The use of e-ASPECTS in acute stroke care: validation of method performance compared to the performance of specialists / O uso do e-ASPECTS no AVC agudo: validação da performance do método comparada com a performance dos especialistas

ABSTRACT Background: The rapid evaluation of non-contrast-enhanced computed tomography (NCCT) brain scans in patients with anterior stroke symptoms saves time and favors optimal and prompt treatment. e-ASPECTS is a tool that automatically calculates the Alberta Stroke Program Early CT Score (ASPECTS) values, leading to a more accurate and timely image evaluation. Objective: To determine the ability of e-ASPECTS in differentiating images with and without injury. Methods: One-hundred sixteen patients admitted to a stroke unit in a Brazilian tertiary hospital underwent a CT scan at admission and at least one control brain imaging (NCCT or magnetic resonance imaging - MRI) 24 hours after admission. ASPECTS evaluation was performed by three neuroradiologists, three neurologists, and three neurology residents, all blinded to the symptoms and the injury side. The scores were compared to the ground truth, and an ASPECTS score was provided by two independent non blinded evaluators. Sensitivity and specificity were analyzed, and receiver operating characteristic curves, Bland-Altman plots with mean error score, and Matthews correlation coefficients (MCCs) were obtained for ASPECTS scores, assuming values equal to 10 for images without injury and values other than 10 for images with ischemic injury. Results: e-ASPECTS demonstrated similar performance to that of neuroradiologists and neurologists, with an area under the curve of 0.78 and an MCC value of 0.48 in the dichotomous analysis. The sensitivity and specificity of e-ASPECTS were 75% and 73%, respectively. Conclusion: e-ASPECTS is a validated and reliable tool for determining early signs of ischemia in NCCT.

RESUMO Introdução: A avaliação rápida da tomografia de crânio sem contraste (TCSC) em pacientes com AVC de circulação anterior economiza tempo e permite um tratamento rápido e otimizado. O e-ASPECTS é um software que calcula automaticamente os valores do ASPECTS e permite uma avaliação da imagem mais precisa e ágil. Objetivo: Determinar a habilidade do e-ASPECTS em diferenciar imagens com e sem lesão. Métodos: Cento e dezesseis pacientes admitidos em uma unidade de AVC de um hospital terciário brasileiro foram submetidos a uma TCSC na admissão e pelo menos uma imagem de controle (TC ou Ressonância de Crânio) 24 horas após a admissão. A avaliação do ASPECTS foi realizada por três neurorradiologistas, três neurologistas e três residentes em neurologia, todos cegados para os sintomas e para o lado da lesão. Os valores foram comparados ao ground truth (GT) e uma pontuação ASPECTS foi obtida por dois avaliadores independentes não cegos. Análise da sensibilidade e especificidade, características das curvas ROC, gráficos de Bland-Altman com média de escore de erro e coeficientes de correlação de Matthews (CCM) foram realizados para os valores de ASPECTS, assumindo valores iguais a 10 como imagens sem lesões e valores diferentes de 10 como imagens com alguma lesão isquêmica. Resultados: o e-ASPECTS demonstrou uma performance similar aos neurorradiologistas e neurologistas, com uma área sob a curva de 0,78 e um valor de CCM de 0,48 na análise dicotômica. Sensibilidade e especificidade do e-ASPECTS foram, respectivamente, 75 e 73%. Conclusão: O e-ASPECTS é uma ferramenta confiável e validada para determinar sinais precoces de isquemia nas TCSC.

Leprosy and hepatitis B coinfection in southern Brazil

To investigate the association of leprosy with hepatitis B virus (HBV) infection, as yet unknown for South Brazil, we assessed hepatitis B virus coinfection in 199 South Brazilian leprosy patients (119 lepromatous, 15 tuberculoid, 30 borderline, 12 undetermined and 23 unspecified) and in 681 matched blood donors by screening for the hepatitis B virus markers HBSAg and anti-HBc, using ELISA. Positive samples were retested and anti-HBc+ only samples were tested for the hepatitis B surface antibody (anti-HBs). There was a strong association between leprosy and hepatitis B virus infection (OR = 9.8, 95% CI = 6.4–14.7; p = 0.004·E−30), as well as an association between HBV infection and lepromatous leprosy, compared to other forms (OR = 2.4, 95% CI = 1.2–4.8; p = 0.017). We also found that confinement due to leprosy was associated with hepatitis B virus infection (OR = 3.9, 95% CI = 2.1–7.4; p = 0.015·E−3). Leprosy patients are susceptible to develop hepatitis B virus infection, especially lepromatous. Institutionalized patients, who probably present a stronger Th2 response, have higher risk of being exposed to hepatitis B virus. This clearly emphasizes the need for special care to leprosy patients in preventing hepatitis B virus coinfection in South Brazil.