Consenso sobre accidente cerebrovascular isquémico agudo / Consensus on acute ischemic stroke

El accidente cerebrovascular es la tercera causa de muerte y la primera de discapacidad en la Argentina. Los eventos isquémicos constituyen el 80% de los casos. Los accidentes vasculares cerebrales requieren la implementación de protocolos sistematizados que permitan reducir los tiempos en la atención, la morbilidad y mortalidad. En el consenso participaron especialistas de nueve sociedades médicas relacionadas con la atención de pacientes con enfermedad cerebrovascular. Se consensuó un temario separado en capítulos y para la redacción de los mismos se conformaron grupos de trabajo con miembros de diferentes especialidades médicas. Se discutió y acordó para cada tema el nivel de recomendación en base a la mejor evidencia clínica disponible para cada tópico. Se realizó una adaptación al ámbito local de las recomendaciones cuando se consideró necesario. El sistema de la American Heart Association se utilizó para redactar las recomendaciones y su grado de evidencia. La corrección y edición fue realizada por cinco revisores externos, que no participaron en la redacción y con amplia experiencia en enfermedad vascular. Finalizado el documento preliminar, se organizó una reunión general con todos los integrantes de los grupos de trabajo y los revisores para redactar las recomendaciones definitivas. El consenso abarca la atención del paciente con accidente cerebrovascular isquémico en la fase pre-hospitalaria, evaluación inicial en la central de emergencias, terapias de recanalización (trombolisis y/o trombectomía mecánica), craniectomía descompresiva, neuroimágenes y cuidados clínicos en la internación.

Stroke is the third cause of death and the first cause of disability in Argentina. Ischemic events constitute 80% of cases. It requires the implementation of systematized protocols that allow reducing the time of care, morbidity and mortality. Specialists from nine medical societies related to the care of patients with cerebrovascular disease participated in the consensus. A separate agenda was agreed upon in chapters and for the writing of them, work groups were formed with members of different medical specialties. The level of recommendation was discussed and agreed upon for each topic based on the best clinical evidence available for each of them. An adaptation to the local scope of the recommendations was made when it was considered necessary.The American Heart Association system was used to draft the recommendations and their level of evidence. The correction and editing were done by five external reviewers, who did not participate in the writing and with extensive experience in vascular pathology. Once the preliminary document was finalized, a general meeting was held with all the members of the working groups and the reviewers to reach final recommendations. The consensus covers the management of ischemic stroke in the pre-hospital phase, initial evaluation in the emergency center, recanalization therapies (thrombolysis and/ or mechanical thrombectomy), decompressive craniectomy, neuroimaging and clinical care in the hospital.

Prevalência e fatores de risco associados à Leptospira spp. em rebanhos bovinos da região centro-sul do estado do Paraná / Prevalence and risk factors for Leptospira spp. in cattle herds in the south central region of Paraná state

O objetivo deste trabalho foi determinar a prevalência de anticorpos anti-Leptospira spp e os fatores de risco associados à infecção em rebanhos bovinos com atividade reprodutiva da região centro-sul do estado do Paraná. Foram utilizados o delineamento estatístico, as amostras sorológicas e as informações referentes às propriedades empregadas no estudo da brucelose bovina no estado do Paraná dentro do Contexto do Programa Nacional de Controle e Erradicação da Brucelose e Tuberculose. Foram estudadas 1.880 fêmeas com idade igual ou superior a 24 meses, provenientes de 274 rebanhos não vacinados contra a Leptospira spp. Para o diagnóstico sorológico da infecção foi utilizada a prova de soroaglutinação microscópica (SAM) com 22 sorovares de Leptospira spp. Em cada propriedade foi aplicado um questionário epidemiológico, a fim de obter informações epidemiológicas e práticas de manejo empregadas. Dos 274 rebanhos analisados, 181 foram considerados positivos para a Leptospira spp., com a prevalência de rebanhos de 66,06% (I.C.95%=60,12- 71,65%). Presença de > 43 bovinos (OR=3,120; I.C=1,418- 6,867), compra de reprodutores (O.R=2,010; I.C=1,154- 3,500), aluguel de pasto (O.R=2,925; I.C=1,060-8,068), presença de piquete de parição (O.R=1,981; I.C=1,068- 3,676) foram identificados como fatores de risco para a infecção para qualquer sorovar de Leptospira spp. na análise de regressão logística multivariada. Os fatores de risco para a infecção pelo sorovar Hardjo foram presença de >43 bovinos (O.R=3,622; I.C=1,512-8,677), compra de reprodutores (O.R=3,143; I.C=1,557-6,342), aluguel de pasto (O.R=4,070; I.C=1,370-12,087) e presença de eqüinos (O.R=2,981; I.C=1,321-6,726). Estes resultados indicam que a infecção pela Leptospira spp está amplamente distribuída na região centro-sul do estado do Paraná e que fatores elacionados às características das propriedades e ao manejo estão associados à infecção.

The aim of this study was to determine the prevalence of anti-Leptospira spp. antibodies and the risk factors for Leptospira spp. infection in breeding cattle herds in the south central region of Paraná state. It was based on the statistic delineation/serological samples and information regarding the selected farms employed in the study of bovine brucellosis for Paraná state in the context of National Program for Control and Eradication of Brucellosis and Tuberculosis. A total of 1.880 females aged >24 months from 274 non vaccinated herds were studied. Serum samples were tested for antibodies against Leptospira spp. using microscopic agglutination test (MAT) with 22 Leptospira serovars. The epidemiological questionnaire was applied on all the selected farms and aimed to obtain epidemiological data. Hundred eighty one of 274 herds were positive for Leptospira spp./presenting prevalence of positive herds of 66.06% (IC95%=60.12-71,65%). Presence of >43 cattle (OR=3.120; IC=1.418-6.867)/animal purchase (OR=2.010; IC=1.154-3.500)/rent of pastures (OR=2.925; IC=1.060-8.068) and presence of maternity paddock (OR=1.981; IC=1,068-3,676) were identified as risk factors for leptospirosis due to any serovar in the multivariate logistic regression. Risk factors for leptospirosis due to serovar Hardjo were presence of >43 cattle (OR=3.622; IC=1.512-8,677)/animal purchase (OR=3.143; IC=1.557-6.342)/rent of pastures (OR=4.070; IC=1.370-12.087) and presence of horses (OR=2.981; IC=1.321-6.726). These results indicate that Leptospira spp. infection is widespread in the south central region of Paraná state and that factors related to the herd characteristic and management are associated with the infection.