Competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica / Competencias de enfermería en el cuidado de personas con accidente cerebrovascular elegibles para terapia trombolítica / Nursing competencies in the care of patients with stroke who are eligible for thrombolytic therapy

Resumo Introdução: O acidente vascular cerebral isquêmico tem como tratamento a terapia trombolítica, aplicada ainda na fase aguda, promovendo melhora importante nas sequelas acarretadas por este agravo. Considerando a complexidade da terapia trombolítica, torna-se necessário que os enfermeiros compreendam suas competências para auxiliar no cuidado. Objetivo: Identificar evidências científicas acerca das competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica. Metodologia: Revisão integrativa composta por seis etapas em seis etapas (elaboração da questão, busca na literatura, coleta de dados, análise, discussão e apresentação da revisão), realizada nas bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase e CINAHL. A busca foi realizada entre agosto e setembro de 2022 adotando como critérios de inclusão estudos primários; gratuitos, disponíveis eletronicamente na íntegra; nos idiomas inglês, português e espanhol. Foram obtidos inicialmente 2.830 estudos, os quais passaram por uma seleção, onde foram incluídos aqueles que atendiam os critérios previamente estabelecidos. Resultados: Com base nos doze estudos incluídos nesta revisão identificaram-se competências voltadas à três atividades do cuidado: gestão do cuidado como trabalho em equipe, códigos, fluxos e protocolos, assistência ao paciente antes, durante e após a utilização da terapia trombolítica e educação em saúde para equipe, pacientes e familiares. Conclusão: Os achados desta revisão puderam evidenciar as competências do enfermeiro no cuidado aos pacientes elegíveis a terapia trombolítica, as quais perpassam diferentes áreas de atuação do enfermeiro. Para este estudo prevaleceram as competências assistências, seguida por competências gerenciais.

Resumen Introducción: El accidente cerebrovascular isquémico se trata con terapia trombolítica, aplicada incluso en la fase aguda, que promueve una mejoría significativa de las secuelas provocadas por este padecimiento. Considerando la complejidad de la terapia trombolítica, es necesario que las personas profesionales de enfermería comprendan sus competencias para ayudar en el cuidado. Objetivo: Identificar evidencias científicas sobre las competencias del personal de enfermería en el cuidado de pacientes con accidente cerebrovascular elegibles para terapia trombolítica. Metodología: Revisión integradora que consta de seis etapas (elaboración de la pregunta, búsqueda bibliográfica, recolección de datos, análisis, discusión y presentación de la revisión), realizada en las bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase y CINAHL. La búsqueda se realizó entre agosto y septiembre de 2022. Los criterio de inclusión fueron: estudios primarios, gratuito, disponible electrónicamente en su totalidad, en inglés, portugués y español. Inicialmente se obtuvieron 2830 estudios, los cuales fueron sometidos a un proceso de selección, que incluyó aquellos que cumplían con los criterios previamente establecidos. Resultados: A partir de los doce estudios incluidos en esta revisión, se identificaron competencias centradas en tres actividades asistenciales: gestión del cuidado como trabajo en equipo, códigos, flujos y protocolos, atención a pacientes antes, durante y después del uso de la terapia trombolítica y educación en salud para personal, pacientes y familias. Conclusión: Los hallazgos de esta revisión pudieron resaltar las competencias de las personas profesionales en enfermería en el cuidado de personas elegibles para terapia trombolítica, que abarcan diferentes áreas de actuación del personal de enfermería. Para este estudio, prevalecieron las habilidades asistenciales, seguidas de las competencias gerenciales.

ABSTRACT Introduction: Ischemic stroke is treated with thrombolytic therapy, applied even in the acute phase, promoting a significant improvement in the after-effects caused by this condition. Considering the complexity of thrombolytic therapy, it is necessary for nurses to understand the skills required to assist in care. Objective: To identify scientific evidence about the competencies of nurses in the care of patients with stroke who are eligible for thrombolytic therapy. Methodology: An integrative review consisting of six stages (elaboration of the question, literature review, data collection, analysis, discussion, and presentation), conducted in MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase, and CINAHL databases. The search was carried out between August and September 2022 using primary studies as the inclusion criteria: free of charge, fully available electronically, published in English, Portuguese, or Spanish. Initially, 2.830 studies were obtained, which underwent a selection process that included only those studies that met the previously established criteria. Results: Based on the twelve studies included in this review, competencies focused on three care activities were identified: care management such as teamwork; codes; flows and protocols; patient care before, during, and after the use of thrombolytic therapy; and education health education for staff, patients, and families. Conclusion: The findings of this review highlighted the nurses' competencies in the care of patients eligible for thrombolytic therapy, which encompass different areas of the nurse's work. For this study, assistance competencies prevailed, followed by management competencies.

Improving walking via real-time visual feedback after stroke in treadmill training (RE-VISIT): a protocol for randomized controlled trial / Melhorando a caminhada por meio de feedback visual em tempo real após acidente vascular cerebral em treinamento em esteira (RE-VISIT): um protocolo para ensaio clínico randomizado

BACKGROUND: After a stroke, most patients often suffer reduced walking ability and balance. Restoring walking ability and improving balance are major goals of stroke rehabilitation. Treadmills are often used in clinical setups to achieve these goals. Adding dimensions to the visual feedback in addition to the mirror for real-time frontal view is proven to enhance the gait. It is, therefore, important to design additional real-time visual feedback in treadmill training, in particular for the sagittal view involved side. OBJECTIVE: The objective of this study is to test if the real-time sagittal visual feedback during treadmill training is superior to the conventional mirror feedback treadmill training program of equivalent intensity in improving walking speed and balance after stroke. METHODS/DESIGN: The RE-VISIT trial (Real-time Visual feedback after Stroke in Treadmill training) is registered in the Clinical Trial Registry of India (CTRI/2023/10/058299). In this two-arm randomized control trial, which will be a single-blinded study, 42 eligible stroke survivors undergoing rehabilitation will be randomly allocated (1:1 ratio) to either real-time visual sagittal feedback along with front mirror (experimental) group or only front mirror treadmill training (control) group, all the participants will receive 15 sessions of treadmill training for up to 15 min at a safe self-selected speed over 5-6 weeks. The RE-VISIT (experimental) group will receive real-time, visual sagittal view feedback of the involved lower limb trajectory along with the routine front mirror view during treadmill training and will be asked to modify their gait pattern. The control group will receive treadmill walking training only with the routine front mirror view feedback. Clinical and gait assessments will be conducted at the baseline, immediately following the final session of training, and at the 9th week during follow-up. The outcome measures of interest are walking speed (primary) and balance (secondary), which will be measured prior to baseline, post 15 sessions of training, and at the 9th week following training. DISCUSSION: This REVISIT trial will provide insight and contribute to the existing innovation and modifications of incorporating realtime visual feedback during treadmill training in post-stroke gait rehabilitation. The findings will help the better designing of a gait rehabilitation program with a treadmill for post-stroke subjects to improve walking speed, and balance for those who have greater difficulties in community ambulation. We anticipate that those in the REVISIT training will demonstrate improved walking ability.

CONTEXTO: Após o acidente vascular cerebral, a maioria dos pacientes frequentemente sofre redução da capacidade de caminhar e do equilíbrio. Restaurar a capacidade de caminhar e melhorar o equilíbrio são os principais objetivos da reabilitação do AVC. As esteiras são frequentemente usadas em ambientes clínicos para atingir esses objetivos. Está comprovado que adicionar dimensões ao feedback visual, além do espelho para visão frontal em tempo real, melhora a marcha. É, portanto, importante projetar feedbacks visuais adicionais em tempo real no treinamento em esteira, em particular para o lado envolvido na visão sagital. OBJETIVO: O objetivo deste estudo é testar se o feedback visual sagital em tempo real durante o treinamento em esteira é superior ao programa de treinamento em esteira com feedback de espelho convencional de intensidade equivalente na melhoria da velocidade de caminhada e equilíbrio após acidente vascular cerebral. MÉTODOS/ DESENHO: O ensaio RE-VISIT (feedback visual em tempo real após acidente vascular cerebral no treinamento em esteira) está registrado no Registro de Ensaios Clínicos da Índia (CTRI/2023/10/058299). Neste ensaio de controle randomizado de dois braços, que será um estudo cego, 42 sobreviventes de AVC elegíveis em reabilitação serão alocados aleatoriamente (proporção de 1:1) para feedback sagital visual em tempo real junto com grupo de espelho frontal (experimental) ou apenas Grupo de treinamento em esteira com espelho frontal (controle), todos os participantes receberão 15 sessões de treinamento em esteira por até 15 minutos em uma velocidade segura e autosselecionada durante 5-6 semanas. O grupo RE-VISIT (experimental) receberá feedback visual em tempo real da visão sagital da trajetória dos membros inferiores envolvidos, juntamente com a visão rotineira do espelho frontal durante o treinamento em esteira e será solicitado a modificar seu padrão de marcha. O grupo de controle receberá treinamento de caminhada em esteira apenas com o feedback rotineiro da visão do espelho frontal. Avaliações clínicas e de marcha serão realizadas no início do estudo, imediatamente após a sessão final de treinamento e na 9ª semana durante o acompanhamento. As medidas de resultados de interesse são a velocidade de caminhada (primária) e o equilíbrio (secundário), que serão medidos antes da linha de base, após a 15ª sessão de treinamento e na 9ª semana após o treinamento. DISCUSSÃO: este ensaio REVISIT fornecerá insights e contribuirá para a inovação e modificações existentes na incorporação de feedbacks visuais em tempo real durante o treinamento em esteira na reabilitação da marcha pós-AVC. As descobertas ajudarão no melhor desenho de um programa de reabilitação da marcha com esteira para indivíduos pós-AVC para melhorar a velocidade de caminhada e o equilíbrio para aqueles que têm maiores dificuldades na deambulação comunitária. Prevemos que aqueles no treinamento REVISIT demonstrarão melhor capacidade de caminhada.

Serum autophagy-related gene 5 level in stroke patients: correlation with CD4+ T cells and cognition impairment during a 3-year follow-up

Abstract Autophagy-related gene (ATG) 5 regulates blood lipids, chronic inflammation, CD4+ T-cell differentiation, and neuronal death and is involved in post-stroke cognitive impairment. This study aimed to explore the correlation of serum ATG5 with CD4+ T cells and cognition impairment in stroke patients. Peripheral blood was collected from 180 stroke patients for serum ATG5 and T helper (Th) 1, Th2, Th17, and regulatory T (Treg) cell detection via enzyme-linked immunosorbent assays and flow cytometry. The Mini-Mental State Examination (MMSE) scale was completed at enrollment, year (Y)1, Y2, and Y3 in stroke patients. Serum ATG5 was also measured in 50 healthy controls (HCs). Serum ATG5 was elevated in stroke patients compared to HCs (P<0.001) and was positively correlated to Th2 cells (P=0.022), Th17 cells (P<0.001), and Th17/Treg ratio (P<0.001) in stroke patients but not correlated with Th1 cells, Th1/Th2 ratio, or Treg cells (all P>0.050). Serum ATG5 (P=0.037), Th1 cells (P=0.022), Th17 cells (P=0.002), and Th17/Treg ratio (P=0.018) were elevated in stroke patients with MMSE score-identified cognition impairment vs those without cognition impairment, whereas Th2 cells, Th1/Th2 ratio, and Treg cells were not different between them (all P>0.050). Importantly, serum ATG5 was negatively linked with MMSE score at enrollment (P=0.004), Y1 (P=0.002), Y2 (P=0.014), and Y3 (P=0.001); moreover, it was positively related to 2-year (P=0.024) and 3-year (P=0.012) MMSE score decline in stroke patients. Serum ATG5 was positively correlated with Th2 and Th17 cells and estimated cognitive function decline in stroke patients.

Fatores associados a incapacidade funcional após acidente vascular cerebral isquêmico / Factores asociados a incapacidad funcional después de accidente cerebrovascular isquémico / Factors associated with functional disability after ischemic stroke

Resumo Objetivo Avaliar o nível de incapacidade funcional e identificar os fatores associados em pessoas após Acidente Vascular Cerebral Isquêmico. Métodos Coorte prospectiva, realizada em hospital de referência em neurologia, com 224 pessoas com acidente vascular cerebral isquêmico. A coleta de dados ocorreu entre março a outubro de 2019. Os participantes foram acompanhados durante a internação, quando as variáveis sociodemográficas e clínicas foram levantadas empregando-se instrumentos específicos e contatados após 90 dias, por ligação telefônica, para aplicação do Índice de Barthel modificado. Na análise, aplicou-se estatística descritiva e o teste Qui-quadrado de Pearson. Adotou-se significância estatística de 5%. Resultados A maioria apresentou algum grau de incapacidade funcional (58,5%), sendo que 29,5% apresentaram dependência moderada e 29,0% severa ou grave. As variáveis sexo feminino (p=0,011), tempo de chegada ao hospital de referência maior ou igual a 4,5h (p=0,017), Acidente vascular cerebral prévio (p=0,031), não ter realizado trombólise (p=0,023), ter hipertensão arterial (p=0,032) e maior gravidade estimada pela National Institute of Health Stroke Scale (p=0,000) foram associadas a maior nível de incapacidade. Conclusão Predominou a dependência de moderada a grave. A gravidade do evento, evento prévio, hipertensão, não submissão à trombólise, retardo à chegada ao hospital e sexo feminino foram associados a maior nível de incapacidade funcional.

Resumen Objetivo Evaluar el nivel de incapacidad funcional e identificar los factores asociados en las personas después de un accidente cerebrovascular isquémico. Métodos Cohorte prospectiva, realizada en un hospital de referencia en neurología, con 224 personas con accidente cerebrovascular isquémico. La recopilación de datos se llevó a cabo entre marzo y octubre de 2019. Se acompañó a los participantes durante la internación, momento en que se recopilaron las variables sociodemográficas y clínicas mediante la utilización de instrumentos específicos, y se los contactó 90 días después, por teléfono, para aplicar el Índice de Barthel modificado. En el análisis se aplicó estadística descriptiva y la prueba χ2 de Pearson. Se adoptó significación estadística de 5 %. Resultados La mayoría presentó algún nivel de incapacidad funcional (58,5 %), de los cuales el 29,5 % presentó dependencia moderada y el 29,0 % dependencia severa o grave. Las siguientes variables fueron asociadas a un mayor nivel de incapacidad: sexo femenino (p=0,011), tiempo de llegada al hospital de referencia mayor o igual a 4,5 h (p=0,017), accidente cerebrovascular previo (p=0,031), no haber realizado trombólisis (p=0,023), tener hipertensión arterial (p=0,032) y mayor gravedad estimada por la National Institute of Health Stroke Scale (p=0,000). Conclusión Predominó la dependencia de moderada a grave. La gravedad del evento, evento previo, hipertensión, no realización de trombólisis, retraso de la llegada al hospital y sexo femenino fueron las variables asociadas a un mayor nivel de incapacidad funcional.

Abstract Objective To assess the functional disability level and identify associated factors in people after Ischemic Cerebral Vascular Accident. Methods A prospective cohort, carried out in a reference hospital in neurology with 224 people with ischemic stroke. Data collection took place between March and October 2019. Participants were followed up during hospitalization, when sociodemographic and clinical variables were collected using specific instruments and contacted after 90 days, by telephone call, to apply the Modified Barthel Index. In the analysis, descriptive statistics and Pearson's chi-square test were applied. Statistical significance of 5% was adopted. Results Most had some degree of functional disability (58.5%), with 29.5% having moderate dependence and 29.0% having severe dependence. The variables being female (p=0.011), time of arrival at the reference hospital greater than or equal to 4.5 hours (p=0.017), previous stroke (p=0.031), not having undergone thrombolysis (p=0.023), having high blood pressure (p=0.032) and greater severity estimated by the National Institute of Health Stroke Scale (p=0.000) were associated with a higher disability level. Conclusion Moderate to severe dependence predominated. The severity of the event, previous event, hypertension, non-submission to thrombolysis, delay in arriving at the hospital and female gender were associated with a higher functional disability level.

Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery

ABSTRACT Introduction: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile. Methods: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021. Results: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6). Conclusion: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America.

A Brazilian series utilizing the SMASH-U system for etiologic classification of intracerebral hemorrhage / Classificação etiológica de pacientes admitidos com hemorragia intracerebral utilizando a escala SMASH-U: uma série brasileira

Abstract Background Understanding the causes of intracerebral hemorrhage (ICH) is crucial for effective treatment and preventing recurrences. The SMASH-U scale is a suggested method for classifying and predicting the outcomes of ICH. Objective To describe the SMASH-U classification and outcomes by etiology in patients admitted to a comprehensive stroke center in São Paulo, Brazil. Methods A retrospective analysis was conducted on patients admitted to the hospital or outpatient clinic between April 2015 and January 2018. Two stroke neurologists evaluated the SMASH-U classification, and patients with incomplete medical records were excluded. Results Out of the 2000 patients with a stroke diagnosis evaluated, 140 were included in the final analysis. The mean age was 57.9 (± 15.5) years, and 54.3% were male. Hypertension was the most frequent etiology, accounting for 41.4% of cases, followed by amyloid angiopathy (18.5%) and structural lesions (14.1%). Structural lesions were more common among women and patients under 45 years old. Favorable outcomes were observed in 61% of patients with structural lesions, compared to 10% of patients with medication-related etiologies. Conclusion This study provides important evidence regarding the etiological classification of Brazilian patients with ICH. Hypertension and amyloid angiopathy were the most frequent causes, while structural lesions and systemic diseases were more common in younger patients.

Resumo Antecedentes Compreender as causas da hemorragia intracerebral (HIC) é crucial para o tratamento eficaz e prevenção de recorrências. A escala SMASH-U é um método sugerido para classificar e prever os resultados da HIC. Objetivo Descrever a classificação SMASH-U e os resultados por etiologia em pacientes admitidos em um centro de acidente vascular cerebral (AVC) em São Paulo, Brasil. Métodos Foi realizada uma análise retrospectiva de pacientes admitidos no hospital ou ambulatório entre abril de 2015 e janeiro de 2018. Dois neurologistas especializados em doenças cerebrovasculares avaliaram a classificação SMASH-U e pacientes com prontuários incompletos foram excluídos. Resultados Dos 2000 pacientes com diagnóstico de AVC avaliados, 140 foram incluídos na análise final. A idade média foi de 57,9 (±15,5) anos e 54,3% eram do sexo masculino. A hipertensão foi a etiologia mais frequente, correspondendo a 41,4% dos casos, seguida pela angiopatia amiloide (18,5%) e lesões estruturais (14,1%). As lesões estruturais foram mais comuns em mulheres e pacientes com menos de 45 anos. Resultados favoráveis foram observados em 61% dos pacientes com lesões estruturais, em comparação com 10% dos pacientes com etiologias relacionadas a medicamentos. Conclusão Este estudo fornece evidências importantes sobre a classificação etiológica de pacientes brasileiros com HIC. A hipertensão e a angiopatia amiloide foram as causas mais frequentes, enquanto lesões estruturais e doenças sistêmicas foram mais comuns em pacientes mais jovens.

Measurement of optic nerve sheath diameter on computed tomography for the differentiation of transient ischemic attacks

SUMMARY OBJECTIVE: The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS: Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS: Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION: The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.

Feasibility of Goal-Directed Fluid Therapy in Patients with Transcatheter Aortic Valve Replacement - An Ambispective Analysis

ABSTRACT Introduction: Goal-directed fluid therapy (GDFT) has been shown to reduce postoperative complications. The feasibility of GDFT in transcatheter aortic valve replacement (TAVR) patients under general anesthesia has not yet been demonstrated. We examined whether GDFT could be applied in patients undergoing TAVR in general anesthesia and its impact on outcomes. Methods: Forty consecutive TAVR patients in the prospective intervention group with GDFT were compared to 40 retrospective TAVR patients without GDFT. Inclusion criteria were age ≥ 18 years, elective TAVR in general anesthesia, no participation in another interventional study. Exclusion criteria were lack of ability to consent study participation, pregnant or nursing patients, emergency procedures, preinterventional decubitus, tissue and/or extremity ischemia, peripheral arterial occlusive disease grade IV, atrial fibrillation or other severe heart rhythm disorder, necessity of usage of intra-aortic balloon pump. Stroke volume and stroke volume variation were determined with uncalibrated pulse contour analysis and optimized according to a predefined algorithm using 250 ml of hydroxyethyl starch. Results: Stroke volume could be increased by applying GDFT. The intervention group received more colloids and fewer crystalloids than control group. Total volume replacement did not differ. The incidence of overall complications as well as intensive care unit and hospital length of stay were comparable between both groups. GDFT was associated with a reduced incidence of delirium. Duration of anesthesia was shorter in the intervention group. Duration of the interventional procedure did not differ. Conclusion: GDFT in the intervention group was associated with a reduced incidence of postinterventional delirium.

Morbimortality and determinants of reperfusion in ischemic stroke

SUMMARY BACKGROUND: Cerebrovascular accident (or stroke) and ischemic heart disease are the the major causes of death in the world. It is estimated that about 85% of strokes are ischemic in origin. Reperfusion therapy in the acute phase of ischemic stroke with a recombinant human tissue plasminogen activator is effective, but some factors influence the success of this treatment. OBJECTIVE: The aim of this study was to evaluate clinical aspects and possible determinants for reperfusion after venous thrombolysis. METHODS: This is a retrospective, cross-sectional, observational study based on a review of hospital records of inpatients diagnosed with ischemic stroke treated with intravenous thrombolysis, the main outcome being reperfusion or not. RESULTS: Data from this study revealed a predominance of females in the group of reperfused patients and males in the non-reperfused group, both maintaining moderate severity on the National Institutes of Health Stroke Scale and admission without statistical significance (p>0.18). In addition, the mean admission severity score was 13.2 for the group of reperfused patients and 14.2 for those not reperfused, and the mean ejection fraction of both groups was within normal functionality, with a mean of 0.50 for reperfused patients and 0.62 for non-reperfused patients. CONCLUSION: We found an association between successful venous chemical thrombolysis reperfusion and lower mortality in patients with acute stroke.

Homocysteine serum levels in patients with ruptured and unruptured intracranial aneurysms: a case-control study / Homocisteína sérica em pacientes com aneurismas rotos e não rotos: um estudo caso-controle

Abstract Background There is very few data regarding homocysteine's influence on the formation and rupture of intracranial aneurysms. Objective To compare homocysteine levels between patients with ruptured and unruptured intracranial aneurysms, and to evaluate possible influences of this molecule on vasospasm and functional outcomes. Methods This is a retrospective, case-control study. We evaluated homocysteinemia differences between patients with ruptured and unruptured aneurysms; and the association of homocysteine levels with vasospasm and functional outcomes. Logistic regressions were performed. Results A total of 348 participants were included: 114 (32.8%) with previous aneurysm rupture and 234 (67.2%) with unruptured aneurysms. Median homocysteine was 10.75μmol/L (IQR = 4.59) in patients with ruptured aneurysms and 11.5μmol/L (IQR = 5.84) in patients with unruptured aneurysms. No significant association was detected between homocysteine levels and rupture status (OR = 0.99, 95% CI = 0.96-1.04). Neither mild (>15μmol/L; OR = 1.25, 95% CI 0.32-4.12) nor moderate (>30μmol/L; OR = 1.0, 95% CI = 0.54-1.81) hyperhomocysteinemia demonstrated significant correlations with ruptured aneurysms. Neither univariate (OR = 0.86; 95% CI 0.71-1.0) nor multivariable age-adjusted (OR = 0.91; 95% CI = 0.75-1.05) models evidenced an association between homocysteine levels and vasospasm. Homocysteinemia did not influence excellent functional outcomes at 6 months (mRS≤1) (OR = 1.04; 95% CI = 0.94-1.16). Conclusion There were no differences regarding homocysteinemia between patients with ruptured and unruptured intracranial aneurysms. In patients with ruptured aneurysms, homocysteinemia was not associated with vasospasm or functional outcomes.

RESUMO Antecedentes Existem poucos dados sobre a influência da homocisteína na formação e rotura de aneurismas intracranianos (AI). Objetivo Comparar os níveis de homocisteína entre pacientes com AI rotos e não rotos e influências no vasoespasmo e resultados funcionais. Métodos Estudo caso-controle, que avaliou as diferenças de homocisteinemia entre pacientes com aneurismas rotos e não rotos, além da associação entre níveis de homocisteína, vasoespasmo e estado funcional. Regressões logísticas foram realizadas. Resultados Um total de 348 participantes foram incluídos: 114 (32,8%) com aneurismas rotos e 234 (67,2%) não rotos. A homocisteína mediana foi de 10,75μmol/L (IQR = 4,59) nos rotos e 11,5μmol/L (IQR = 5,84) nos não rotos. Não houve associação significativa entre os níveis de homocisteína e o status de ruptura (OR = 0,99, 95% CI = 0,96-1,04). Nem a hiperhomocisteinemia leve (>15μmol/L; OR = 1,25, 95% CI = 0,32-4,12) nem a moderada (>30μmol/L; OR = 1,0, 95% CI = 0,54-1,81) mostraram correlações significativas com aneurismas rotos. Modelos univariados (OR = 0,86; 95% CI = 0,71-1,0) e multivariados ajustados por idade (OR = 0,91; 95% CI = 0,75-1,05) não evidenciaram associação entre homocisteína e vasoespasmo. A homocisteinemia não influenciou resultados funcionais excelentes em seis meses (mRS ≤ 1) (OR = 1,04; 95% CI = 0,94-1,16). Conclusão Não houve diferenças em relação à homocisteinemia entre pacientes com aneurismas intracranianos rotos e não rotos. Em pacientes com aneurismas rotos, a homocisteinemia não foi associada ao vasoespasmo ou resultados funcionais.

Reliability and validity of remote Life Space Assessment: LSA in persons with chronic stroke / Confiabilidade e validade da escala Life Space Assessment aplicada remotamente: LSA em pacientes com AVC crônico

Abstract Background StepWatch Activity Monitor (SAM) is used to measure the mobility of chronic hemiparetic patients and the Life Space Assessment (LSA) scale was developed to assess the displacement of hemiparetic patients in different contexts through self-reporting. Studies that apply the LSA remotely and correlate it with the number of steps measured by the SAM were not found. Objective To evaluate the measurement properties of the LSA applied remotely and to evaluate the correlation between the LSA scale score and the number of steps measured by the SAM in post-stroke chronic hemiparetic patients. Methods Nineteen patients participated in the study. The LSA scale was applied remotely and later, face to face. The SAM measured the steps taken by the participants over a period of three consecutive days. The correlation between the LSA and the SAM was performed using Pearson's correlation. The measurement properties calculated of remote LSA were the intraclass correlation coefficient (ICC), Cronbrach's alpha, standard error of measurement (SEM), and smallest real difference (SRD). Results The reproducibility of the LSA scale between remote and face-to-face applications was considered excellent with ICC = 0.85 (IC 95% 0.62-0.94); SEM = 8.4; SRD = 23.2, and Cronbach's alpha = 0.85. The correlation between SAM and LSA was positive, considered moderate (r = 0.51) and significant (p = 0.025). Conclusion The LSA is a reproducible measure for post-stroke chronic hemiparetic patients even if applied remotely and can be used as a remote measurement for mobility in a real-world environment for people with chronic hemiparesis after stroke.

Resumo Antecedentes O StepWatch Activity Monitor (SAM) é utilizado para medir a mobilidade de pacientes hemiparéticos crônicos e a escala Life Space Assessment (LSA) avalia o deslocamento de pacientes hemiparéticos em diferentes contextos por meio de autorrelato. Não foram encontrados estudos que tenham aplicado a LSA remotamente nem que a correlacionam com o número de passos mensurados pelo SAM. Objetivo Avaliar as propriedades de medida da LSA aplicada remotamente e avaliar a correlação entre o escore da escala LSA e o número de passos mensurados pelo SAM em pacientes com hemiparesia crônica pós-AVC. Métodos Dezenove participantes responderam a LSA remotamente e, posteriormente, presencialmente. O SAM mediu os passos dados pelos participantes durante um período de três dias consecutivos. A correlação entre a LSA e o SAM foi realizada por meio da correlação de Pearson. As propriedades de medida calculadas da LSA aplicada remotamente foram o coeficiente de correlação intraclasse (ICC), alfa de Cronbrach, erro do padrão de medida (SEM) e menor diferença real (SRD). Resultados A reprodutibilidade da escala LSA entre as aplicações remotas e presenciais foi considerada excelente com ICC = 0,85 (IC 95% 0,62-0,94); SEM = 8,4; SRD = 23,2 e alfa de Cronbrach = 0,85. A correlação entre SAM e a LSA foi positiva, considerada moderada (r = 0,51) e significativa (p= 0,025). Conclusão A LSA é uma medida reprodutível para pacientes hemiparéticos crônicos pós-AVC mesmo se aplicada remotamente e pode ser usada como uma medida remota de mobilidade em ambiente real para pessoas com hemiparesia crônica após AVC.

Awareness of stroke among patients with chronic kidney disease on hemodialysis: a cross-sectional study

ABSTRACT BACKGROUND: Stroke is a major cause of mortality worldwide. Renal dysfunction is an important risk factor for stroke. Brazilian studies on stroke knowledge are generally population based. Studies stratifying stroke knowledge according to comorbidities are rare. Scientific data are essential to guide the awareness of stroke. OBJECTIVE: To assess stroke knowledge in patients with chronic kidney disease (CKD) on hemodialysis. DESIGN AND SETTING: Cross-sectional analytical study of patients with CKD on hemodialysis in north-eastern Brazil. METHODS: A self-administered questionnaire survey on stroke awareness was administered to patients with CKD on hemodialysis between April and November 2022. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 197 patients were included in the analysis. The Brazilian acronym for stroke was used by 53.5% of the participants. Less than 10.0% of the sample showed optimal decision-making ability regarding stroke. Of the participants, 29.9% knew at least one risk factor and one symptom; however, this was considered as having below the minimum capacity because they did not know the emergency service call number. In the analysis adjusted for income and education, females (odds ratio [OR], 0.40%; 95% confidence interval [CI], 0.20-0.82), older patients (OR, 0.24%; 95% CI, 0.09-0.63) and having at most one comorbidity (OR, 0.48%; 95% CI, 0.23-0.98) were factors for lower levels of knowledge or ideal decision-making capacity against stroke. CONCLUSIONS: Patients on hemodialysis, especially women and older people, have little knowledge about stroke.

Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação / Functional independence, clinical aspects, and sociodemographic factors in patients in the acute phase of stroke: an association analysis

RESUMO Objetivo Analisar a associação da independência funcional com aspectos clínicos de comprometimento neurológico, a localização e extensão do dano neuronal e os fatores sociodemográficos em pacientes na fase aguda do AVC. Método Estudo analítico de recorte transversal, realizado com 90 pacientes adultos e idosos acometidos por AVC isquêmico, que tiveram admissão no ambiente hospitalar nas primeiras 24 horas após o evento vascular. A coleta dos dados referentes aos aspectos clínicos e fatores sociodemográficos foi realizada pelo prontuário eletrônico e/ou entrevista para descrever o perfil dos pacientes, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale e a Medida de Independência Funcional. Resultados O comprometimento neurológico, de acordo com a National Institute of Health Stroke Scale, foi associado à funcionalidade nas primeiras 24 horas após o AVC. Além disso, a presença de hipertensão arterial, idade, trabalho inativo, tabagismo e extensão do dano neuronal estiveram associados à dependência funcional, mas não permaneceram no modelo final deste estudo. Conclusão A dependência funcional está associada à hipertensão arterial, idade, trabalho inativo, tabagismo, extensão do dano neuronal e grau de comprometimento neurológico nas primeiras 24 horas após o evento vascular. Além disso, um nível mais elevado de comprometimento neurológico foi independentemente associado a níveis aumentados de dependência funcional.

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

Ocular disorders among stroke patients in Federal Teaching Hospital, Lokoja, Nigeria

Objectives:To determine the pattern of ocular disorders among stroke patients in Federal Teaching Hospital, Lokoja (FTHL).Materials and Methods:Consecutive new stroke patients seen at the Federal Teaching Hospital, Lokoja over a 3-month period were studied. Data was collected with the use of a structured questionnaire divided into four major sections: bio-data, visual history, results of ocular assessment and NEI VFQ-25 quality of life questionnaire. Data analysis was done using SPSS for Windows, version 23.0. Univariate analyses were presented in the form of frequencies, percentages, means, ranges, and standard deviations, charts and tables.Results:Eighty-three patients were recruited with an age range of 40-71 years, a mean age of 55.3(±7.1) years. Thirty-nine patients (47.0%) were between the ages of 51 and 60 years. Thirty-four (41.0%) patients were females while 49(59.0%) were males. Of 46 (55.4%) patients that had neuro-imaging, stroke was ischaemic in 37(80.4%) and haemorrhagic in 9(19.6%). Of the 63 patients with left sided stroke, 2 (2.4%), 4(4.8%) and 57(68.7%) had severe, moderate and mild and normal visual impairment respectively while of the 20 patients with right sided stroke, 3(3.6%) each had severe and moderate visual impairment and 14(16.9%) had normal or mild visual impairment. Other ocular abnormalities included corneal anaesthesia and macular hole in 2(1.2%).Conclusion:Anterior and posterior segments, together with neuro-ophthalmic disorders were found among stroke patients in this study. Many of the ocular abnormalities are as a result of long-standing uncontrolled hypertension which caused the stroke. It is recommended that awareness should be created among the populace about uncontrolled hypertension. It is also advised that internists should refer hypertensive patients for routine ophthalmic screening.

Mortalité à long terme des survivants d'accidents vasculaires cérébraux ischémiques à Bobo Dioulasso, Burkina Faso / Long-term mortality of ischaemic stroke survivors in Bobo-Dioulasso, Burkina Faso

Contexte et objectif. La survie à long terme des accidents vasculaires cérébraux ischémiques (AVCI) reste un défi majeur. L'objectif de ce travail était d'analyser la mortalité à long terme des survivants d'AVCI. Méthodes. Il s'est agi d'une cohorte rétrospective portant sur les patients hospitalisés du 1er janvier 2017 au 31 décembre 2019, sortis vivants du service de neurologie au Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso après un AVCI. Nous avons recouru aux méthodes de Kaplan Meier et la regression de Cox pour décrire respectivement la survie et les prédicteurs de la mortalité. Résultats. Au total, 87 patients dossiers ont été colligés. L'âge moyen était de 61,2 ans (±13,7). Le sex-ratio M/F était de 1,23/1. L'hypertension artérielle était le principal facteur de risque cardiovasculaire (65,5 %). Les antécédents de cardiopathies étaient présents chez 6 patients. La conscience était normale chez 82 patients et les complications de décubitus ont été observées chez 20 patients au cours de l'hospitalisation. La durée moyenne d'hospitalisation était de 15,8 jours. La mortalité cumulée en post hospitalisation était de 40,2 % à 4 ans. Les facteurs prédictifs de la mortalité étaient l'âge > 60 ans (p=0,008; HRa= 3,05 ; IC 95 % : 1,33-6,99), le score de Glasgow>9 (p<0,001; HRa = 0,09; IC 95 % : 0,02-0,31) et l'absence de complication de décubitus (p=0,009; HRa = 0,34; IC95 % : 0,15-0,76). Conclusion. Dans ce contexte, la mortalité à long terme des AVCI est élevée. Le renforcement du suivi vis-à-vis des groupes spécifiques pourrait contribuer à réduire considérablement cette mortalité à long terme.

Context and objective. Long-term survival from ischaemic stroke remains a major challenge. The aim of this study was to analyse the long-term mortality of stroke survivors at the Sourô Sanou University Hospital in Bobo-Dioulasso. Methods. This was a retrospective cohort of hospitalized patients from January 1, 2017 to December 31, 2019, discharged alive from the neurology service after ischaemic stroke. We used Kaplan Meier and Cox regression methods to describe survival and predictors of mortality, respectively. Results. A total of 87 patients were included in this study. The mean age was 61.2 years (±13.7). The sex ratio M/F was 1.23. Hypertension was the main cardiovascular risk factor (65.5%). A history of heart disease was present in 6 patients (6.9%). Consciousness was normal in 82 patients (94.2%) and decubitus complications were observed in 20 patients (23%) during hospitalisation. The average length of hospital stay was 15.8 days. Cumulative post-hospital mortality was 40.2% at 4 years. Factors predictive of mortality were age >60 years (p=0.008; aHR= 3.05; 95%CI: 1.33-6.99), Glasgow score>9 (p<0.001; aHR = 0.09; 95% CI: 0.02-0.31) and absence of decubitus complication (p=0.009; aHR = 0.34; 95%CI: 0.15-0.76). Conclusion. In this context, long-term mortality in ischaemic stroke is high. Closer monitoring of specific groups could help to reduce considerably this long-term mortality.

Hyperglycémie de stress: prévalence et impact sur la mortalité intra hospitalière au cours des accidents vasculaires cérébraux ischémiques à la phase aigue au Centre Hospitalier Universitaire Yalgado Ouédraogo, Burkina Faso / Stress hyperglycemia: Prevalence and impact on intra-hospital mortality during ischemic strokes in the acute phase at the Yalgado Ouédraogo University Hospital, Burkina Faso

Contexte et objectif. L'hyperglycémie de stress est fréquente et délétère à la phase aigüe de l'accident vasculaire cérébral ischémique. L'objectif de la présente étude était de déterminer la prévalence de l'hyperglycémie de stress à la phase aigüe de l'AVCI et d'analyser son impact sur la mortalité intra hospitalière Méthodes. Il s'est agi d'une série retrospective de cas qui s'est déroulée du 1er janvier 2021 au 31 Décembre 2022 dans les services des urgences médicales et de Neurologie du Centre hospitalier Yalgado Ouédraogo. Les patients non diabétiques de plus de 15 ans hospitalisés pour un AVCI confirmé par une imagerie cérébrale et ayant une hyperglycémie avec une hémoglobine glyquée normale ont été inclus. Résultats. La prévalence de l'hyperglycémie de stress était de 37,8 %. L'âge moyen était de 59,98 ± 15,9 ans avec des extrêmes de 20 et 98 ans. Le sex-ratio M/F était de 1,12/1. Les facteurs de risque vasculaire les plus fréquents étaient l'hypertension artérielle (54,1 %), la sédentarité (20,3 %) et l'antécédent personnel d'AVC (11 %). Le taux moyen de l'hyperglycémie était de 8,8 ± 2,2mmol/l avec des extrêmes de 7,0 à 15,3 mmol/l. La mortalité intra hospitalière était de 13,37 %. L'hyperglycémie à l'admission ≥ 7mmol/l (p= 0,0027) la température ≥ 38,5° à l'admission (p= 0,0107) et l'insuffisance cardiaque (p= 0,0045) ont émergé comme prédicteurs indépendants de la mortalité intra-hospitalière. Conclusion. L'hyperglycémie de stress est associée à un mauvais pronostic au cours de la phase aigüe des AVCI d'où la nécessité d'un monitorage de la glycémie et d'une prise en charge adaptée

Context and objective. Neonatal jaundice is a common symptom. The objective of the present study was to update the epidemiological profile and identify the factors associated with neonatal jaundice in sick newborns. Methods. A descriptive cross-sectional study was conducted from June 2022 to April 2023 at the Kinshasa University Hospital. The study included sick newborns who presented with mucocutaneous jaundice. Sociodemographic, perinatal, clinical and paraclinical variables were sought. Results. Out of 152 sick newborns, 102 (67.1 %) cases of jaundice were identified. Fullterm newborns (72.5 %), born vaginally (67.6 %) and whose mothers had presented with urogenital infections (98 %) and blood group O (53 %) rhesus positive (97.1 %) were the most represented. Jaundice appeared in the first week of life (85.3 %). Baseline total serum bilirubin was between 10 and 15 mmol/L (57.8 %). The infectious origin was noted in 85 % of cases (Klebsiella pneumoniae in 50 % of cases). Conventional phototherapy was used in 74.5 %. Vaginal delivery was the only associated factor (p=0.001). Conclusion. Neonatal jaundice is common in sick newborns. The infectious etiology must be systematically sought. Appropriate management helps reduce the occurrence of neurosensory after effects.

Health management demand among occupational populationat high risk of stroke / 预防医学

Objective @#Objective To investigate the demand for health management and influencing factors among occupational population at high risk of stroke, so as to provide insights into the development of stroke health management strategies among occupational population.@*Methods@#Occupational population aged 40 to 60 years who participated in health examination were sampled from three tertiary hospitals in Luzhou City, Sichuan Province using a quota sampling method in the ratio of 4∶1∶1, from August to December 2020. Participants' blood biochemistry tests and health examination were collected through the examination reports, and the participants at high risk of stroke were screened using the assessment criteria for high-risk of stroke. Participants' general information and demand for health management were collected using questionnaire surveys. In addition, factors affecting the demand for health management were identified using a multivariable logistic regression model. @*Results@#A total of 3 003 people who participated in health examination were investigated, and 1 062 participants met the assessment criteria for high risk of stroke, accounting for 35.36%. There were 1 000 men (94.16%) and 62 women (5.84%), with a mean age of (49.26±4.97) years. There were 414 professional and technical staff (39.50%). There were 709 participants (66.76%) with demand for health management, with the top three in the demand as health checkups (915 participants, accounting for 86.16%), health consultation (601 participants, accounting for 56.60%) and exercise guidance (560 participants, accounting for 52.73%), and 210 participants (19.77%) received health management. Multivariable logistic regression analysis showed that occupational population at high risk of stroke who received health management were more likely to have the demand for health management (OR=2.158, 95%CI: 1.479-3.149). @*Conclusions@#The occupational population at high risk of stroke have the demand for health management. Having received health management may affect the demand for health management among occupational population at high risk of stroke.

Effect and Mechanism of N-acetylcysteine in Ischemic Stroke / 中山大学学报(医学科学版)

Ischemic stroke （CIS） refers to ischemic necrosis or softening of localized brain tissue caused by cerebral blood circulation disorders， ischemia and hypoxia. The incidence of CIS is the highest among cerebrovascular diseases. Reduced supply of oxygen and nutrients leads to severe loss of neurons and deficits in brain function in stroke patients. Developing treatments for ischemic stroke remains an important challenge in clinical medicine. The antioxidant N-acetylcysteine （NAC） is a precursor of glutathione， and evidence from animal models of ischemic stroke and some clinical studies suggest that NAC can effectively protect the brain from ischemic damage. In this paper， the mechanism of NAC in CIS is described from various aspects， such as anti-oxidation， inhibition of inflammation， protection of cerebral nerve and mitochondrial function， stabilization of arterial plaque and thrombolytic function， aiming to explore the relationship between NAC and CIS in depth from the basic level， and to provide a theoretical basis for the further application of NAC in the prevention and treatment of patients with ischemic stroke.

Advances in Neuromuscular Electrical Stimulation in Post-Stroke Movement Disorders / 中山大学学报(医学科学版)

In recent years， the incidence of stroke patients in China is increasing， and the motor dysfunction caused by it often seriously affects the quality of daily life of the patients， Neuromuscular electrical stimulation （NMES）， as an emerging rehabilitation therapy， is widely used in the treatment of motor dysfunction in stroke patients. This paper summarizes the parameters and mechanisms of the role of NMES in motor function rehabilitation after stroke and its use in clinical practice. In the future， the specific mechanism of NMES action and efficient and safe therapeutic options should be further explored.

Recent progress of targeting Nrf2-ferroptosis to treat brain injury after ischemic stroke / 中国临床药理学与治疗学

Emerging evidences suggest that ferroptosis plays a vital role in the pathophysiological process of brain injury after Ischemic stroke. Accumulating evidence supports pharmacological inhibition of ferroptosis as a therapeutic target for brain injury after Ischemic stroke through activating nuclear factor erythroid 2-related factor 2 (Nrf2), which transcriptionally controls many key components of the ferroptosis pathway. In this review, briefly describe ferroptosis processes and the roles they play in contributing to brain injury after ischemic stroke in the brain. We then provide a critical overview of the relationship between Nrf2 signalling and ferroptosis. With a focus on discuss how therapeutic modulation of the Nrf2 pathway is a viable strategy to explore in the treatment of ferroptosis-driven brain injury after Ischemic stroke.