Peri-intraventricular hemorrhage and oxidative and inflammatory stress markers in very-low birth weight newborns / Hemorragia peri-intraventricular e marcadores de estresse oxidativo e inflamatório em RNs de muito baixo peso ao nascer

OBJECTIVES: To evaluate the association between oxidative and inflammatory stress markers with peri-intraventricular hemorrhage (PIVH) in very-low birth weight newborns.METHODS: This was a prospective study conducted in a level III neonatal unit. Basal and stimulated reactive oxygen intermediates (ROIs), reduced glutathione (GSH), and interleukin-6 (IL-6) levels were measured in umbilical cord blood. Newborns underwent serial ultrasound at the bedside, at 6, 12, 24, and 72 hours of life and at seven days for the diagnosis of PIVH, classified as grades I to IV. Two groups were assessed, those with and without PIVH; maternal and neonatal control variables were used for comparison. Univariate and multiple regression analyses were applied.RESULTS: A total of 125 newborns were assessed. PIVH incidence rate was 12.0%. In the univariate analysis, basal ROI, the use of two or more doses of corticosteroids, birth weight < 1,000 g, ventilatory support use, and SNAPPE II value ≥ 22 were significantly associated with PIVH. However, in the multivariate analysis, only antenatal steroid use was independently associated with the disease (OR 0,194; 95% CI: 0,048 to 0,773; p=0,02).CONCLUSION: ROI, GSH, and IL-6 levels were not associated with the occurrence of PIVH in very-low birth weight infants.

OBJETIVOS: Avaliar a associação entre marcadores de estresse oxidativo e inflamatório com a hemorragia peri- e intraventricular (HPIV) em recém-nascidos (RN) de muito baixo peso ao nascer.MÉTODOS: Estudo prospectivo em unidade neonatal nível III. Foi feita dosagem em sangue de cordão umbilical de intermediários reativos de oxigênio (ROI) basal e estimulado, glutationa reduzida (GR) e interleucina-6 (IL-6). Recém-nascidos foram submetidos a ultrassonografia seriada, à beira do leito, com seis, 12, 24 e 72 horas de vida e sete dias para o diagnóstico de HPIV, classificada em graus de I a IV. Foram avaliados dois grupos: com e sem HPIV e variáveis de controle maternas e neonatais foram usadas para comparação. Análise univariada e de regressão múltipla foram aplicados.RESULTADOS: Foram avaliados 125 recém-nascidos. A taxa de incidência de HPIV foi de 12%. Na análise univariada o valor basal de ROI, o uso de duas ou mais doses de corticosteroide, peso ao nascer menor do que 1.000 g, o uso de assistência respiratória e valor de SNAPPE II maior ou igual a 22 foram significativamente associados à HPIV. Porém, na análise multivariada, apenas o uso antenatal de esteroides se mostrou independentemente associado à doença (OR 1,94 IC95% 0,048-0,773 p = 0,02).CONCLUSÃO: ROI, GR e Il-6 não foram associados à ocorrência de HPIV em RN de muito baixo peso ao nascer.

Characteristics of Subjects with Very Low Serum Low-Density Lipoprotein Cholesterol and the Risk for Intracerebral Hemorrhage

BACKGROUND/AIMS: The clinical implications of hypocholesterolemia have not been well studied, although some studies have revealed an association between hypocholesterolemia and intracerebral hemorrhage (ICH). We evaluated the clinical characteristics of subjects with very low-density lipoprotein cholesterol (LDL-C) and compared the risk for ICH using various clinical parameters. METHODS: Using hospital records, we evaluated the clinical characteristics of subjects with LDL-C levels < or = 40 mg/dL (very low LDL-C group). We also evaluated the risk for ICH in this very low LDL-C group and in subjects with low LDL-C < or = 70 mg/dL (low LDL-C group). RESULTS: Among 34,415 subjects who presented at the laboratory for serum LDL-C measurements, 250 subjects had a very low serum LDL-C level (< or = 40 mg/dL). About half of the subjects were statin users; the very low LDL levels in the other subjects were likely attributable to alcohol consumption or a various chronic illness such as liver disease or end-stage renal disease (ESRD). ICH occurred in three subjects with very low LDL-C, all of whom had no history of statin use. ESRD tended to be associated with ICH in subjects with serum LDL-C < or = 70 mg/dL. CONCLUSIONS: About 1% of the subjects whose LDL-C was measured in the hospital had a LDL-C level < or = 40 mg/dL, and about half of these subjects had no history of hypolipidemic therapy. ICH incidence was not related to LDL-C level or statin use.

Utilização do fator VII recombinante ativado (rFVIIa) como adjuvante na neuroproteção à zona de penumbra nas hemorragias intracranianas / Activated recombinant factor VII (rFVIIa) as adjunct neuroprotection therapy to the penumbra zone in intracranial hemorrhage

As hemorragias intracranianas constituem-se num grave distúrbio, geralmente de origem vascular, que acomete a inexpansível caixa craniana. Acometimentos cerebrais envolvem a formação de uma área perilesional denominada zona de penumbra adicionada a edemas e efeitos de massa com elevação da pressão intracraniana. Muito se discute sobre o comportamento desta zona de penumbra nas situações de acidentes vasculares cerebrais isquêmicos. Hoje em dia, estudos mostram que esta mesma zona de penumbra está presente também nos acidentes vasculares hemorrágicos e, sendo assim, o neurocirurgião deve a qualquer custo evitar a expansão dos hematomas intracranianos que sabidamente crescem devido a hemorragias secundárias com posteriores déficits neurológicos. Numa meta-análise envolvendo 58 pacientes, várias foram as indicações para uso de rFVIIa, mostrando-se sempre eficácia na melhora dos parâmetros hematimétricos. Dentre as indicações para sangramentos em SNC, pode ser uma arma de utilidade na redução da disseminação da lesão inicial, protegendo a zona de penumbra e minimizando as seqüelas.

Niveles de colesterol y accidente vascular hemorrágico: un estudio de casos y controles en Chile / Blood cholester level and hemorrhagic stroke: a case control study in Chile

Objetivo: estudiar el colesterol sérico como factor de riesgo en el accidente vascular encefálico hemorrágico. Diseño: es un estudio de casos y controles, asumiendo un riesgo relativo de 2, un Alfa de 0,20, 15 por ciento de prevalencia de colesterol alto en los controles,la muestra mínima fue de 112 casos y 112 controles. Pacientes: corresponden a pacientes prospectivos al hospital J.J. Aguirre, de la Universidad de Chile entre agosto de 1992 y julio de 1994. Todos ellos tenían tomografía cerebral. Los controles fueron pacientes ingresados a otras unidades del Hospital Clínico, sin el diagnóstico de hemorragia cerebral y fueron pareados por edad y sexo con los casos. Otras variables estudiadas fueron: diabetes, alcohol, enfermedad hepática, uso crónico de medicamentos. Se analizó utilizando STATA 3.1 empleando análisis pareado y análisis de regresión logística condicional

Clinical profile of stroke in relation to glycaemic status of patients.

Present study was undertaken in fifty consecutive patients of acute stroke to assess the role of glycemic status on clinical profile of stroke. Majority of patients (76%) were in age group of 41-70 years. The patients were classified into four groups: euglycemics (33), known diabetics (8), newly diagnosed diabetics (6) and stress hyperglycemics (3). Diabetics as well as stress hyperglycemics had higher prevalence of larger sized severe haemorrhagic stroke with poor outcome and there was positive correlation between them.

Platelet functions & lipid profile within 24 hours following an attack of TIA, thrombotic & haemorrhagic stroke.

The present study was undertaken to evaluate comparatively the lipid profile and platelet functions within 24 h of the three most frequent types of stroke encountered in clinical practice. Twenty patients of transient ischaemic attacks, 22 of thrombotic stroke and 26 of haemorrhagic stroke (hypertensive putaminal haemorrhage), all within 24 h of the acute event, and 21 control subjects were studied. Spontaneous platelet aggregation, platelet aggregation induced with adenosine diphosphate (2.5, 3.75 and 5.0 microM) and lipid profile (serum cholesterol, triglycerides, high density lipoprotein, low density lipoprotein and very low density lipoprotein) estimations were performed in all the subjects. Mean platelet aggregation values were significantly lower in haemorrhagic stroke patients as compared to controls. Serum cholesterol, triglycerides and very low density lipoprotein levels in ischaemic groups i.e., transient ischaemic attacks and thrombotic stroke patients, were significantly elevated, more so in the former group. It appears that platelet hypofunction has a role in the pathogenesis of hypertensive putaminal haemorrhage while in patients of transient ischaemic attack and thrombotic stroke, lipids may be a contributing factor in cerebral atherogenesis.

Platelet functions and lipid profile in haemorrhagic and thrombotic stroke patients.

The present study was conducted in 17 patients of haemorrhagic stroke (HS), 19 patients of thrombotic stroke (TS) and 14 control subjects. In each subject platelet functions (spontaneous platelet aggregation (SPA), aggregation induced with 10, 5, 2.5 microM ADP and 10 micrograms/ml of collagen) and complete lipid profile (total cholesterol, triglycerides, high density lipoprotein [HDL], low density lipoprotein [LDL], very low density lipoprotein [VLDL] and LDL/HDL ratio) were performed within 7 days of onset of stroke. Platelet aggregation with 2.5 microM ADP was significantly lower (P < 0.05), in both the stroke groups in comparison to controls. No other changes were significant. Mean serum triglycerides and VLDL of TS group were significantly higher than that of controls. Mean LDL/HDL ratio of the same group was significantly lower than HS group. It can be concluded that alterations in platelet functions and lipid profile are induced by both types of strokes in acute stage.