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2.
Int. j. cardiovasc. sci. (Impr.) ; 34(5): 517-522, Sept.-Oct. 2021. tab
Article in English | LILACS | ID: biblio-1340060

ABSTRACT

Abstract Background: Stroke related to atrial fibrillation (AF) is associated with high recurrence and mortality rates. Embolic Stroke of Undetermined Source (ESUS) is associated with fewer vascular risk factors, less disability, and a high recurrence rate. Objective: To compare risk factors, functional outcomes and the occurrence of primary endpoint (a composite of recurrent stroke, cardiovascular death, and myocardial infarction) between AF stroke and ESUS patients. Method: A retrospective analysis was conducted including all consecutive patients with first-ever ischemic stroke admitted to the Hospital de Clinicas (Clinical Hospital) of the Federal University of Paraná from October 2012 to January 2017 (n=554). There were 61 patients with stroke due to AF and 43 due to ESUS. Both groups were compared for demographic characteristics and vascular risk factors. Logistic regression models were performed to assess the impact of each variable on the primary endpoint in a 12-month follow-up. Statistical significance was considered for p-values < 0.05. Results: ESUS patients, as compared to AF patients, were younger and more likely to be smokers. ESUS patients presented a mean CHADS2VASc score of 4, while the AF group presented a score of 5 (p <0.001). The primary endpoint was observed in 9 (20.9%) ESUS and 11 (18.0%) AF patients over a 12-month period (p=0.802). Higher glucose levels upon hospital admission (p=0.020) and a higher modified Rankin Scale upon hospital discharge (p=0.020) were predictors of the primary endpoint occurrence. Conclusion: AF and ESUS stroke patients presented very similar independence rates upon hospital discharge and outcomes after 12 months, despite some baseline differences, including stroke recurrence, vascular death, and myocardial infarction.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Stroke/complications , Heart Disease Risk Factors , Sociodemographic Factors , Patient Discharge , Atrial Fibrillation , Retrospective Studies , Stroke/etiology , Stroke/mortality , Stroke/epidemiology , Brain Infarction , Intracranial Embolism , Measures of Association
3.
Rev. cuba. anestesiol. reanim ; 20(2): e688, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289349

ABSTRACT

Introducción: El accidente cerebrovascular es una de las causas más comunes de mortalidad a nivel mundial. Objetivo: Determinar la asociación existente entre el desarrollo de afecciones neurológicas y la necesidad de ventilación mecánica con el aumento de la incidencia de mortalidad en la unidad de cuidados intensivos. Métodos: Estudio observacional, prospectivo de corte transversal, realizado en la unidad de cuidados intensivos de un hospital de atención secundaria. La población de estudio estuvo constituida por 52 pacientes con accidente cerebrovascular los cuales recibieron soporte respiratorio artificial entre los años 2018 y 2020. La variable de interés final fue la mortalidad. Los factores neurológicos estudiados fueron el tipo de accidente cerebrovascular, puntuación de la escala de coma de Glasgow, ausencia de reflejos de tallo encefálico, anisocoria y complicaciones neurológicas. El nivel de significación se halló según p valor ≤ 0,05 a través de Chi cuadrado de independencia. Resultados: La mortalidad proporcional predominó en el accidente cerebrovascular hemorrágico tipo hemorragia intracraneal no traumática (p= 0,118), ausencia de reflejos del tallo encefálico (p=0,000), anisocoria (p=0,000), escala de coma de Glasgow <8 puntos (p=0,000) y complicaciones neurológicas como la hipertensión endocraneana (p=0,010). Conclusiones: Los factores neurológicos asociados a la mortalidad fueron la ausencia de reflejos del tallo encefálico, anisocoria, escala de coma de Glasgow <8 puntos y complicaciones neurológicas como la hipertensión endocraneana(AU)


Introduction: Cerebrovascular accident is one of the commonest causes of mortality in the world. Objective: To determine the association between development of neurological disorders and the need for mechanical ventilation with an increased incidence of mortality in the intensive care unit. Methods: An observational, prospective and cross-sectional study was carried out in the intensive care unit of a secondary care hospital. The study population consisted of 52 patients with cerebrovascular accident who received artificial respiratory support between 2018 and 2020. The final variable of interest was mortality. The neurological factors studied were type of cerebrovascular accident, score according to the Glasgow coma scale, absence of brainstem reflexes, anisocoria, and neurological complications. The level of significance was determined according to P ≤ 0.05, through chi-square of independence. Results: Proportional mortality prevailed in hemorrhagic cerebrovascular accident of nontraumatic intracranial hemorrhage type (P=0.118), absence of brainstem reflexes (P=0.000), anisocoria (P=0.000), score of less than eight points according to the Glasgow coma scale (P=0.000), and neurological complications such as endocranial hypertension (P=0.010). Conclusions: The neurological factors associated with mortality were absence of brainstem reflexes, anisocoria, score of less than eight points according to the Glasgow coma scale, and neurological complications such as endocranial hypertension(AU)


Subject(s)
Humans , Stroke/mortality , Respiration, Artificial/adverse effects , Secondary Care , Cross-Sectional Studies , Prospective Studies , Intensive Care Units , Nervous System Diseases/complications
4.
Article in English | WPRIM | ID: wpr-880334

ABSTRACT

BACKGROUND@#Previous studies have suggested that exposure to air pollution may increase stroke risk, but the results remain inconsistent. Evidence of more recent studies is highly warranted, especially gas air pollutants.@*METHODS@#We searched PubMed, Embase, and Web of Science to identify studies till February 2020 and conducted a meta-analysis on the association between air pollution (PM@*RESULTS@#A total of 68 studies conducted from more than 23 million participants were included in our meta-analysis. Meta-analyses showed significant associations of all six air pollutants and stroke hospital admission (e.g., PM@*CONCLUSIONS@#Exposure to air pollution was positively associated with an increased risk of stroke hospital admission (PM


Subject(s)
Air Pollutants/adverse effects , Air Pollution/adverse effects , Environmental Exposure/adverse effects , Hospitalization/statistics & numerical data , Humans , Incidence , Particle Size , Particulate Matter/adverse effects , Stroke/mortality
5.
Ciencia Tecnología y Salud ; 8(2): 202-210, 2021. il 27 c
Article in Spanish | LILACS-Express | LILACS, LIGCSA, DIGIUSAC | ID: biblio-1353113

ABSTRACT

La medición de las desigualdades en salud al interior de los países de ingresos bajos y medios es necesaria para la planificación, monitoreo y evaluación de intervenciones de salud pública, especialmente para problemas que contribuyen altamente a la carga de enfermedad, como las enfermedades cardiometabólicas. El objetivo de este estudio fue caracterizar los patrones de desigualdad de las tasas de mortalidad para las principales causas cardiometabólicas en Guatemala. Se usó datos del Censo Nacional de Población, y estadísticas oficiales de de-función de 2018 para calcular tasas crudas de mortalidad para diabetes (DM), infarto agudo de miocardio (IAM), y accidente cerebrovascular (ACV). Se calcularon indicadores simples y complejos de desigualdad absoluta y relativa (diferencia, razón, índice de pendiente, índice de concentración, distancia de la media, índice de Theil, riesgo atribuible poblacional, y porcentaje de riesgo atribuible poblacional) para seis dimensiones de desigualdad: sexo, pueblo de pertenencia, nivel educativo, tipo de ocupación, departamento y municipio. Se documentaron 6,445 muertes por DM, 5,761 por IAM, y 3,218 por ACV. Los indicadores mostraron marcadas desigualdades para las seis dimensiones estudiadas. El patrón de desigualdad predominante para sexo, pueblo de pertenencia y departamento fue de privación masiva. Para nivel educativo y ocupación predominó un patrón de incrementos escalonados. Se identificó exclusión marginal superpuesta en nivel educativo, ocupación y municipio. Se concluye que los patrones de desigualdad de las tasas de mortalidad para estas tres enfermedades sugieren la superposición de patrones de privación masiva, incrementos escalonados, y exclusión marginal.


Measuring health inequalities within low- and middle-income countries is needed for planning, monitoring, and evaluation of public health interventions, especially for problems that represent a high burden of disease, like cardio metabolic diseases. The goal of this study was to characterize inequality patterns in mortality rates from cardio metabolic causes in Guatemala. Data from the 2018 National Population Census, and official vital statistics were used to estimate crude mortality rates for diabetes (DM), acute myocardial infarction (IAM), and stroke (ACV). Simple and complex indicators of absolute and relative inequality (difference, ratio, slope index, concentration index, distance from the mean, Theil index, population attributable risk, and percentage of popula-tion attributable risk) were calculated for six dimensions of inequality: sex, race/ethnicity, education level, type of occupation, department, and municipality. A total of 6,445 DM deaths, 5,761 IAM deaths, and 3,218 ACV deaths were documented. Indicators showed marked inequalities for the six dimensions studied. Massive deprivation was the predominant inequality pattern for sex, race/ethnicity, and department. Staggered increments were iden-tified for education level and type of occupation. Overlapping marginal exclusion was found for education level, occupation, and municipality. We conclude that inequality patterns found for the three causes of death suggest overlapping patterns of mass deprivation, staggered increments, and marginal exclusion.


Subject(s)
Humans , Male , Female , Cause of Death , Stroke/mortality , Metabolic Diseases/mortality , Socioeconomic Factors , Ethnicity , Vital Statistics , Health Status Indicators , Guatemala/epidemiology , Occupations/economics
6.
Rev. bras. neurol ; 56(4): 11-16, out.-dez. 2020. tab
Article in English | LILACS | ID: biblio-1140801

ABSTRACT

OBJECTIVE: To determine the frequency of mortality, length of stay and nosocomial pneumonia outcomes, as well as their distribution according to predictor variables, in stroke patients treated at the emergency room of a tertiary hospital. METHODS: A retrospective cohort study, with a sample of patients attended between January 1 and December 31, 2018. Based on the data collected in the medical records, the sample was characterized. Therefore, the frequency of each outcome was checked, as well as its distribution according to the predictor variables. RESULTS: The sample population consisted of 210 patients. The frequencies observed in death and nosocomial pneumonia were 17.6% and 17.1%, respectively. The general mean length of stay was 13.8 ±12.9 days. Statistically significant differences were observed both in the occurrence of nosocomial pneumonia and atrial fibrillation (AF); days of hospitalization in intensive care unit; total days of hospitalization; orotracheal intubation; use of nasoenteral tube and surgical procedure secondary to stroke. Morever, there was also the relation of total time of hospitalization regarding dyslipidemia; orotracheal intubation; use of nasoenteral tube and surgical procedure secondary to stroke. CONCLUSION: The results found in the frequency of mortality, nosocomial pneumonia and mean total number of days of hospitalization are comparable with other Brazilian studies. However, it is possible to optimize the time of care provided for patients who arrive in the emergency room. In addition, the decrease of hospitalization days in dyslipidemic patients and the increase of nosocomial pneumonia in AF patients require further studies to verify such findings


OBJETIVO: Averiguar a frequência dos desfechos mortalidade, tempo de internação e pneumonia nosocomial, bem como sua distribuição de acordo com variáveis preditoras, em pacientes vítimas de acidente vascular cerebral (AVC) atendidos na emergência de um hospital terciário. MÉTODOS: Estudo de coorte retrospectiva, com uma amostra de pacientes atendidos entre 1º de janeiro e 31 de dezembro de 2018. Com base nos dados coletados em prontuário, a amostra foi caracterizada. Desta forma, foi verificada a frequência de cada desfecho e sua distribuição conforme as variáveis preditoras. RESULTADOS: A população da amostra foi de 210 pacientes. A frequência observada em óbito e pneumonia nosocomial foi de 17,6% e 17,1%, respectivamente. O tempo médio geral de internação foi de 13,8 ±12,9 dias. Foram observadas diferenças estatisticamente significativas, tanto na ocorrência de pneumonia nosocomial quanto a fibrilação atrial (FA); dias de internação em unidade de terapia intensiva; total de dias de internação; intubação orotraqueal; uso de sonda nasoenteral e procedimento cirúrgico secundário ao AVC. Além disso, verificou-se também a relação de tempo total de internação quanto à dislipidemia; intubação orotraqueal; uso de sonda nasoenteral e procedimento cirúrgico secundário ao AVC. CONCLUSÃO: Os resultados encontrados na frequência de mortalidade, pneumonia nosocomial e média do número total de dias de hospitalização são comparáveis com outros estudos brasileiros. Entretanto, é possível otimizar o tempo de atendimento dos pacientes que chegam ao pronto-socorro. Ademais, a diminuição dos dias de hospitalização em pacientes dislipidêmicos e o aumento da pneumonia nosocomial em pacientes com FA necessitam mais estudos para verificar tais achados


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Stroke/mortality , Stroke/epidemiology , Retrospective Studies , Risk Factors , Mortality , Healthcare-Associated Pneumonia , Hospitalization , Length of Stay/statistics & numerical data
7.
Medicina (B.Aires) ; 80(3): 211-218, jun. 2020. graf, tab
Article in Spanish | LILACS | ID: biblio-1125072

ABSTRACT

La terapia endovascular (TEV) es el tratamiento estándar del ataque cerebrovascular isquémico (ACVi) con oclusión de gran vaso (OGVC). Aún no se conoce si esos resultados pueden generalizarse a la práctica diaria. Se describen los resultados de la TEV en pacientes con ACVi por OGVC dentro de las 24 horas, en un análisis retrospectivo entre enero 2013 y diciembre 2017 que incluyó 139 casos consecutivos con ACVi y OGVC en arteria cerebral media (ACM), hasta 24 horas del inicio de los síntomas, que recibieron TEV en nuestra institución. El resultado primario medido fue la escala de Rankin modificada (mRS) ≤ 2 a 90 días. Se evaluaron también: reperfusión exitosa, según la escala modificada de trombólisis en infarto cerebral (mTICI) 2b/3, hemorragia intracraneal sintomática (HIS) y mortalidad a 90 días. La edad media: 67.5 ± 15.0, siendo el 51.8% mujeres. La mediana basal de National Institute of Health Stroke Scale (NIHSS) fue 14 (IIC 8-18); la mediana del tiempo desde inicio de síntomas hasta punción inguinal: 331 min (IIC 212-503). El 45.3%, 63 pacientes, fueron tratados > 6 horas después del inicio de síntomas. La tasa de mRS ≤ 2 fue 47.5%. Se logró una reperfusión exitosa en el 74.8%. La tasa de mortalidad a 90 días fue del 18.7% y la HIS del 7.9%. Nuestro registro de pacientes de la vida real con ACVi por OGVC tratados con TEV dentro de las 24 horas mostró altas tasas de reperfusión, buenos resultados funcionales y pocas complicaciones, acorde con las recomendaciones internacionales.


Endovascular treatment (EVT) has become the standard of care for acute ischemic stroke (AIS) with proximal large vessel occlusions (LVO). However, it is still unknown whether these results can be generalized to clinical practice. We aimed to perform a retrospective review of patients who received EVT up to 24 hours, and to assess safety and efficacy in everyday clinical practice. We performed a retrospective analysis, from January 2013 to December 2017, on 139 consecutive patients with AIS for anterior circulation LVO strokes up to 24 h from symptoms onset, who received EVT in our institution. The primary outcome measured was a modified Rankin scale (mRS) ≤ 2 at 90 days. Secondary outcomes included successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) scale 2b/3, mortality rate at 90 days and symptomatic intracranial hemorrhage (sICH). The mean age was 67.5 ± 15.0, with 51.8% female patients. Median baseline National Institute of Health Stroke Scale (NIHSS) was 14 (IQR 8-18); median time from symptom onset to groin puncture was 331 min (IQR 212-503). Sixty-three patients (45.3%) were treated beyond 6 hours after symptoms onset. The rate of mRS ≤ 2 was 47.5%. Successful reperfusion was achieved in 74.8 %. Mortality rate at 90 days was 18.7 % and sICH was 7.9 %. Our registry of real-life patients with AIS due to LVO who received EVT within 24 hours showed high reperfusion rates, and good functional results with few complications, according to international recommendations.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Brain Ischemia/surgery , Stroke/surgery , Infarction, Middle Cerebral Artery/surgery , Endovascular Procedures/methods , Argentina , Time Factors , Severity of Illness Index , Brain Ischemia/mortality , Retrospective Studies , Risk Factors , Treatment Outcome , Stroke/mortality , Infarction, Middle Cerebral Artery/mortality , Endovascular Procedures/mortality
8.
Arq. neuropsiquiatr ; 78(3): 158-162, Mar. 2020. tab
Article in English | LILACS | ID: biblio-1098072

ABSTRACT

Abstract Ischemic stroke is a common cause of death. The role of statins in the secondary prevention of the chronic ischemic stroke phase has been established. However, evidence regarding their efficacy in this phase is limited and contradictory. Objective: To evaluate the association between statin use and mortality risk during the acute phase of ischemic stroke in patients admitted to an intensive care unit. Methods: This was an observational and prospective study of ischemic stroke patients aged ≥18, admitted to an intensive care unit. Medications used during the first 7 days after the ictus, as well as medications used previously, were recorded. The primary outcome was all-cause mortality during the first 7 days. Results: We screened 212 patients and included 97 patients with ischemic stroke in the study period. The mortality rate among patients who used statins during the acute IS phase [14% (9/63)] was significantly lower than that among patients who did not use statins [41% (14/34); p=0.007]. This was confirmed in logistical regression with an 0.19 Odds Ratio - OR [p=0.018; 95% confidence interval - 95%CI 0.05-0.75]. Patients who died were older, had a higher incidence of acute myocardial infarction, higher scores on the NIHSS and lower systolic blood pressure. Statins and angiotensin converting enzyme inhibitors were used more frequently among survivors. These associations persisted even after adjustment for confounding variables. Conclusion: Statins and angiotensin converting enzyme inhibitors use during hospitalization were independently associated to a lower rate of all-cause mortality in the first 7 days of intensive care unit admission.


Resumo O acidente vascular cerebral (AVC) isquêmico é uma causa comum de morte. O papel das estatinas na prevenção secundária da fase crônica do AVC isquêmico foi estabelecido. No entanto, as evidências sobre a sua eficácia na fase aguda do AVC isquêmico são limitadas e contraditórias. Objetivo: Avaliar a associação entre o uso de estatinas e o risco de mortalidade durante a fase aguda do AVC isquêmico em pacientes internados em uma unidade de terapia intensiva. Métodos: Estudo observacional e prospectivo de pacientes com AVC isquêmico com idade ≥18 anos, internados em uma unidade de terapia intensiva. Os medicamentos utilizados durante os primeiros 7 dias após o ictus, bem como os medicamentos utilizados anteriormente, foram registrados. O desfecho primário foi mortalidade por todas as causas durante os primeiros 7 dias. Resultados: Foram selecionados 212 pacientes e incluídos 97 pacientes com AVC isquêmico no período do estudo. A taxa de mortalidade entre os pacientes que usaram estatinas durante a fase aguda do AVC [14% (9/63)] foi significativamente menor do que a dos pacientes que não usaram estatinas [41% (14/34); p=0,007]. Isso foi confirmado na regressão logística com Odds Ratio - OR 0,19 [p=0,018; intervalo de confiança de 95% - IC95% 0,05-0,75]. Os pacientes que morreram eram mais velhos, apresentavam maior incidência de infarto agudo do miocárdio, escores mais altos na National Institute of Health Stroke Scale (NIHSS) e menor pressão arterial sistólica. Estatinas e inibidores da enzima conversora de angiotensina foram utilizados com maior frequência entre os sobreviventes. Essas associações persistiram mesmo após o ajuste para variáveis de confundimento. Conclusão: O uso de estatinas e inibidores da enzima conversora de angiotensina durante a hospitalização foram associados de forma independente à uma menor taxa de mortalidade por todas as causas nos primeiros 7 dias de internação na unidade de terapia intensiva.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Prospective Studies , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Stroke/mortality , Stroke/drug therapy , Brain Ischemia/mortality , Brain Ischemia/drug therapy , Hospitalization , Intensive Care Units
9.
Int. j. cardiovasc. sci. (Impr.) ; 32(5): 460-470, Sept-Oct. 2019. tab, graf, graf
Article in English | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1040110

ABSTRACT

In atrial fibrillation (AF), the CHA2DS2-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique. Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA2DS2VASc score. Methodology: A total of 247 patients were divided into three groups considering the CHA2DS2-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted. Results: The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions: The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA2DS2VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation , Thrombosis , Echocardiography, Transesophageal/methods , Stroke/mortality , Stroke Volume , Magnetic Resonance Spectroscopy/methods , Tomography/methods , Data Interpretation, Statistical , Retrospective Studies , Risk Factors , Atrial Appendage , Diabetes Mellitus , Heart Failure , Hypertension
10.
J. bras. nefrol ; 41(3): 323-329, July-Sept. 2019. tab, graf
Article in English | LILACS, SESSP-IDPCPROD, SES-SP | ID: biblio-1040257

ABSTRACT

Abstract Introduction: The occurrence of acute kidney injury (AKI) after ischemic stroke has been associated to a worse prognosis. There is a lack of Brazilian studies evaluating this issue. This study aimed to describe the impact of AKI after a first-ever ischemic stroke in relation to fatality rate in 30 days. Methods: This was a retrospective hospital-based cohort. We included patients who had their first ischemic stroke between January to December 2015. AKI was defined by an increase of serum creatinine in relation to baseline value at admission ≥ 0.3 mg/dL or a rise in serum creatinine level by 1.5 times the baseline value at any point in the first week after admission. We performed a univariate and multivariate analysis to evaluate the presence of AKI with fatality in 30 days. Results: The final study population (n=214) had mean age of 66.46 ± 13.73 years, 48.1% were men, the mean NIHSS was 6.33 ± 6.27 and 20 (9.3%) presented AKI. Patients with AKI were older, had a higher score on the NIHSS, and had higher creatinine values on hospital discharge. The 30-day mortality was higher in the AKI subgroup compared to non-AKI (35% vs. 6.2%, p < 0.001). AKI was an independent predictor of fatality after an ischemic stroke but limited by severity of stroke (NIHSS). Conclusion: The presence of AKI is an important complication after ischemic stroke. Despite its impact on 30-day fatality, the predictive strength of AKI was limited by the severity of stroke.


Resumo Introdução: A ocorrência de insuficiência renal aguda (IRA) após acidente vascular cerebral isquêmico (AVCI) está associada a pior prognóstico. Há uma deficiência de estudos brasileiros a respeito dessa questão. O presente estudo teve como objetivo descrever o impacto da IRA após o primeiro episódio de AVCI em relação à taxa de letalidade em 30 dias. Métodos: A presente coorte retrospectiva de base hospitalar incluiu pacientes que sofreram seu primeiro AVCI entre janeiro e dezembro de 2015. IRA foi definida por elevações da creatinina sérica em relação ao valor basal na internação ≥ 0.3 mg/dL ou aumento da creatinina sérica equivalente a 1,5 vez o valor basal em qualquer instante durante a primeira semana após a internação. Foi realizada análise univariada e multivariada para avaliar a presença de IRA com letalidade em 30 dias. Resultados: A população final do estudo (n = 214) apresentou média de idade de 66,46 ± 13,73 anos; 48,1% eram homens; a média de pontuação no NIHSS foi 6,33 ± 6,27; e 20 (9,3%) apresentaram IRA. Pacientes com IRA tinham idade mais avançada, pontuação maior na NIHSS e valores mais elevados de creatinina no momento da alta hospitalar. A mortalidade em 30 dias foi maior no subgrupo com IRA em comparação ao grupo sem IRA (35% vs. 6,2%, p < 0,001). IRA foi preditor independente de mortalidade após AVCI, porém limitado pela gravidade do acidente vascular cerebral (NIHSS). Conclusão: A presença de IRA é uma complicação importante após AVCI. Apesar de seu impacto na letalidade de 30 dias, a força preditiva da IRA foi limitada pela gravidade do AVC.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Brain Ischemia/complications , Brain Ischemia/mortality , Hospital Mortality , Stroke/complications , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Prognosis , Severity of Illness Index , Brazil/epidemiology , Prevalence , Retrospective Studies , Risk Factors , Creatinine/blood , Stroke/mortality , Kaplan-Meier Estimate , Hospitalization
12.
Rev. bras. cir. cardiovasc ; 34(4): 396-405, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020497

ABSTRACT

Abstract Objective: To evaluate whether there is any difference on the results of patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in the setting of ischemic heart failure (HF). Methods: Databases (MEDLINE, Embase, Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Literatura Latino-americana e do Caribe em Ciências da Saúde [LILACS], and Google Scholar) were searched for studies published until February 2019. Main outcomes of interest were mortality, myocardial infarction, repeat revascularization, and stroke. Results: The search yielded 5,775 studies for inclusion. Of these, 20 articles were analyzed, and their data were extracted. The total number of patients included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR 0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in the PCI group. The HR for stroke showed no statistically significant difference between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237; P=0.459). Conclusion: This meta-analysis found that CABG surgery remains the best option for patients with ischemic HF, without increase in the risk of stroke.


Subject(s)
Humans , Male , Female , Aged , Coronary Artery Bypass/mortality , Myocardial Ischemia/surgery , Stroke/etiology , Percutaneous Coronary Intervention/mortality , Heart Failure/surgery , Postoperative Complications/etiology , Postoperative Complications/mortality , Brazil/epidemiology , Review Literature as Topic , Randomized Controlled Trials as Topic , Meta-Analysis as Topic , Coronary Artery Bypass/adverse effects , Epidemiologic Methods , Multicenter Studies as Topic , Treatment Outcome , Practice Guidelines as Topic , Myocardial Ischemia/mortality , Evidence-Based Medicine , Stroke/mortality , Percutaneous Coronary Intervention/adverse effects
13.
Rev. medica electron ; 41(4): 899-913, jul.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094097

ABSTRACT

RESUMEN Introducción: la diabetes mellitus es un trastorno metabólico caracterizado por hiperglucemia crónica con alteraciones en los carbohidratos, grasas y proteínas. Las tasas de morbimortalidad han aumentado al igual que la obesidad, constituye un problema de salud en el mundo, Cuba y la provincia de Matanzas. Objetivo: realizar una caracterización clínica epidemiológica de la diabetes mellitus tipo 2 en dos áreas de salud, conocer las variables e identificar las barreras para una posterior intervención. Materiales y métodos: se realizó un estudio epidemiológico descriptivo- transversal a 750 diabéticos tipo 2 mayores de 18 años en dos áreas de salud. Se realizaron encuestas, procesándose en el programa Epi-Info, obteniéndose la frecuencia de las variables, y las diferencias estadísticas significativas entre variables de las dos aéreas de salud, utilizándose el valor de p < 0,05 % y el Chi2. Resultados: el promedio de edad fue de 62,2 años, predominio del sexo femenino y color de la piel blanca. La hipertensión arterial y la obesidad fueron las enfermedades más asociadas, y el tabaquismo, la ingestión de bebidas alcohólicas y azucaradas, y la no realización de ejercicios físicos fueron los factores asociados más relevantes. Los medicamentos más utilizados fueron la glibenclamida y la metformina. Conclusiones: la diabetes mellitus es la primera causa de fracaso renal en el mundo occidental, siendo la insuficiencia renal una de las complicaciones crónicas más graves de esta enfermedad. Entre las principales causas de muerte de esta enfermedad son las complicaciones macrovasculares, manifestadas clínicamente como cardiopatía isquémica, insuficiencia cardíaca, la enfermedad vascular cerebral y la insuficiencia arterial periférica.


ABSTRACT Introduction: diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia with alterations in carbohydrates, fats and proteins. Morbi-mortality rates have increased as have done obesity, being a health problem in the world, Cuba and the province of Matanzas. Objective: to carry out clinical-epidemiological characterization of type 2 diabetes mellitus in two health areas, knowing the variables and identifying the barriers for a subsequent intervention. Materials and methods: a cross-sectional descriptive study was carried out in 750 type-2 diabetic patients over 18 years in two health areas. Surveys were made and processed in Epi-Info program, showing significant statistic differences among variables of both health areas; p < 0,05 % value and Chi2 were used. Results: the average age was 62.2 years, predominating female sex and white skin color. The most commonly associated diseases were arterial hypertension and obesity; smoking and drinking alcoholic and sugar-sweetened beverages and sedentary life were the most relevant associated factors. The most commonly used medications were glibenclamide and metformin. Conclusions: diabetes is the first cause of renal failure in the Western world, being renal insufficiency one of the most serious chronic complications of this disease. The main causes of death of this disease are macro vascular complications clinically manifested as ischemic heart disease, heart failure, cerebra-vascular disease and peripheral arterial insufficiency.


Subject(s)
Humans , Adult , Risk Factors , Glyburide/therapeutic use , Diabetes Mellitus/diagnosis , Diabetes Mellitus/etiology , Diabetes Mellitus/mortality , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiology , Metformin/therapeutic use , Tobacco Use Disorder/diagnosis , Epidemiology, Descriptive , Cross-Sectional Studies , Myocardial Ischemia/mortality , Stroke/mortality , Alcoholism/diagnosis , Renal Insufficiency/complications , Sedentary Behavior , Peripheral Arterial Disease/mortality , Heart Failure/mortality , Hypertension/diagnosis , Obesity/diagnosis
14.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 408-413, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1012348

ABSTRACT

Negative changes in cardiovascular and autonomic variables in stroke survivors have encouraged the global scientific community to focus on investigating therapeutic strategies to mitigate stroke damage. The objective of the present study was to describe the effects of exercise training on cardiovascular and autonomic variables in stroke survivors. We used the PICO (population, intervention, control/comparison, and outcome variables) model for the search of articles in PubMed and Physiotherapy Evidence Databases from 2009 to December 2018. The following data were also recorded: type of study, author, year of publication, participants (time after stroke, sample size, and age) and benefits of exercise training. A total of 544 articles were initially selected, of which nine peer-reviewed articles met the search criteria. These nine studies enrolled 611 participants (middle-aged or elderly), and pointed to positive effects of training on maximal oxygen uptake, peak aerobic capacity, 6-minute walk test and resting heart rate. However, more well-controlled studies are needed to confirm the benefits of exercise training on cardiovascular and autonomic variables in this population


Subject(s)
Humans , Male , Female , Autonomic Nervous System , Cardiovascular System , Exercise , Stroke/mortality , Rehabilitation , Physical Therapy Specialty/methods , Resistance Training/methods , Data Accuracy , Walk Test
15.
Arch. cardiol. Méx ; 89(1): 5-11, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038470

ABSTRACT

Abstract Introduction: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.


Resumen La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía Métodos: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. Resultados: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). Conclusiones: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carotid Artery Diseases/complications , Coronary Angiography , Stroke/etiology , Plaque, Atherosclerotic/complications , Myocardial Infarction/etiology , Carotid Artery Diseases/diagnosis , Survival Analysis , Retrospective Studies , Risk Factors , Follow-Up Studies , Disease Progression , Stroke/diagnosis , Stroke/mortality , Myocardial Infarction/diagnosis
17.
Article in English | AIM | ID: biblio-1258804

ABSTRACT

Background: Stroke is a significant cause of hospital admissions, disability and mortality, but there is a lack of information onstroke in parts of the southern region of Nigeria.Objective: To analyze the frequency of stroke admissions, clinical presentations, risk factors, stroke types and outcomes over seven years, in a secondary level hospital in southern Nigeria. Methods:Thiswas a retrospective study. The hospital recordof patients hospitalizedbetween January 2006 and December 2012 at the Central Hospital, Benin-City with thediagnosis of stroke based on the World Health Organization (WHO)-clinical criteria,were studied. Results: Four hundred and nineteen patients with stroke were hospitalizedduring the study period; thisaccounted for 3.1% of all the medical admissions. The mean age was 62.4 ± 13.6 years. There were 222 (53%) males and 197(47.0%) females. Ischaemic stroke occurred among 71% of cases; others included intra-cerebral haemorrhage (26%)andsubarachnoid haemorrhage (3.1%). The main presenting features includedhemiparesis (69%) and sudden loss of consciousness (27.2%). The risk factors included hypertension (84%)and diabetes mellitus (12.2%). The 7, 14 and 30 days case fatality rates were 21.2%, 25.5% and 30.8% respectively. A higher case fatality rate was recordedin haemorrhagic stroke compared to ischaemic stroke (68.8% vs24%, p =0.0001).Conclusion:Stroke was a significant cause of mortality amongst medical admissions and hypertension was the most common risk factor. Closer attention to the risk factors for stroke may likely help to reduce the burden of stroke


Subject(s)
Diabetes Mellitus , Hypertension , Nigeria , Paresis , Patients , Risk Factors , Stroke/mortality
19.
São Paulo; s.n; 2019. 88 p.
Thesis in Portuguese | LILACS | ID: biblio-987697

ABSTRACT

Introdução: A Doença Cerebrovascular é uma das principais causas de morte no mundo, inclusive no Brasil, além de ser a primeira causa de internação hospitalar no Sistema Único de Saúde brasileiro. Objetivo: avaliar os desfechos epidemiológicos da doença cerebrovascular em adultos jovens residentes no município de São Paulo, assim como avaliar os fatores associados à falta de assistência hospitalar nos óbitos ocasionados pelo acidente cerebrovascular no estado de São Paulo. Método: foram utilizados dados oficiais de mortalidade e hospitalização por DCV provenientes do Sistema de Informações sobre Mortalidade e Sistema de Informações Hospitalares do Sistema Único de Saúde, respectivamente. As séries temporais foram padronizadas pelo método direto, segundo sexo, idade e tipos da doença. Para a mortalidade, utilizouse dois intervalos de tempo de 10 anos consecutivos (1996-2005 e 2006-2015). Foi utilizado o modelo de regressão de Prais-Winsten, obtendo o Annual Percent Change (APC). Para analisar a associação entre os óbitos por doença cerebrovascular sem assistência hospitalar e as variáveis explicativas utilizou-se regressão de Poisson. Resultados: Ocorreram 13.129 óbitos e 17.972 hospitalizações em adultos jovens residentes na cidade de São Paulo. Quando analisadas conjuntamente, a mortalidade por doença cerebrovascular apresentou tendência decrescente (APC -4,94% entre 1996-2005 e APC -3,17% entre 2006-2017). Mulheres tiveram redução da mortalidade por DCV durante todo o período (1996-2005; APC: -4,29% e 2006-2015; APC: -4,57%), enquanto homens apresentaram redução da mortalidade por DCV somente na primeira década do estudo (1996-2005; APC= -5,71%). A tendência de hospitalização foi estacionária, sem diferenças segundo sexo e faixa etária. A morbimortalidade por DCV no mês mais frio do ano (junho) foi 11,5% mais elevada, em média durante o período 1996-2015 e 2008-2017, em comparação com o período mais quente, no mês de dezembro (p<0,05). Também foram registrados 127.319 óbitos por Doença Cerebrovascular no estado de São Paulo nos períodos de 1996-1998 e 2013-2015. Destes, 19.362 (15,2%) não tiveram assistência hospitalar. No período mais recente (2013-2015) a proporção da falta de assistência hospitalar foi maior para indivíduos de cor da pele amarela (RR=1,48; IC95%, 1,25 : 1,77), enquanto pessoas de cor preta (RR=0,85; IC95%, 0,76 : 0,95), casadas (RR=0,70; IC95%, 0,64 : 0,75), residentes no município de São Paulo (RR=0,92; IC95%: 0,86 - 0,98) e acometidos pela Doença Cerebrovascular hemorrágica (RR=0,47; IC95%, 0,43 : 0,51) tiveram menor proporção de falta de atendimento hospitalar na análise multivariada. Conclusão: a tendência da mortalidade por Doença Cerebrovascular em adultos jovens declinou durante 1996- 2015, com variação segundo sexo, idade e tipos da DCV, enquanto a incidência de hospitalização permaneceu estacionária durante 2008-2017. Além disso, verificamos variação sazonal significante, com maior morbimortalidade por doença cerebrovascular em adultos jovens na cidade de São Paulo, no período mais frio do ano. Em relação aos fatores associados aos óbitos por Doença Cerebrovascular sem assistência hospitalar, identificamos que as mesmas condições continuaram restringindo ou favorecendo a falta de assistência hospitalar nesses óbitos durante os dois períodos de tempo.


Introduction: Cerebrovascular disease (CVD) is one of the leading causes of death worldwide, including in Brazil. Besides being the first cause of hospitalization in the Brazilian Unified Health System. Objective: to evaluate the epidemiological outcomes of cerebrovascular disease in young adults living in the city of São Paulo, as well as to evaluate the factors associated with the lack of hospital care in the deaths caused by stroke in the state of São Paulo. Method: Official data on mortality and hospitalization for CVD from the Mortality Information System and Hospital Information System of the National Health System were used, respectively. Time series were standardized by the direct method, according to sex, age and types of disease. For mortality, two time intervals of 10 consecutive years (1996-2005 and 2006-2015) were used. The Prais- Winsten regression model was used, obtaining Annual Percent Change (APC). Poisson regression was used to analyze the association between deaths due to cerebrovascular disease without hospital care and the explanatory variables. Results: There were 13,129 deaths and 17,972 hospitalizations among young adults living in the city of São Paulo. When analyzed together, stroke mortality presented a decreasing trend (APC -4.94% between 1996-2005 and APC -3.17% between 2006-2017). Women had a reduction in CVD mortality during the whole period (1996-2005, APC: -4.29% and 2006-2015, APC: -4.57%), while men had a reduction in CVD mortality only in the first decade of the study (1996-2005; APC = -5.71%). The trend of hospitalization was stationary, with no differences according to gender and age group. CVD morbidity and mortality in the coldest month of the year (June) was 11.5% higher, on average during the period 1996- 2015 and 2008-2017, compared to the warmer period in December (p<0.05). There were also 127,319 deaths due to stroke in the State of São Paulo during 1996-1998 to 2013- 2015. Of these, 19,362 (15.2%) did not have hospital care. In the most recent period (2013-2015), the proportion of hospital attendance was higher for yellow-skinned individuals (RR = 1.48, 95% CI, 1.25: 1.77), whereas black people ( RR = 0.85, 95% CI 0.76 : 0.95), married (RR = 0.70, 95% CI, 0.64: 0.75), living in the city of São Paulo (RR = 0.92 ; 95% CI: 0.86-0.98) and hemorrhagic cerebrovascular disease (RR = 0.47, 95% CI, 0.43: 0.51) had a lower proportion of lack of hospital care in the multivariate analysis. Conclusion: The trend of mortality due to stroke in young adults declined during 1996- 2015, with variation according to gender, age and types of CVD, while the incidence of hospitalization remained stationary during 2008-2017. In addition, we verified a significant seasonal variation, with higher morbidity and mortality due to cerebrovascular disease in young adults in the city of São Paulo, during the coldest period of the year. Regarding the factors associated with deaths due to Cerebrovascular Disease without hospital care, we identified that the same conditions continued to restrict or favor the lack of hospital care in these deaths during the two time periods.


Subject(s)
Humans , Adult , Stroke/mortality , Stroke/epidemiology , Hospital Care , Incidence
20.
Rev. bras. epidemiol ; 22(supl.3): e190013.supl.3, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1057805

ABSTRACT

RESUMO Introdução: O acidente vascular cerebral não especificado (AVC-NE) é de grande relevância nas estatísticas de mortalidade, sendo a quarta maior causa de morte no Brasil. O objetivo deste estudo foi identificar o perfil de causas reclassificadas após investigação de óbitos por AVC-NE no Brasil. Métodos: Foram selecionados todos os óbitos registrados em 2017 no Sistema de Informação sobre Mortalidade (SIM) como AVC-NE, considerados códigos garbage. As causas específicas, detectadas após investigação em 60 cidades selecionadas, foram analisadas segundo idade e sexo. Resultados: Do total de óbitos por AVC-NE das 60 cidades (n = 11.289), foram investigados 25,8%, dos quais 56,3% foram reclassificados para AVC isquêmico, 12,7% para AVC hemorrágico, e 23,3% migraram para outras causas específicas, como diabetes e doença renal crônica, em ambos os sexos. Discussão: A maior proporção de reclassificação dos óbitos por AVC-NE para AVC isquêmico em relação ao hemorrágico era esperada. No entanto, a detecção de outras causas específicas fora do grupo de AVC indica possíveis problemas de qualidade do preenchimento das causas na declaração de óbito (DO). Conclusão: As investigações realizadas permitiram identificação de subgrupos de AVC. Além da investigação, entretanto, é importante realizar capacitação com médicos para o preenchimento adequado da DO, a fim de melhorar as estimativas da mortalidade por AVC específico e possibilitar direcionamento adequado das ações e dos serviços de saúde.


ABSTRACT Introduction: Unspecified stroke (UnST) is of great importance in mortality statistics, as it is the fourth leading cause of death in Brazil. The objective of this study was to identify the profile of reclassified causes of death after investigation of deaths caused by UnST in Brazil. Methods: All deaths registered as UnST in 2017 in the Mortality Information System (SIM) were considered as garbage codes. The specific causes, detected after investigation in 60 selected cities, were analyzed by age and sex. Results: Of the total deaths due to UnST identified in these 60 cities (n = 11,289), 25.8% were investigated. Of these, 56.3% were reclassified to ischemic stroke, 12.7% to hemorrhagic stroke, and 23.3% to other specific causes, such as diabetes and chronic kidney disease, in both sexes. Discussion: The higher proportion of deaths due to ischemic stroke in comparison to hemorrhagic stroke was expected. However, the detection of other specific causes outside the stroke group indicates possible quality problems in the filling of death certificate (DC). Conclusion: The investigations allowed the identification of subgroups of deaths due to stroke. In addition to the research, however, it is important to conduct physician training in the adequate filling in of the DC, in order to improve estimates of specific stroke mortality, and to enable appropriate targeting of health actions and services.


Subject(s)
Humans , Male , Female , Adult , Aged , Cause of Death , Stroke/mortality , Brazil/epidemiology , Information Systems , Death Certificates , Cross-Sectional Studies , Cities/epidemiology , Sex Distribution , Age Distribution , Stroke/etiology , Geography , Middle Aged
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