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Lotz RC, Welter CDS, Ramos SA, Ferreira LE, Cabral NL, França PHCD. ABO blood group system and occurrence of ischemic stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:1070-1075. [PMID: 34852069 DOI: 10.1590/0004-282x-anp-2020-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ischemic stroke (IS) is a multifactorial disease that presents high rates of morbimortality in Brazil. Several studies proved that there is a link between the ABO blood group system and the occurrence of thrombotic events. Nonetheless, its association with IS is not well established. OBJECTIVE For that reason, the purpose hereof was to investigate the relation between the ABO blood groups and the occurrence of IS in a Brazilian cohort of cerebrovascular diseases. METHODS Five hundred and twenty-nine subjects were included over 12 months, from which 275 presented an IS episode and 254 composed the control group. Blood samples were drawn for direct and reverse serotyping. The control and IS groups were compared regarding the traditional risk factors and the distribution of the ABO blood groups. RESULTS The IS group presented a higher prevalence of systemic arterial hypertension (SAH), diabetes mellitus, smoking habits, family history, cardiopathy, and sedentary lifestyle in comparison with the control group. The AB blood type prevailed among the patients (5.1 vs. 1.6%; p<0.05) and this group had more SAH cases in comparison with the O type group (92.9 vs. 67.3%; p<0.05). CONCLUSIONS Our results suggest that the occurrence of IS is more frequent among patients of the AB blood type.
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Affiliation(s)
| | | | | | - Leslie Ecker Ferreira
- Universidade da Região de Joinville, Departamento de Medicina, Joinville SC, Brazil.,Universidade da Região de Joinville, Joinville Stroke Biobank, Joinville SC, Brazil
| | - Norberto Luiz Cabral
- Universidade da Região de Joinville, Departamento de Medicina, Joinville SC, Brazil.,Universidade da Região de Joinville, Joinville Stroke Biobank, Joinville SC, Brazil.,Hospital Municipal São José, Serviço de Neurologia, Joinville SC, Brazil
| | - Paulo Henrique Condeixa de França
- Universidade da Região de Joinville, Departamento de Medicina, Joinville SC, Brazil.,Universidade da Região de Joinville, Joinville Stroke Biobank, Joinville SC, Brazil
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Correa Neto Y, Teive HAG. Norberto Luiz Cabral, MD, PhD - (1963‒2019). ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:128-129. [PMID: 32159719 DOI: 10.1590/0004-282x20190200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Ylmar Correa Neto
- Universidade Federal de Santa Catarina, Hospital Universitário, Departamento de Medicina Interna, Serviço de Neurologia, Florianópolis SC, Brazil
| | - Hélio Afonso Ghizoni Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brazil
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Torrealba-Acosta G, Carazo-Céspedes K, Chiou SH, O'Brien AT, Fernández-Morales H. Epidemiology of Stroke in Costa Rica: A 7-Year Hospital-Based Acute Stroke Registry of 1319 Consecutive Patients. J Stroke Cerebrovasc Dis 2017; 27:1143-1152. [PMID: 29284569 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/15/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Limited data on stroke exist for Costa Rica. Therefore, we created a stroke registry out of patients with stroke seen in the Acute Stroke Unit of the Hospital Calderon Guardia. METHODS We analyzed 1319 patients enrolled over a 7-year period, which incorporated demographic, clinical, laboratory, and neuroimaging data. RESULTS The mean age of patients with stroke was 68.0 ± 15.5 years. Seven hundred twenty-five were men and the age range was 13-104 years. The most prevalent risk factors were hypertension (78.8%), dyslipidemia (36.3%), and diabetes (31.9%). Fifteen percent had atrial fibrillation and 24.7% had a previous stroke or transient ischemic attack. Prevalence of hypertension and atrial fibrillation increased with age; however, younger patients were more associated with thrombophilia. We documented 962 (72.9%) ischemic and 270 (20.5%) hemorrhagic strokes. Of the ischemic strokes, 174 (18.1%) were considered secondary to large-artery atherothrombosis, 175 (18.2%) were due to cardiac embolism, 19 (2.0%) were due to lacunar infarcts, and 25 (2.6%) were due to other determined causes. Five hundred sixty-nine (59.1%) remained undetermined. Atherothrombotic strokes were mostly associated with dyslipidemia, diabetes, metabolic syndrome, and obesity, whereas lacunar infarcts were associated with hypertension, smoking, sedentary lifestyle, and previous stroke or transient ischemic attack. Of our patients, 69.9% scored between 0 and 9 in the initial National Institutes of Health Stroke Scale (NIHSS). CONCLUSIONS We found differences in sociodemographic features, risk factors, and stroke severity among stroke subtypes. Risk factor prevalence was similar to other registries involving Hispanic populations.
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Affiliation(s)
- Gabriel Torrealba-Acosta
- Division of Neurology, Department of Internal Medicine, Hospital Rafael Ángel Calderón Guardia, Caja Costarricense de Seguro Social, San José, Costa Rica; Neurosciences Research Center, University of Costa Rica, San José, Costa Rica.
| | - Kenneth Carazo-Céspedes
- Division of Neurology, Department of Internal Medicine, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Sy Han Chiou
- Department of Mathematical Sciences, The University of Texas at Dallas, Richardson, Texas
| | | | - Huberth Fernández-Morales
- Division of Neurology, Department of Internal Medicine, Hospital Rafael Ángel Calderón Guardia, Caja Costarricense de Seguro Social, San José, Costa Rica
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Pontes-Neto OM, Cougo P, Martins SCO, Abud DG, Nogueira RG, Miranda M, Castro-Afonso LHD, Rebello LC, Caldas JGMP, Bazan R, Bezerra DC, Rezende MT, Freitas GRD, Longo A, Magalhães P, Carvalho JJFD, Montalverne FJ, Lima FO, Andrade GH, Massaro AR, Oliveira-Filho J, Gagliardi R, Silva GS. Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:50-56. [DOI: 10.1590/0004-282x20160174] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022]
Abstract
ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Gabriel R. de Freitas
- Universidade Federal Fluminense, Brasil; Instituto D'Or de Pesquisa e Ensino, Brasil
| | | | | | | | | | | | | | | | | | | | - Gisele Sampaio Silva
- Universidade Federal de São Paulo, Brasil; Hospital Israelita Albert Einstein, Brasil
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Pandian JD, Padma V, Vijaya P, Sylaja PN, Murthy JMK. Stroke and Thrombolysis in Developing Countries. Int J Stroke 2016; 2:17-26. [DOI: 10.1111/j.1747-4949.2007.00089.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Over the past few decades, the burden of stroke in developing countries has grown to epidemic proportions. Two-thirds of global stroke occurs in low- and middle-income countries. We have found that little information is obtainable concerning the availability of thrombolysis therapy in developing countries. Summary of review The epidemiology of stroke is well investigated in the developed world; however, in the developing world stroke is less well documented. Most of the available stroke data from these countries are hospital-based. Stroke thrombolysis is currently used in few developing countries like Brazil, Argentina, Senegal, Iran, Pakistan, China, Thailand, and India. The two main barriers for implementation of thrombolysis therapy in developing countries are the high cost of tissue plasminogen activator and lack of proper infrastructure. Most of the centers with the infrastructure to deliver thrombolysis for stroke are predominantly private sector, and only available in urban areas. Conclusion Until a more cost-effective thrombolytic agent and the proper infrastructure for widespread use of thrombolysis therapy are available, developing nations should focus on primary and secondary stroke prevention strategies and the establishment of stroke units wherever possible. Such multi-faceted approaches will be more cost-effective for developing countries than the use of thrombolysis.
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Affiliation(s)
| | - Vasantha Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pamidimukkala Vijaya
- Ankineedu Stroke Unit, Heart and Brain Center, Lalitha Super Specialty Hospital, Kothapet, Guntur, Andhra Pradesh, India
| | - P. N. Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Túbero GS, Gobbi S, Teixeira CVL, Pereira JR, Shigematsu R, Canonici AP. Effects of square stepping exercise in patients with sequel of cerebrovascular accident. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.002.ao08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Cerebral stroke is the interruption of blood flow to the brain and can be classified into hemorrhagic and ischemic. It may result in serious body balance and cognition complications. Kinesiotherapy is a privileged means of rehabilitation.Objective Verify the effects of Square Stepping Exercise (SSE) on cognitive functions, depressive symptoms and the body balance of cerebral stroke sequel patients.Methods Thirteen brain stroke sequel patients were divided into two groups: SSE (SSEG n = 8) and conventional physiotherapy group (PG, n = 5). The SSEG participated only of the SSE training protocol, while the PG participated of its physical therapy routine group, both for 4 months. They were evaluated using the Mini Mental State Examination (MMSE), the Brief Cognitive Screening Battery (BBRC), the Geriatric Depression Scale (GDS),Berg Balance Scale(BBS) and Timed Up and Go(TUG).Results The U Mann Whitney test showed no significant differences between groups. In intragroup analysis, the Wilcoxon test showed significant improvement in global cognitive status for PG (p < 0.042), and for SSEG there were positive results for verbal fluency (p < 0.04) and in TUG for number of steps (p < 0.04) and the time (p < 0.02).Conclusion The SSE seems to benefit dynamic balance, influencing gait agility, cognition related to verbal fluency and may have contributed to maintain other cognitive functions.
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Affiliation(s)
| | - Sebastião Gobbi
- Universidade Estadual Paulista “Júlio Mesquita Filho”, Brazil
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Oliveira-Filho J, Martins SCO, Pontes-Neto OM, Longo A, Evaristo EF, Carvalho JJFD, Fernandes JG, Zétola VF, Gagliardi RJ, Vedolin L, Freitas GRD. Guidelines for acute ischemic stroke treatment: part I. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 70:621-9. [PMID: 22899035 DOI: 10.1590/s0004-282x2012000800012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jamary Oliveira-Filho
- Rua Reitor Miguel Calmon s/n; Instituto de Ciências da Saúde / sala 455; 40110-100 Salvador BA - Brasil
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Del Brutto OH, Del Brutto VJ. Is the Rate of Cerebral Hemorrhages Declining among Stroke Patients in South America? Int J Stroke 2013; 9:207-9. [DOI: 10.1111/ijs.12031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent stroke registries suggest that the rate of cerebral hemorrhages is declining among stroke patients in South America. High rates of cerebral hemorrhages (approaching 40% of stroke cases) reported in pioneer registries during the 1990s have not been duplicated in more recent studies. In contrast, almost all studies recruiting patients from 2003 on, reported less than 20% of cerebral hemorrhages among their stroke patients. Intermediate rates of hemorrhagic strokes (from 25% to 27%) were noted among registries recruiting patients by the end of the 20th century and the start of the new Millennium. We also noted a significant declining rate of hemorrhagic stroke over the past 20 years at our Institution. In a series of 651 consecutive first-ever stroke patients included in the Hospital-Clínica Kennedy stroke registry (Guayaquil), cerebral hemorrhages accounted for 26·3% of patients recruited between 1990 and 1994 but for only 16·5% of those seen between 2005 and 2009 ( P = 0·03). More longitudinal studies are needed to confirm these findings and to determine whether the reported declining rate of hemorrhagic strokes in South America is related to increase life expectancy of the population, or to changes in lifestyle, dietary habits, or some other specific stroke risk factors not well evaluated so far.
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Affiliation(s)
- Oscar H. Del Brutto
- Department of Neurological Sciences, Hospital – Clínica Kennedy, Guayaquil, Ecuador
- School of Medicine, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
| | - Victor J. Del Brutto
- Department of Neurological Sciences, Hospital – Clínica Kennedy, Guayaquil, Ecuador
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Riberto M, Lopes KAT, Chiappetta LM, Lourenção MIP, Battistella LR. The use of the comprehensive International Classification of Functioning, Disability and Health core set for stroke for chronic outpatients in three Brazilian rehabilitation facilities. Disabil Rehabil 2012; 35:367-74. [DOI: 10.3109/09638288.2012.694573] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Carvalho JJF, Alves MB, Viana GÁA, Machado CB, dos Santos BFC, Kanamura AH, Lottenberg CL, Neto MC, Silva GS. Stroke Epidemiology, Patterns of Management, and Outcomes in Fortaleza, Brazil. Stroke 2011; 42:3341-6. [DOI: 10.1161/strokeaha.111.626523] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Little information exists on the epidemiology and patterns of treatment of patients admitted to Brazilian hospitals with stroke. Our objective was to describe the frequency of risk factors, patterns of management, and outcome of patients admitted with stroke in Fortaleza, the fifth largest city in Brazil.
Methods—
Data were prospectively collected from consecutive patients admitted to 19 hospitals in Fortaleza with a diagnosis of stroke or transient ischemic attack from June 2009 to October 2010.
Results—
We evaluated 2407 consecutive patients (mean age, 67.7±14.4 years; 51.8% females). Ischemic stroke was the most frequent subtype (72.9%) followed by intraparenchymal hemorrhage (15.2%), subarachnoid hemorrhage (6.0%), transient ischemic attack (3%), and undetermined stroke (2.9%). The median time from symptoms onset to hospital admission was 12.9 (3.8–32.5) hours. Hypertension was the most common risk factor. Only 1.1% of the patients with ischemic stroke received thrombolysis. The median time from hospital admission to neuroimaging was 3.4 (1.2–26.5) hours. In-hospital mortality was 20.9% and the frequency of modified Rankin Scale score ≤2 at discharge was less than 30%. Older age, prestroke disability, and having a depressed level of consciousness at admission were independent predictors of poor outcome; conversely, male gender was a predictor of good outcome.
Conclusions—
The prevalence of stroke risk factors and clinical presentation in our cohort were similar to previous series. Treatment with thrombolysis and functional independency after a stroke admission were infrequent. We also found long delays in hospital admission and in evaluation with neuroimaging and high in-hospital mortality.
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Affiliation(s)
- João José Freitas de Carvalho
- From the Hospital Geral de Fortaleza (J.J.F.d.C.), Fortaleza, Brazil, Hospital Israelita Albert Einstein (M.B.A., B.F.C.d.S., A.H.K., C.L.L., M.C.N., G.S.S.), São Paulo, Brazil; the Department of Health (G.A.A.V., C.B.M.), State of Ceará, Brazil; and Federal University of São Paulo (G.S.S.), São Paulo, Brazil
| | - Monique Bueno Alves
- From the Hospital Geral de Fortaleza (J.J.F.d.C.), Fortaleza, Brazil, Hospital Israelita Albert Einstein (M.B.A., B.F.C.d.S., A.H.K., C.L.L., M.C.N., G.S.S.), São Paulo, Brazil; the Department of Health (G.A.A.V., C.B.M.), State of Ceará, Brazil; and Federal University of São Paulo (G.S.S.), São Paulo, Brazil
| | - Georgiana Álvares Andrade Viana
- From the Hospital Geral de Fortaleza (J.J.F.d.C.), Fortaleza, Brazil, Hospital Israelita Albert Einstein (M.B.A., B.F.C.d.S., A.H.K., C.L.L., M.C.N., G.S.S.), São Paulo, Brazil; the Department of Health (G.A.A.V., C.B.M.), State of Ceará, Brazil; and Federal University of São Paulo (G.S.S.), São Paulo, Brazil
| | - Cícera Borges Machado
- From the Hospital Geral de Fortaleza (J.J.F.d.C.), Fortaleza, Brazil, Hospital Israelita Albert Einstein (M.B.A., B.F.C.d.S., A.H.K., C.L.L., M.C.N., G.S.S.), São Paulo, Brazil; the Department of Health (G.A.A.V., C.B.M.), State of Ceará, Brazil; and Federal University of São Paulo (G.S.S.), São Paulo, Brazil
| | - Bento Fortunato Cardoso dos Santos
- From the Hospital Geral de Fortaleza (J.J.F.d.C.), Fortaleza, Brazil, Hospital Israelita Albert Einstein (M.B.A., B.F.C.d.S., A.H.K., C.L.L., M.C.N., G.S.S.), São Paulo, Brazil; the Department of Health (G.A.A.V., C.B.M.), State of Ceará, Brazil; and Federal University of São Paulo (G.S.S.), São Paulo, Brazil
| | - Alberto Hideki Kanamura
- From the Hospital Geral de Fortaleza (J.J.F.d.C.), Fortaleza, Brazil, Hospital Israelita Albert Einstein (M.B.A., B.F.C.d.S., A.H.K., C.L.L., M.C.N., G.S.S.), São Paulo, Brazil; the Department of Health (G.A.A.V., C.B.M.), State of Ceará, Brazil; and Federal University of São Paulo (G.S.S.), São Paulo, Brazil
| | - Claudio Luiz Lottenberg
- From the Hospital Geral de Fortaleza (J.J.F.d.C.), Fortaleza, Brazil, Hospital Israelita Albert Einstein (M.B.A., B.F.C.d.S., A.H.K., C.L.L., M.C.N., G.S.S.), São Paulo, Brazil; the Department of Health (G.A.A.V., C.B.M.), State of Ceará, Brazil; and Federal University of São Paulo (G.S.S.), São Paulo, Brazil
| | - Miguel Cendoroglo Neto
- From the Hospital Geral de Fortaleza (J.J.F.d.C.), Fortaleza, Brazil, Hospital Israelita Albert Einstein (M.B.A., B.F.C.d.S., A.H.K., C.L.L., M.C.N., G.S.S.), São Paulo, Brazil; the Department of Health (G.A.A.V., C.B.M.), State of Ceará, Brazil; and Federal University of São Paulo (G.S.S.), São Paulo, Brazil
| | - Gisele Sampaio Silva
- From the Hospital Geral de Fortaleza (J.J.F.d.C.), Fortaleza, Brazil, Hospital Israelita Albert Einstein (M.B.A., B.F.C.d.S., A.H.K., C.L.L., M.C.N., G.S.S.), São Paulo, Brazil; the Department of Health (G.A.A.V., C.B.M.), State of Ceará, Brazil; and Federal University of São Paulo (G.S.S.), São Paulo, Brazil
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Oliveira BCD, Garanhani ML, Garanhani MR. Cuidador de pessoa com acidente vascular encefálico: necessidades, sentimentos e orientações recebidas. ACTA PAUL ENFERM 2011. [DOI: 10.1590/s0103-21002011000100006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVOS: Compreender as necessidades e sentimentos do cuidador e identificar as orientações prestadas por profissionais de saúde. MÉTODOS: Pesquisa exploratória e descritiva com abordagem qualitativa, utilizando entrevista semiestruturada. Junto a seis cuidadoras nos meses de maio a agosto de 2008. Os relatos foram submetidos à análise de discurso. RESULTADOS: Configuraram-se três categorias analíticas: as necessidades iniciais do cuidador; o cuidador e seus sentimentos e as orientações recebidas pelo cuidador. As necessidades envolvem diversos aspectos, representando dificuldades adaptativas. A diversidade de sentimentos vivenciados denotou ambivalência e diferentes graus de intensidade. Houve desde a ausência total de orientações, orientações incompletas e o fato de não sentirem falta de nenhuma orientação. CONCLUSÕES: Há necessidade da discussão a respeito de um plano de orientações, sendo uma estratégia de apoio para cuidador e paciente.
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Pontes-Neto OM, Oliveira-Filho J, Valiente R, Friedrich M, Pedreira B, Rodrigues BCB, Liberato B, Freitas GRD. Diretrizes para o manejo de pacientes com hemorragia intraparenquimatosa cerebral espontânea. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:940-50. [DOI: 10.1590/s0004-282x2009000500034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 08/15/2009] [Indexed: 01/24/2023]
Abstract
A hemorragia intraparenquimatosa cerebral (HIC) é o subtipo de AVC de pior prognóstico e com tratamento ainda controverso em diversos aspectos. O comitê executivo da Sociedade Brasileira de Doenças Cerebrovasculares, através de uma revisão ampla dos artigos publicados em revistas indexadas, elaborou sugestões e recomendações que são aqui descritas com suas respectivas classificações de níveis de evidência. Estas diretrizes foram elaboradas com o objetivo de prover o leitor de um racional para o manejo apropriado dos pacientes com HIC, baseado em evidências clínicas.
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13
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Conforto AB, Paulo RBD, Patroclo CB, Pereira SLDA, Miyahara HDS, Fonseca CBD, Yamamoto FI, Marchiori PE, Evaristo EF, Scaff M. Stroke management in a university hospital in the largest South American city. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:308-11. [PMID: 18641861 DOI: 10.1590/s0004-282x2008000300004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 04/26/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe characteristics and provision of care for patients admitted with cerebrovascular disorders (CVD), focusing on ischemic stroke (IS), in a large, public, academic hospital in São Paulo, Brazil. METHOD We retrieved information about 357 patients with CVD admitted to the Neurology Emergency Department (NED) and Neurology Ward (NW) of our institution. We described patient characteristics and management of IS in NED and in NW. RESULTS IS was diagnosed in 79.6% of CVD patients admitted to NED; 2.7% were submitted to thrombolysis. Extent of IS investigation and management were significantly different in NED and NW. CONCLUSION IS patients in our center were younger than in developed countries. IS management was significantly influenced by patient characteristics. This information can aid in planning strategies to decrease stroke burden.
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Cabral NL, Gonçalves ARR, Longo AL, Moro CHC, Costa G, Amaral CH, Souza MV, Eluf-Neto J, Fonseca LAM. Trends in stroke incidence, mortality and case fatality rates in Joinville, Brazil: 1995-2006. J Neurol Neurosurg Psychiatry 2009; 80:749-54. [PMID: 19147630 PMCID: PMC2688773 DOI: 10.1136/jnnp.2008.164475] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Revised: 12/02/2008] [Accepted: 12/04/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND Studying stroke rates in a whole community is a rational way to assess the quality of patient care and primary prevention. However, there are few studies of trends in stroke rates worldwide and none in Brazil. OBJECTIVE Established study methods were used to define the rates for first ever stroke in a defined population in Brazil compared with similar data obtained and published in 1995. METHODS All stroke cases occurring in the city of Joinville during 2005-2006 were prospectively ascertained. Crude incidence and mortality rates were determined, and age adjusted rates and 30 day case fatality were calculated and compared with the 1995 data. RESULTS Of the 1323 stroke cases registered, 759 were first ever strokes. The incidence rate per 100 000 was 105.4 (95% CI 98.0 to 113.2), mortality rate was 23.9 (95% CI 20.4 to 27.8) and the 30 day case fatality was 19.1%. Compared with the 1995 data, we found that the incidence had decreased by 27%, mortality decreased by 37% and the 30 day case fatality decreased by 28%. CONCLUSIONS Using defined criteria we showed that in an industrial southern Brazilian city, stroke rates are similar to those from developed countries. A significant decrease in stroke rates over the past decade was also found, suggesting an improvement in primary prevention and inpatient care of stroke patients in Joinville.
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Affiliation(s)
- N L Cabral
- Clinica Neurológica de Joinville, Rua Plácido O de Oliveira, 1244, CEP 892-02451, Joinville, Santa Catarina, Brazil.
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Martins Jr AN, Figueiredo MMD, Rocha OD, Fernandes MAF, Jeronimo SM, Dourado Jr ME. Frequency of stroke types at an emergency hospital in Natal, Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:1139-43. [DOI: 10.1590/s0004-282x2007000700009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 09/01/2007] [Indexed: 11/22/2022]
Abstract
We performed a cross-sectional study of stroke type frequency at a local emergency hospital, in Natal, Brazil. The sample consisted of all patients who were admitted to an emergency hospital with a presumptive diagnosis of stroke. Of the 416 patients, 328 were studied, 88 were excluded for not meeting inclusion criteria, 74.7% (n= 245) had ischemic stroke 17.7% (n=58) had intracerebral hemorrhage, 7.6% (n=25) had subarachnoid hemorrhage; 173 were men (52.7%). Mean age was 64.1 years. The intrahospital mortality rate was 10.2%, 17.2% and 36% for ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage, respectively. The most prevalent modifiable risk factor was hypertension for ischemic stroke (67.6%) and hemorrhage stroke (57.8%). Logistic regression analysis identified diabetes (OR=3.70; CI=1.76-7.77) as independent risk factor for ischemic stroke. The ischemic stroke was most common type of stroke. Hypertension and diabetes were important risk factors for stroke.
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Minelli C, Fen LF, Minelli DPC. Stroke incidence, prognosis, 30-day, and 1-year case fatality rates in Matão, Brazil: a population-based prospective study. Stroke 2007; 38:2906-11. [PMID: 17916767 DOI: 10.1161/strokeaha.107.484139] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is the main cause of death in Brazil and no prospective population-based study has been conducted in the country. The purpose of this study was to determine the incidence of stroke, stroke subtypes, case fatality, and prognosis after 1 year of follow-up in the city of Matão, Brazil. METHODS Using overlapping methods of case ascertainment, all stroke cases that occurred in the city of Matão (population, 75,053) from November 1, 2003 to October 31, 2004 were followed-up at 1 month and 1 year after the episode. Standard criteria for population-based stroke studies were followed. RESULTS Of 141 suspect stroke cases identified, 81 were first-ever-in-a-lifetime strokes. All patients underwent a CT scan. The crude annual incidence rate per 100,000 per year was 108 (95% CI, 85.7-134.1) and the rate adjusted for sex and age to the Segi population was 137 (95% CI, 112.0 to 166.4) per 100,000 inhabitants per year. Ischemic stroke occurred in 69 (85.2%) subjects, intracerebral hemorrhage in 11 (13.6%), and subarachnoid hemorrhage in 1 (1.2%). The 30-day case fatality rate was 18.5 and the 1-year case fatality rate was 30.9%. After 1 year of follow-up, 43% of the patients were independent in activities of daily living, 49.4% had independent gait, and 15.9% had a recurrent stroke. CONCLUSIONS The present results are similar to those obtained in other stroke population-based studies. Future studies in Matão will provide the opportunity to discover ways to decrease the stroke burden in Brazil.
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Affiliation(s)
- Cesar Minelli
- Department of Neurology , Hospital Carlos Fernando Malzoni, Rua Sinharinha Frota, 556-Centro, Matão, São Paulo, Brazil.
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Lavados PM, Hennis AJM, Fernandes JG, Medina MT, Legetic B, Hoppe A, Sacks C, Jadue L, Salinas R. Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean. Lancet Neurol 2007; 6:362-72. [PMID: 17362840 DOI: 10.1016/s1474-4422(07)70003-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Stroke is a major health problem in Latin American and Caribbean countries. In this paper, we review the epidemiology, aetiology, and management of stroke in the region based on a systematic search of articles published in Spanish, Portuguese, and English. Stroke mortality is higher than in developed countries but rates are declining. Population-based studies show variations in incidence of strokes: lower rates of ischaemic stroke and similar rates of intracranial haemorrhages, compared with other regions. A significant proportion of strokes in these populations can be attributed to a few preventable risk factors. Some countries have published national clinical guidelines, although much needs to be done in the organisation of care and rehabilitation. Even though the burden of stroke is high, there is a paucity of information for implementing evidence-based management. The Global Stroke Initiative, the WHO STEPS Stroke surveillance, and WHO-PREMISE projects provide opportunities for surveillance at institutional and community levels.
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Affiliation(s)
- Pablo M Lavados
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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Lavados PM, Sacks C, Prina L, Escobar A, Tossi C, Araya F, Feuerhake W, Gálvez M, Salinas R, Alvarez G. Incidence, case-fatality rate, and prognosis of ischaemic stroke subtypes in a predominantly Hispanic-Mestizo population in Iquique, Chile (PISCIS project): a community-based incidence study. Lancet Neurol 2007; 6:140-8. [PMID: 17239801 DOI: 10.1016/s1474-4422(06)70684-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Incidence of ischaemic stroke subtypes, classified by cause, seems to vary between communities. We aimed to prospectively ascertain the incidence of first-ever ischaemic stroke in a predominantly Hispanic-Mestizo population in the northern desertic region of Chile. METHODS Between July, 2000, and June, 2002, all patients with possible stroke or transient ischaemic attacks were identified from multiple overlapping sources and were rapidly assessed by two field neurologists. All identified patients were diagnosed by at least two stroke neurologists according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) definitions and were followed up at 6 months. Annual incidence rates were age adjusted to WHO, European, and US populations by the direct method to allow comparisons. FINDINGS A total of 239 ischaemic strokes were identified, of which 185 (77%) were first-ever cases. 151 (82%) patients were hospitalised, of whom only 70 (38%) were assessed within 6 h of symptom onset. The mean age of patients was 66.4 years (SD 14.9) and 56% were men. The crude annual incidence rates (per 100 000) according to stroke subtype were: cardioembolic, 9.3; large-artery disease, 2.0; small-vessel disease, 15.8; other determined cause, 0.2; and undetermined cause, 17.4. Hypertension was the most common cardiovascular risk factor in all subtypes and atrial fibrillation was the most common cause of cardioembolic stroke. Case fatality at 30 days was highest in cardioembolic strokes (28%) and lowest in small-vessel disease (0%). Dependency or death at 6 months was also highest in cardioembolic strokes (62%) and lowest in small-vessel disease (21%). INTERPRETATION Incidence and prognosis of small vessel and cardioembolic infarction was similar to that in other populations and incidence of large-artery atherothrombotic infarction was lower than in most previous reports. Hypertension and atrial fibrillation were the most common risk factor and cause, respectively, of ischemic stroke in this population. These findings should help the national stroke programme in the prevention of cardioembolic stroke, increase access to specialists and acute brain imaging and vascular studies, and improve stroke care.
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Affiliation(s)
- Pablo M Lavados
- Neurology Service, Department of Medicine, Clínica Alemana de Santiago-Universidad del Desarrollo, Department of Neurological Sciences, School of Medicine, Universidad de Chile, Santiago, Chile.
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Abstract
Stroke is one of the leading causes of mortality in Latin America, with variable incidence and prevalence throughout the continent reflecting regional socioeconomic differences. In Latin America, uncontrolled hypertension is one of the major causes of stroke, but other modifiable risk factors also play a role, such as heavy alcohol consumption and smoking. Intracerebral hemorrhage and lacunar stroke are more frequent in Latin America than in North America and Europe. There are multiple causes of stroke that are endemic to Latin America, including neurocysticercosis, Chagas' disease, sickle cell anemia, malaria, hemorrhagic fever, and snake bites.
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Affiliation(s)
- Erica C S Camargo
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-2622, USA.
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Soares CM, Carvalho ACP. Hematoma intraparenquimatoso cerebral espontâneo: aspectos à tomografia computadorizada. Radiol Bras 2005. [DOI: 10.1590/s0100-39842005000100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Identificar os aspectos mais freqüentes do hematoma intraparenquimatoso cerebral espontâneo observados na tomografia computadorizada. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os exames de tomografia computadorizada de 250 pacientes com hematoma intraparenquimatoso cerebral espontâneo, provenientes de três diferentes hospitais da cidade do Rio de Janeiro. RESULTADOS: O hematoma intraparenquimatoso cerebral profundo foi o de maior incidência, equivalendo a 54,4% (136 casos), seguido do lobar com 34,8% (87 casos). Mais raramente, observou-se sangramento cerebelar em 8,4% (21 casos) e do tronco cerebral em 2,4% (seis casos) dos pacientes. CONCLUSÃO: A cefaléia foi o sintoma mais comum e a hipertensão arterial foi o sinal mais freqüentemente apresentado. A drenagem do hematoma para o sistema ventricular ocorreu mais comumente nos hematoma profundos.
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Cabral NL, Volpato D, Ogata TR, Ramirez T, Moro C, Gouveia S. Fibrilação atrial crônica, AVC e anticoagulação: sub-uso de warfarina ? ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:1016-21. [PMID: 15608962 DOI: 10.1590/s0004-282x2004000600016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Correlacionar acidente vascular cerebral (AVC) cardioembólico em portadores de fibrilação atrial (FA) crônica não valvular, potencialmente evitáveis, previamente acompanhados por cardiologistas, sem restrições ao uso da warfarina, com o grau de absorção das recomendações e limitações publicadas sobre anticoagulação e FA. MÉTODO: Registramos prospectivamente todos os casos de AVC internados em dois hospitais de Joinville.Na presença de FA, foi questionado aos pacientes se sabiam da existência da arritmia, freqüência de visitas a cardiologistas e uso prévio de warfarina. Posteriormente aplicamos um questionário transversal a 11 cardiologistas sobre o FA, anticoagulação e AVC. RESULTADOS: Entre 167 pacientes com AVC, 22 tinham FA prévia e AVC isquêmico. Destes, 15 tinham consultado previamente um cardiologista. Nove pacientes faleceram, sete tiveram alta anticoagulados e seis não receberam warfarina. O questionário evidenciou que 91% dos colegas conheciam as recomendações publicadas, mas somente 54 % deles consideravam-nas aplicáveis para pacientes do serviço público. CONCLUSÃO: A anticoagulação na FA reduz 68% o risco relativo para AVC/ano. Logo, 11 dos 22 pacientes poderiam ter evitado o evento. Extrapolando a incidência em 1997 e a população atual, podemos considerar que 4% de todos os AVC por ano em Joinville são potencialmente evitáveis.
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Lotufo PA, Bensenor IM. Stroke mortality in São Paulo (1997-2003): a description using the Tenth Revision of the International Classification of Diseases. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:1008-11. [PMID: 15608960 DOI: 10.1590/s0004-282x2004000600014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Stroke mortality rates are higher in Brazil when compared to other countries. The city of São Paulo has a good system of mortality surveillance that allow us to describe the epidemiology of the stroke in the city. Our aim was to describe the stroke mortality pattern by gender and age characterizing the ischemic/ hemorrhagic ratio. We categorized mortality data by gender and a 10-year age-strata from 30-39 years-old to 70-79 years-old. To avoid random variations, we calculated the mean of all deaths occurred during the period of 1997 to 2003. Mortality rates were calculated using the population from the Brazilian National Census occurred in 2000. The proportion of deaths from all types of stroke related to all cardiovascular among women was higher when compared to men, mainly during middle-age. In other hand, the risk of stroke death is always higher among men during all ages. Ill-defined stroke certification is more common as underlying cause of death above the 60 years-old (40 per cent).Intracerebral hemorrhage was the most frequent cause of stroke death for both sexes from 30 to 59 years-old. Subarachnoideal hemorrhage was much more frequent as cause of death among women than in men. The ratio between ischemic/hemorrhagic (both subtypes) was 0.59 for men and 0.56 for women. Concluding, the magnitude of hemorrhagic stroke is still higher in São Paulo city, with an special burden to middle-aged people for both gender.
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Affiliation(s)
- Paulo A Lotufo
- Department of Internal Medicine, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Pires SL, Gagliardi RJ, Gorzoni ML. [Study of the main risk factors frequencies for ischemic cerebrovascular disease in elderly patients]. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:844-51. [PMID: 15476081 DOI: 10.1590/s0004-282x2004000500020] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Two hundred and sixty two patients with clinical diagnosis of permanent ischemic stroke, all of them aged 60 or more were retrospectively studied from the 1015 cerebrovascular diseases (CVD) records of the Atherosclerosis League of the Neurology Clinics of the ISCMSP, from 1990 to 2002. The study emphasized modifiable risk factors frequencies for ischemic stroke in this population, considering gender and age of the patients. Results have evidenced that systemic arterial hypertension is a main risk factor significantly frequent in old people (87.8%), independently of gender and age. Smoking (46.9%) and alcohol consumption (35.1%) have revealed to be very frequent important modifiable risk factors especially among men. Lower frequencies have been presented for cardiac diseases (27.0%), Diabetes Mellitus (19.9%), and dyslipidemia (15.6%) as risk factors for ischemic stroke in old people of both genders and all ages after 60. There was relatively low frequency of hyperuricemia in this set of patients.
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Soares CM, Carvalho ACP, Rodrigues ADJ. Hemorragia intraparenquimatosa encefálica espontânea: achados à tomografia computadorizada. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:682-8. [PMID: 15334231 DOI: 10.1590/s0004-282x2004000400022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Foram analisados os exames de tomografia computadorizada de crânio de 250 pacientes com hematoma intraparenquimatoso encefálico espontâneo em três diferentes hospitais na cidade do Rio de Janeiro, com o objetivo de se levantar os aspectos mais freqüentes desta doença. O hematoma intraparenquimatoso cerebral profundo foi o de maior incidência, seguido do lobar. Mais raramente foi observado sangramento cerebelar e do tronco cerebral. A faixa etária de acometimento mais freqüente foi entre 61 e 70 anos de idade. Não houve diferença expressiva quanto ao sexo predominante ou ao lado mais acometido, porém verificou-se que os homens são mais acometidos em uma faixa etária mais precoce do que as mulheres. A cefaléia foi o sintoma de maior freqüência e a hipertensão arterial esteve presente na maioria dos casos. A drenagem da hemorragia para o sistema ventricular ocorreu mais comumente nos hematomas profundos.
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Falcão IV, Carvalho EMFD, Barreto KML, Lessa FJD, Leite VMM. Acidente vascular cerebral precoce: implicações para adultos em idade produtiva atendidos pelo Sistema Único de Saúde. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2004. [DOI: 10.1590/s1519-38292004000100009] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: conhecer as incapacidades e identificar se há diferenças de gênero, em sobreviventes de primeiro episódio de acidente vascular cerebral (AVC), entre 20 e 59 anos de idade, na cidade do Recife e que tenham sido hospitalizados pelo Sistema Único de Saúde. MÉTODOS: entrevista domiciliar com uma amostra de sobreviventes, investigando-se as incapacidades referidas na vida funcional e produtiva deles. RESULTADOS: amostra equilibrada entre os sexos, média de idade de 52 anos, com nível elementar de estudos ou analfabeto e trabalhando no setor de serviços, informal ou doméstico. Menos de 20% informam recuperação total após o AVC. Aproximadamente 80% apresentam algum déficit, sendo os problemas de comunicação e os sintomas depressivos mais freqüentes entre as mulheres. Após o AVC aumentou o número de desempregados e aposentados e as incapacidades repercutem negativamente na satisfação de vida de mais de 70% dos entrevistados. CONCLUSÕES: é expressivo o percentual de casos, ainda jovens, com seqüelas pós AVC, sendo este mais precoce e o quadro de incapacidades mais freqüente e/ou grave entre as mulheres. A prevenção e a reabilitação após o AVC são desejáveis, com a implantação de programas, considerando as condições de gênero, para o controle dos riscos e para as seqüelas resultantes do AVC.
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Cabral NL, Moro C, Silva GR, Scola RH, Werneck LC. Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2003; 61:188-93. [PMID: 12806495 DOI: 10.1590/s0004-282x2003000200006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE To assess the impact of a stroke unit (SU) on acute phase treatment when compared to a conventional general ward treatment (GW). METHOD Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW). We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41), whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24), 17.4% and 28.7% on the 3rd month (p= 0.39), and 25.7% and 30.7% on the 6th month (p= 0.41). Thirty-day survival curve achieved 1.8 log rank (p= 0.17), with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat) was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.
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Radanovic M. [Characteristics of care to patients with stroke in a secondary hospital]. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:99-106. [PMID: 10770873 DOI: 10.1590/s0004-282x2000000100015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the assistance profile of stroke patients accomplished in Hospital Universitário of University of São Paulo (HU-USP), by the Internal Medicine team of the Emergency Room, as being a standard of non-tertiary hospital. METHOD Retrospective analysis of 228 patients with cerebrovascular disease, assisted from 1989 to 1993. RESULTS We found the following subgroup distribution: 53% of patients had ischemic strokes, 26%, had hemorrhagic strokes, 2% had association from both and 19% were not classified. Among risk factors, we found an incidence of 67,5% for arterial hypertension; 24.6% for cardiac disease (chronic atrial fibrillation being the most frequent); diabetes occurred in 20.2% of cases. Among complications, coma was present in 22.4% of cases; respiratory insufficiency occurred in 15%; infection, in 29%. Death rate was 14. 5%. Average permanence in hospital was 4.11 days. CONCLUSIONS The epidemiological aspects and complications reproduced the data described in the literature. Some negative aspects were inadequacy of accommodations and the great incidence of pulmonary infections. However, the mortality rate was comparable to the lowest found in literature.
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Affiliation(s)
- M Radanovic
- Departamento de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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