfield Epilepsy Program, Department of Neurology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, United States.
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Demartini Junior Z, Gatto LAM, Koppe GL, Oliveira TFVHD, Francisco AN. Rescue therapy with stent retrievers for thromboembolism during endovascular treatment of intracranial aneurysms. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:332-338. [PMID: 29898080 DOI: 10.1590/0004-282x20180027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/24/2018] [Indexed: 11/22/2022]
Abstract
Thromboembolism is the most frequent complication in endovascular treatment of intracranial aneurysms, causing disability and death. As stent retrievers have achieved high rates of arterial recanalization in the management of ischemic stroke, these devices were tested as rescue therapy of thromboembolism during aneurysm embolization. We retrospectively analyzed 10 consecutive patients with transprocedural arterial occlusion, treated with mechanical thrombectomy at a single center. Good angiographic recanalization was achieved in eight cases, mTICI 3, 2b and 2a in five, three and two patients, respectively, without additional complications or any deaths. Five patients showed complete recovery (mRS 0) and all patients showed improvement of disability (average mRS 1.1) over a mean follow-up period of 31 months. Eight patients had good clinical recovery, while two remained with deficits (mRS 3 and 4). The study found that the stent retriever is a valuable, rapid and effective tool for restoring blood flow, improving the safety of endovascular treatment.
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Affiliation(s)
| | - Luana A Maranha Gatto
- Pontifícia Universidade Católica do Paraná, Departamento de Neurocirurgia, Curitiba PR, Brasil
| | - Gelson Luis Koppe
- Pontifícia Universidade Católica do Paraná, Departamento de Neurocirurgia, Curitiba PR, Brasil
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Vicente VS, Cabral NL, Nagel V, Guesser VV, Safanelli J. Prevalence of obesity among stroke patients in five Brazilian cities: a cross-sectional study. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:367-372. [DOI: 10.1590/0004-282x20180053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/03/2018] [Indexed: 12/31/2022]
Abstract
ABSTRACT Objective There is gap in knowledge about obesity prevalence in stroke patients from low- and middle-income countries. Therefore, we aimed to measure the prevalence of overweight and obesity status among patients with incident stroke in Brazil. Methods In a cross-sectional study, we measured the body mass index (BMI) of ischemic and hemorrhagic stroke patients. The sample was extracted in 2016, from the cities of Sobral (CE), Sertãozinho (SP), Campo Grande (MS), Joinville (SC) and Canoas (RS). Results In 1,255 patients with first-ever strokes, 64% (95% CI, 62–67) were overweight and 26% (95%CI, 24–29) were obese. The obesity prevalence ranged from 15% (95%CI, 9–23) in Sobral to 31% (95%CI, 18–45) in Sertãozinho. Physical inactivity ranged from 53% (95%CI, 43-63) in Sobral to 80% (95%CI, 73–85) in Canoas. Conclusions The number of overweight patients with incident stroke is higher than the number of patients with stroke and normal BMI. Although similar to other findings in high-income countries, we urgently need better policies for obesity prevention.
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Yan T, Liu C, Li Y, Xiao W, Li Y, Wang S. Prevalence and predictive factors of urinary tract infection among patients with stroke: A meta-analysis. Am J Infect Control 2018; 46:402-409. [PMID: 29153643 DOI: 10.1016/j.ajic.2017.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/01/2017] [Accepted: 10/01/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is thought to be a common complication of stroke and is regarded as a potential risk factor for poor stroke outcomes. However, there is a controversy among predictive factors of stroke-associated UTIs. We aim to estimate the prevalence and predisposing factors of UTIs among patients with stroke. METHODS PubMed, EMBASE, and Elsevier Science Direct were searched by 2 independent researchers. Sixteen studies with a total of 13,513 patients were included to evaluate the prevalence and predictive factors of stroke-associated UTIs published from the earliest records to March 10, 2017. Pooled effect sizes were calculated using the fixed effect model or random effect model according to I2 and P values. RESULTS The pooled prevalence of UTI was 19.0% (95% confidence interval [CI], 15%-22%; P <.01). The predisposing factors for UTIs include female sex (odds ratio [OR], 1.93; 95% CI, 1.55-2.41), older age (OR, 1.28; 95% CI, 1.09-1.50), higher modified Rankin Scale score (OR, 1.90; 95% CI, 1.43-2.53), and postvoid residual volume >100 mL (OR, 3.69; 95% CI, 2.09-6.52). CONCLUSIONS Approximately one-fifth of patients with stroke contracted at least 1 UTI after cerebral apoplexy. Female sex, older age, higher modified Rankin Scale score, and postvoid residual volume >100 mL were associated with higher risk of UTI.
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Affiliation(s)
- Tianyuan Yan
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Chenxia Liu
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Yingxia Li
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Wei Xiao
- Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Yating Li
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Shuhui Wang
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
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Montanaro V, Hora T, da Silva C, Santos C, Lima M, Negrão E, Ribeiro D, Oliveira E, de Freitas G. Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease. Eur Neurol 2018. [DOI: 10.1159/000488033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Chagas disease is related to ischemic stroke (IS), although few epidemiological studies have evaluated the associated mortality and recurrence. Our objective is to determine factors associated with mortality and recurrence of IS in patients with IS and Chagas disease. Methods: We retrospectively studied data obtained from electronic medical records of patients admitted at SARAH Hospitals across Brazil between 2009 and 2013. Using Cox regression analysis for mortality and logistic regression for recurrence, we assessed primary population characteristics and statistical associations between risk factors and outcomes. Results: We analyzed 279 patients who were followed up until 2016. The mean age at stroke onset was 61 with a 10% frequency of death. Multivariate analysis assessing mortality demonstrated that the associated factors were age at stroke (hazard ratio [HR] 1.04), initial modified Rankin Scale (mRS; HR 20.91), bladder dysfunction (HR 2.51), diabetes mellitus (DM; HR 3.64), and alcoholism (HR 3.37). Multivariate analysis assessing recurrence demonstrated that the associated factors were age at ictus (OR 0.96), cognitive deficit (OR 0.44), initial mRS (OR 1.84), cardioembolic etiology (OR 2.47), and female sex (OR 2.73). Conclusions: Cardiac conditions did not correlate with mortality or recurrence. Age was a protective factor against recurrence, probably due to cumulative risk of IS over time, while initial mRS was associated with both outcomes. Treating diseases such as DM and bladder dysfunction, and early treatment to reduce the initial mRS could potentially prevent both outcomes; also, establishing a correct etiological diagnosis is important.
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Havsteen I, Ovesen C, Willer L, Nybing JD, Ægidius K, Marstrand J, Meden P, Rosenbaum S, Folke MN, Christensen H, Christensen A. Small cortical grey matter lesions show no persistent infarction in transient ischaemic attack? A prospective cohort study. BMJ Open 2018; 8:e018160. [PMID: 29358426 PMCID: PMC5780721 DOI: 10.1136/bmjopen-2017-018160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To find determining factors for persistent infarction signs in patients with transient ischaemic attack (TIA), herein initial diffusion lesion size, visibility on apparent diffusion coefficient (ADC) or fluid-attenuated inversion recovery (FLAIR) and location. DESIGN Prospective cohort study of patients with clinical TIA receiving 3T-MRI within 72 hours of symptom onset and at 8-week follow-up. SETTING Clinical workflow in a single tertiary stroke centre between February 2012 and June 2014. PARTICIPANTS 199 candidate patients were recruited, 64 patients were excluded due to non-TIA discharge diagnosis or no 8-week MRI. 122 patients completed the study. PRIMARY OUTCOME MEASURES The primary outcome was visible persistent infarction defined as 8-week FLAIR hyperintensity or atrophy corresponding to the initial diffusion-weighted imaging (DWI) lesion. RESULTS 50 patients showed 84 initial DWI lesions. 29 (35%) DWI lesions did not result in infarction signs on 8-week FLAIR. 26 (90%, P<0.0001) reversing lesions were located in the cortical grey matter (cGM). cGM location (vs any other location) strongly predicted no 8-week infarction sign development (OR 0.02, 95% CI 0.001 to 0.17) or partial lesion area decrease (>30% of initial DWI-area, OR 14.10, 95% CI 3.61 to 54.72), adjusted for FLAIR-visibility, DWI-area, ADC-confirmation and time to scan (TTS) from symptom onset to baseline MRI. Acute FLAIR-visibility was a strong associated factor for persistent infarction signs (OR 33.06, 95% CI 2.94 to 1432.34). For cGM lesions area size was sole associated factor for persistent infarction signs with a 0.31 cm2 (area under the curve (AUC), 0.97) threshold. In eight (16%) DWI-positive patients, all lesions reversed fully. CONCLUSIONS 16% of DWI-positive patients and one-third of acute DWI lesions caused no persistent infarction signs, especially small cGM lesions were not followed by development of persistent infarction signs. Late MRI after TIA is likely to be less useful in the clinical setting, and it is dubious if the absence of old vascular lesions can be taken as evidence of no prior ischaemic attacks. TRIAL REGISTRATION NUMBER NCT01531946; Results.
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Affiliation(s)
- Inger Havsteen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Christian Ovesen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Lasse Willer
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Karen Ægidius
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Jacob Marstrand
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Per Meden
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Marie Norsker Folke
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Anders Christensen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Amaral CHD, Amaral AR, Nagel V, Venancio V, Garcia AC, Magalhaes PSC, Longo AL, Moro CHC, Reis FI, D’Avila A, Cabral NL. Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:288-294. [DOI: 10.1590/0004-282x20170039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 02/03/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Among ischemic strokes, cardioembolic (CE) stroke has the worst outcome. We measured the incidence of atrial fibrillation (AF) and non-AF related CE strokes, previous anticoagulant use, and the 90-day functional outcome. Using multiple overlapping sources, we included all CE strokes that occurred in 2015 in Joinville, Brazil. Of the 374 ischemic strokes, 23% (84) were CE. The CE age-adjusted incidence, per 1,000 person-years, was 0.14 (0.11–0.17). Of the 26 patients with known prior AF, 73% (19) were not anticoagulated, 77% (20) had a CHA2DS2VASc score ≥ 3 and 81% (21) had a HAS-BLED score < 3. After three months, approximately one third of those 26 patients died or became disabled. The incidence of CE stroke in our sample was lower than in other population-based studies. The opportunity for anticoagulation was missed in one third of cases.
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de Campos LM, Martins BM, Cabral NL, Franco SC, Pontes-Neto OM, Mazin SC, dos Reis FI. How Many Patients Become Functionally Dependent after a Stroke? A 3-Year Population-Based Study in Joinville, Brazil. PLoS One 2017; 12:e0170204. [PMID: 28107401 PMCID: PMC5249115 DOI: 10.1371/journal.pone.0170204] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/30/2016] [Indexed: 12/04/2022] Open
Abstract
The decrease in stroke mortality will increase the burden of survivors with functional dependence (FD). The aim of this study was to evaluate how many patients become functionally dependent over 3 years after an incident event in Joinville, Brazil. The proportion of FD (defined as a modified Rankin score 3 to 5) among stroke survivors from the Joinville Stroke Registry was assessed using a validated telephone interview. Incidence of FD after stroke in Joinville in one year was 23.24 per 100,000 population. The overall proportion of FD among stroke survivors at discharge was 32.7%. Of 303 patients with first-ever ischaemic stroke (IS), one-third were FD at discharge, and 12%, 9% and 8%, respectively at 1, 2 and 3 years. Among 37 patients with haemorrhagic stroke (HS), 38% were dependent at discharge, 16% after 1 and 2 years and 14% after 3. Among 27 patients with subarachnoid haemorrhage (SAH), 19% were dependent at discharge and 4% from 1 to 3 years. Among IS subtypes, cardioembolic ones had the worst risk of FD. (RR 19.8; 95% CI: 2.2 to 175.9). Our results showed that one-third of stroke survivors have FD during the first year after stroke in Brazil. Therefore, a city with half a million people might expect 120 new stroke patients with FD each year.
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Affiliation(s)
- Lívia Mizuki de Campos
- Department of Medicine, University of Joinville Region, Joinville, Santa Catarina, Brazil
| | - Bruna Mariah Martins
- Department of Medicine, University of Joinville Region, Joinville, Santa Catarina, Brazil
| | - Norberto Luiz Cabral
- Department of Medicine, University of Joinville Region, Joinville, Santa Catarina, Brazil
- Joinville Stroke Registry, University of Joinville Region, Joinville, Santa Catarina, Brazil
| | - Selma Cristina Franco
- Department of Medicine, University of Joinville Region, Joinville, Santa Catarina, Brazil
- * E-mail:
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Aoki J, Kimura K, Sakamoto Y. Early administration of tissue-plasminogen activator improves the long-term clinical outcome at 5years after onset. J Neurol Sci 2016; 362:33-9. [DOI: 10.1016/j.jns.2016.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
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Yin R, Chang F, Hong B, Shi XQ, Zhang GZ, Liu Z, Zhang ZQ, Wei YX, Liu JM. Safety and Efficacy Analyses of Angioplasty and Stenting for Severe Intracranial Arterial Stenosis: A Single-Center Retrospective Study in China. Med Sci Monit 2015; 21:3311-9. [PMID: 26517946 PMCID: PMC4632988 DOI: 10.12659/msm.894574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The value of percutaneous transluminal angioplasty and stenting (PTAS) in the context of aggressive medical treatment for severe intracranial artery stenosis (ICAS) is under debate. This study compared the effects of PTAS and aggressive medical treatment in patients with severe ICAS and transient ischemic attack or stroke. Material/Methods A retrospective cohort study was performed. Patients with severe ICAS were assigned to a PTAS group or aggressive medical treatment group, according to the angiographic features of the stenotic lesions. The primary outcome was defined as stroke or death within 30 days or cerebral ischemia occurring ipsilaterally to the qualifying artery beyond 30 days. Results We included 220 patients: 48 in the PTAS group and 172 in the medical group. The median follow-up was 32 months. PTAS was not associated with an increased incidence of the primary outcomes (10/42 vs. 39/172, p=0.96) or increased risks of the secondary outcomes of stroke, cardiovascular events, major bleeding, or mortality. The results of log-rank tests did not support a significant difference in event-free survival as a primary outcome between the 2 groups (chi-square=0.07, p=0.79). Moreover, although not significantly greater, the mean survival of patients in the PTAS group appeared to be better than that among patients in the medical group, as indicated by the curve for cumulative survival. Conclusions A suitable PTAS procedure is safe for patients with severe ICAS, and no significant differences in incidence of recurrent stroke or death were found between PTAS and aggressive medication treatment.
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Affiliation(s)
- Rong Yin
- Department of Neurology, The General Hospital of Lanzhou Military Command of the Chinese People's Liberation Army, Lanzhou, Gansu, China (mainland)
| | - Fei Chang
- Department of Neurology, The General Hospital of Lanzhou Military Command of the Chinese People's Liberation Army, Lanzhou, Gansu, China (mainland)
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Xiang-Qun Shi
- Department of Neurology, The General Hospital of Lanzhou Military Command of the Chinese People's Liberation Army, Lanzhou, Gansu, China (mainland)
| | - Guo-Zhen Zhang
- Department of Neurology, The General Hospital of Lanzhou Military Command of the Chinese People's Liberation Army, Lanzhou, Gansu, China (mainland)
| | - Zhao Liu
- Department of Neurology, The General Hospital of Lanzhou Military Command of the Chinese People's Liberation Army, Lanzhou, Gansu, China (mainland)
| | - Zhi-Qiang Zhang
- Department of Neurology, The General Hospital of Lanzhou Military Command of the Chinese People's Liberation Army, Lanzhou, Gansu, China (mainland)
| | - Ya-Xuan Wei
- Department of Neurology, The General Hospital of Lanzhou Military Command of the Chinese People's Liberation Army, Lanzhou, Gansu, China (mainland)
| | - Jian-Min Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
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