Percutaneous Pedicle Screw for Thoracolumbar Fractures: A Long-term Follow-up.

Objective: This is a retrospective cohort study to analyze the long-term outcomes of thoracolumbar spine fracture patients who underwent minimally invasive percutaneous fixation. Methods: The cases of 17 patients with thoracolumbar spine fractures who had percutaneous fixation between 2009 and 2011 were the subject of a retrospective analysis. Clinical and radiographic variables were collected. For the clinical evaluation the questionnaires SF-36 and Oswestry were used. Radiographic parameters were evaluated using fracture's classification based on Magerls's criteria, the fractured vertebra's wedging angle, and the affected segment's segmental Cobb angle. The measures were made at different stages: before surgery, immediately after surgery, one year later, and at a late follow-up (5 years later). Trauma associated injuries, post-surgical and implant related complications were among the additional information taken into account. Results: The SF-36 questionnaire showed averages above 63,5% in all domains in the late postoperative data (from 5 years after the surgery). Oswestry questionnaire answers showed minimal or no physical limitations in 80% of the patients with a mean score of 10,8%±10,5. The average preoperative Cobb angle value was 5,53° ± 13,80° of kyphosis, the immediate postoperative 2,18° ± 13,38° of kyphosis, one year postoperative 5,26 ± 13,95° of kyphosis, and the late follow-up 8,78° ± 15,06° of kyphosis. The mean correction was 3,35°, and mean loss of correction was 6,6°. There were no complications observed, no case of neurological deficit, infection or implant failure occurred. Conclusion: Thoracolumbar vertebrae fractures can be surgically treated with positive late clinical and radiological outcomes and low complication rates using a minimally invasive percutaneous method.

Percutaneous Pedicle Screw for Thoracolumbar Fractures: A Long-term Follow-up / Parafuso pedicular percutâneo em fraturas toracolombares: Acompanhamento em longo prazo

Abstract Objective: This is a retrospective cohort study to analyze the long-term outcomes of thoracolumbar spine fracture patients who underwent minimally invasive percutaneous fixation. Methods: The cases of 17 patients with thoracolumbar spine fractures who had percutaneous fixation between 2009 and 2011 were the subject of a retrospective analysis. Clinical and radiographic variables were collected. For the clinical evaluation the questionnaires SF-36 and Oswestry were used. Radiographic parameters were evaluated using fracture's classification based on Magerls's criteria, the fractured vertebra's wedging angle, and the affected segment's segmental Cobb angle. The measures were made at different stages: before surgery, immediately after surgery, one year later, and at a late follow-up (5 years later). Trauma associated injuries, postsurgical and implant related complications were among the additional information taken into account. Results: The SF-36 questionnaire showed averages above 63,5% in all domains in the late postoperative data (from 5 years after the surgery). Oswestry questionnaire answers showed minimal or no physical limitations in 80% of the patients with a mean score of 10,8% ± 10,5. The average preoperative Cobb angle value was 5,53º ± 13,80º of kyphosis, the immediate postoperative 2,18º ± 13,38º of kyphosis, one year postoperative 5,26 ± 13,95º of kyphosis, and the late follow-up 8,78º ± 15,06º of kyphosis. The mean correction was 3,35º, and mean loss of correction was 6,6º. There were no complications observed, no case of neurological deficit, infection or implant failure occurred. Conclusion: Thoracolumbar vertebrae fractures can be surgically treated with positive late clinical and radiological outcomes and low complication rates using a minimally invasive percutaneous method.

Resumo Objetivo: Este é um estudo de coorte retrospectivo para analisar os desfechos em longo prazo de pacientes com fratura da coluna toracolombar submetidos à fixação percutânea minimamente invasiva. Métodos: Os casos de 17 pacientes com fraturas da coluna toracolombar submetidos à fixação percutânea entre 2009 e 2011 foram objeto de análise retrospectiva. Variáveis clínicas e radiográficas foram coletadas. A avaliação clínica foi baseada nos questionários SF-36 e Oswestry. Os parâmetros radiográficos foram avaliados de acordo com a classificação de fratura baseada nos critérios de Magerls, o ângulo de cunha da vértebra fraturada e o ângulo de Cobb do segmento acometido. As medidas foram feitas em diferentes momentos: antes da cirurgia, imediatamente após a cirurgia, um ano depois e no acompanhamento tardio (cinco anos depois). Lesões associadas a traumas, complicações pós-cirúrgicas e relacionadas a implantes também foram consideradas. Resultados: O questionário SF-36 apresentou médias acima de 63,5% em todos os domínios no período pós-operatório tardio (a partir de cinco anos após a cirurgia). As respostas do questionário Oswestry mostraram limitações físicas mínimas ou nulas em 80% dos pacientes, com pontuação média de 10,8% ± 10,5%. O valor médio do ângulo de Cobb foi de 5,53º± 13,80º de cifose no período pré-operatório, 2,18º ± 13,38º de cifose no pós-operatório imediato, 5,26 ±13,95º de cifose no pós-operatório de um ano e de 8,78º ± 15,06º de cifose no período pós-operatório tardio. A correção média foi de 3,35º e a perda média de correção foi de 6,6º. Não foram observadas complicações, casos de déficit neurológico, infecções ou falhas do implante. Conclusão: As fraturas das vértebras toracolombares podem ser tratadas cirurgicamente com desfechos clínicos e radiológicos tardios positivos e baixas taxas de complicações usando um método percutâneo minimamente invasivo.

Dual-energy X-ray absorptiometry: an effective approach for predicting broiler chicken body composition.

Two trials were carried out to develop and validate linear regression equations for body composition prediction using Dual-energy X-ray absorptiometry (DEXA). In Trial 1, 300 Cobb500 male chickens raised from 1 to 42 d of age were scanned in DEXA to estimate total weight, fat mass, soft lean tissue (SLT) mass, bone mineral content (BMC), and fat percentage. DEXA estimates were compared to body ash, crude fat, SLT (sum of protein and water) and scale body weight. The dataset was split, with 70% used for prediction equations development and 30% for testing, and the 5k-fold cross-validation analysis was used to optimize the equations. The R2, mean absolute error (MAE), and root-mean-squared error (RMSE) were used as precision and accuracy indicators. A negative correlation (ρ = -0.27) was observed for ash content, while no correlation was observed for protein content (P > 0.05). Predictive linear equations were developed to assess broiler weight (R2 = 0.999, MAE = 25.12, RMSE = 38.99), fat mass (R2 = 0.981, MAE = 13.87, RMSE = 21.28), ash mass (R2 = 0.956, MAE = 3.98, RMSE = 5.61), SLT mass (R2 = 0.997, MAE = 35.73, RMSE = 52.45), water mass (R2 = 0.997, MAE = 29.56, RMSE = 43.94), protein mass (R2 = 0.989, MAE = 12.94, RMSE = 19.05), fat content (R2 = 0.855, MAE = 0.81, RMSE = 1.05), SLT content (R2 = 0.658, MAE = 1.01, RMSE = 1.28), and water content (R2 = 0.678, MAE = 0.99, RMSE = 1.27). All equations passed the test. In Trial 2, 395 Cobb500 male chickens were raised from 1 to 42 d of age and used for validation of prediction equations. The equations developed for weight, fat mass, ash mass, SLT mass, water mass, and protein mass were validated. In conclusion, DEXA was found to be an effective approach for measuring the body composition of broilers when using predictive equations validated in this study for estimate calibration.

Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports.

Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.

Transcranial doppler as screening method for sickling crises in children with sickle cell anemia: a latin America cohort study.

BACKGROUND: Sickle cell anemia (SCA) is the leading cause of childhood stroke. We aimed to evaluate whether altered cerebral flow velocities, as measured by transcranial Doppler (TCD), are associated with vaso-occlusive complications in addition to stroke in pediatric SCA patients. METHODS: We evaluated 37 children aged between 2 and 16 years with SCA who underwent screening for TCD between January 2012 and October 2018. Genotypic profiles and demographic data were collected, TCD examinations were performed during follow-up, and the presence of sickling crises was compared. Survival analyses were performed using simple frailty models, in which each predictor variable was analyzed separately in relation to the occurrence of a sickling crisis. RESULTS: The variables related to sickle cell crises in the univariate analysis were peak systolic velocity (PSV) in the middle cerebral artery (MCA), hazard ratio (HR) 1.01 (1.00-1.02) p = 0.04; end-diastolic velocity (EDV) in the MCA, HR 1.02 (1.01-1.04) p = 0.01; time average mean maximum velocity (TAMMV) in the basilar artery (BA), HR 1.02 (1.00-1.04) p = 0.04; hemoglobin, HR 0.49 (0.38-0.65) p < 0.001; hematocrit, HR 0.78 (0.71-0.85) p < 0.001; leukocyte counts, HR 1.1 (1.05-1.15) p < 0.001; platelets counts, HR 0.997 (0.994-0.999) p = 0.02; and reticulocyte numbers, HR 1.14 (1.06-1.23) p < 0.001. CONCLUSIONS: Our results indicate PSV and EDV in the MCA and TAMMV in the BA as markers of risk for the occurrence of sickling crises in SCA.

Ultrasound evaluation of digital flexor tendons of jumping horses undergoing treadmill training.

This study aimed to perform ultrasonographic evaluation of the digital flexor tendons of jumping horses undergoing complementary training on a treadmill. Fifteen Brazilian Sport horses were divided into two groups: Group I with 7 animals in physical training complementary to the standard training at the Brazilian Army's Riding School; and Group II with 8 animals in standard training used in the Brazilian Army's Riding School. Complementary training was performed on a treadmill on an inclined plane. Ultrasonographic images were taken at the beginning and at the end of training. The left thoracic and pelvic limbs of horses were evaluated for echogenicity values and cross-sectional areas of the superficial digital flexor tendons (SDFTs) and deep digital flexor tendons (DDFTs) in zones IA, IIB, and IIIB. The mean areas of the SDFT were 93.7 mm2 and 95.8 mm2 at the beginning and the end of training, respectively. The cross-sectional area of DDFT increased from 124.6 mm2 at the beginning of training to 136.8 mm2 at the end of training. The echogenicity values of both tendons were between 0 and 1 as expected, concluding that clinically, the animals showed adaptation to the exercise protocol with no signs of tendon injury being detected, implying that traditional training and complementary training are safe.

Esta pesquisa teve como objetivo proceder avaliações ultrassonográficas dos tendões flexores digitais de equinos em treinamento complementar em esteira ergométrica. Foram utilizados 15 equinos da raça Brasileiros de Hipismo (BH), divididos em dois grupos: Grupo I, com sete animais em treinamento físico complementar ao treinamento padrão da Escola de Equitação do Exército; Grupo II, com oito animais em treinamento padrão utilizados na Escola de Equitação do Exército. O treinamento complementar foi executado na esteira ergométrica, em plano inclinado. As imagens ultrassonográficas foram realizadas no início e no final do treinamento. Foram avaliados os membros locomotores torácico e pélvico esquerdos dos equinos quanto a ecogenicidade e a área da seção transversal dos tendões flexores digitais superficiais (TFDS) e tendões flexores digitais profundos (TFDP), nas zonas IA, IIB e IIIB. A média da área dos TFDS foi de 93,7 mm2 e de 95,8 mm2, no início e no final do treinamento, respectivamente. O DDFT apresentou um aumento da área da seção transversa, de 124,6 mm2 no início do treinamento e, de 136,8 mm2 no final do treinamento. A ecogenicidade de ambos os tendões se apresentou entre 0 e 1, como esperado, concluindo-se que clinicamente os animais apresentaram adaptação ao exercício atribuído, não sendo detectados sinais de lesões tendíneas, qualificando o treinamento tradicional e o treinamento complementar como seguros.

Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports

Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.

Comparison of right-to-left shunt characteristics in cryptogenic embolic ischemic stroke and non-cardioembolic ischemic stroke.

BACKGROUND: Patent foramen ovale (PFO) has been considered a potential mechanism of embolic stroke of undetermined origin. OBJECTIVE: The aim of the present study was to identify the features of the right-to-left shunt (RLS) in patients with undetermined embolic ischemic stroke and compare them with those of patients with non-cardioembolic ischemic stroke. METHODS: A retrospective study was conducted with 168 patients with stroke and RLS separated into the following two groups: the undetermined embolic stroke group (UES group) and non-cardioembolic stroke group (NCES group). All patients were assessed by transcranial Doppler to evaluate the presence and quantification of microembolic signals (MES) at rest and under Valsalva maneuver. RESULTS: Of all patients evaluated in the current study, 96 were included in the UES group and 72 in the NCES group. In the UES group, 65 patients had RLS with ≥10 MES (67.7%), which was higher than that observed in the NCES group (51.4%, p=0.038). According to the moment of the cardiac cycle, 75 patients (78.1%) in the UES group had a positive test at rest compared to 42 (58.3%) in the NCES group (p=0.007). CONCLUSIONS: The current study demonstrated that almost 70% of patients with undetermined embolic stroke and PFO presented a large RLS and more than 75% had RLS at rest. These findings suggest that the size of the shunt should be taken into account when evaluating whether PFO could be a possible mechanism underlying cryptogenic stroke.

Comparison of right-to-left shunt characteristics in cryptogenic embolic ischemic stroke and non-cardioembolic ischemic stroke / Comparação das características do shunt direita-esquerda em pacientes com AVC isquêmico criptogênio e AVC não cardioembólico

Abstract Background: Patent foramen ovale (PFO) has been considered a potential mechanism of embolic stroke of undetermined origin. Objective: The aim of the present study was to identify the features of the right-to-left shunt (RLS) in patients with undetermined embolic ischemic stroke and compare them with those of patients with non-cardioembolic ischemic stroke. Methods: A retrospective study was conducted with 168 patients with stroke and RLS separated into the following two groups: the undetermined embolic stroke group (UES group) and non-cardioembolic stroke group (NCES group). All patients were assessed by transcranial Doppler to evaluate the presence and quantification of microembolic signals (MES) at rest and under Valsalva maneuver. Results: Of all patients evaluated in the current study, 96 were included in the UES group and 72 in the NCES group. In the UES group, 65 patients had RLS with ≥10 MES (67.7%), which was higher than that observed in the NCES group (51.4%, p=0.038). According to the moment of the cardiac cycle, 75 patients (78.1%) in the UES group had a positive test at rest compared to 42 (58.3%) in the NCES group (p=0.007). Conclusions: The current study demonstrated that almost 70% of patients with undetermined embolic stroke and PFO presented a large RLS and more than 75% had RLS at rest. These findings suggest that the size of the shunt should be taken into account when evaluating whether PFO could be a possible mechanism underlying cryptogenic stroke.

RESUMO Antecedentes: Uma das potenciais fontes embólicas no acidente vascular cerebral (AVC) de origem indeterminada é o forame oval patente (FOP). Objetivo: O objetivo do presente estudo foi identificar as características do shunt direita-esquerda em paciente com AVC de etiologia indeterminada, presumidamente embólica, e comparar tais características com pacientes apresentando AVC por outras causas não embólicas. Métodos: Trata-se de um estudo retrospectivo com 168 pacientes com AVC e forame oval patente, separados em dois grupos: AVC embólico de etiologia indeterminada e AVC por outras causas não embólicas. Todos os pacientes foram submetidos a Doppler transcraniano, para avaliar a presença de shunt direita-esquerda por meio do teste de embolia paradoxal. Além da quantificação de microbolhas, também foi avaliada a presença de shunt em repouso e sob manobra de Valsalva. Resultado: Do total, 96 pacientes foram incluídos no primeiro grupo (AVC indeterminado) e 72, no segundo grupo (AVC não embólico). No primeiro grupo, 65 pacientes exibiram shunt com passagem de mais de 10 microbolhas (67,5%), enquanto no segundo grupo isso aconteceu em 51,4% (p=0,038) dos casos. Além disso, 75 pacientes (78,1%) do primeiro grupo tiveram teste positivo ao repouso, comparados com 42 pacientes (58,3%) no segundo grupo (p=0,007). Conclusão: O presente estudo demonstrou que até 70% dos pacientes com AVC de etiologia indeterminada e forame oval apresentaram shunts maiores; em mais de 75%, houve passagem de microbolhas ao repouso. Esses achados sugerem que as características do shunt, como quantidade de microbolhas e passagem ao repouso, devem ser levadas em consideração na avaliação do FOP como possível mecanismo subjacente ao AVC.

Chlorella vulgaris growth on anaerobically digested sugarcane vinasse: influence of turbidity.

This paper shows the influence of turbidity (in Nephelometric Turbidity Units - NTU), chemical oxygen demand (COD) and aeration (CO2 supply) on the productivity and growth rate and lipid content of microalgae (a mixed culture predominantly composed of Chlorella vulgaris), using anaerobically digested vinasse as a culture medium. The microalgae can be cultivated in anaerobically digested vinasse, at turbidity and chemical oxygen demand of 690 NTU and 2.5 gCOD L -1, respectively, according to the modified Gompertz model, and removal of turbidity by filtration did not influence the microalgae productivity (≈ 77 mg L1 d1). Furthermore, aeration increased the productivity up to 139 mg L1 d1, with a biomass dry weight of 2.7 g L-1. Finally, a maximum lipid content of 265 mg L -1 was obtained, while a nitrogen removal of 98% was recorded for all conditions. Thus, the combination of anaerobic digestion followed by the use of the digestate for the cultivation of microalgae may be an efficient way to treat large quantities of this residue, in turn yielding large amounts of microalgae biomass, which can be transformed into fertilizer and biofuel.

A Genotyping Study in Benin Comparing the Carriage of Plasmodium falciparum Infections Before Pregnancy and in Early Pregnancy: Story of a Persistent Infection.

BACKGROUND: Malaria infections in the first trimester of pregnancy are frequent and deleterious for both mother and child health. To investigate if these early infections are newly acquired or already present in the host, we assessed whether parasites detected before pregnancy and those detected in early pregnancy are the same infection. METHODS: We used data from the preconceptional "RECIPAL" study (Benin, 2014-2017). Sixty-three pregnant women of 411 included who had a malaria infection detected by quantitative polymerase chain reaction both before pregnancy and at the first antenatal care (ANC) visit were selected for this study. Two highly polymorphic markers, msp-2 and glurp, and a fragment-analysis method were used to enumerate the Plasmodium falciparum genotypes and to quantify their proportions within isolates. An infection was considered as persistent when identical msp-2 and glurp genotypes were found in the corresponding prepregnancy and early-pregnancy samples. RESULTS: The median time between the 2 malaria screenings was 3 months. The median gestational age at the first ANC visit was 6.4 weeks. Most infections before pregnancy were submicroscopic infections. Based on both msp-2 and glurp genotyping, the infection was similar before and in early pregnancy in 46% (29/63) of cases. CONCLUSIONS: Almost half of P. falciparum infections detected in the first trimester originate before pregnancy. Protecting young women from malaria infection before pregnancy might reduce the prevalence of malaria in early pregnancy and its related poor maternal and birth outcomes.

Strain pattern and T-wave alterations are predictors of mortality and poor neurologic outcome following stroke.

BACKGROUND: Stroke is associated with electrocardiogram (ECG) abnormalities. However, the role of strain pattern as predictor of poor neurologic outcome and mortality after stroke has not yet been demonstrated. HYPOTHESIS: ECG abnormalities, with a particular focus on ST-segment changes, are predictors of mortality and neurologic disability 90 days after stroke. METHODS: Patients with up to 24 hours of stroke were prospectively recruited. An ECG was taken at the time of admission. The patients' clinical evolution was evaluated during hospitalization and after discharge by means of a prescheduled return in 90 days. The degree of disability was measured by the modified Rankin scale (mRs). In relation to the mRs, patients were divided into those with scores from 0 to 2 and those with scores equal to or greater than 3 at the end of the observation period. RESULTS: Of the 112 patients studied, 29 (25.8%) died during the study period. Patients who died presented higher National Institute of Health Stroke Scale and mRs scores on admission, elevated biomarkers of myocardial necrosis, and abnormalities on the ECG. The prevalence of ECG abnormalities was 63%. A logistic regression model showed that strain pattern and T-wave alterations were predictors of mortality (odds ratio [OR]: 12.970, 95% confidence interval [CI]: 1.519-110.723, P = .019; OR: 3.873, 95% CI: 1.135-13.215, P = .031, respectively) and mRs at 90 days (OR: 12.557, 95% CI: 1.671-94.374, P = .014; OR: 15.970, 95% CI: 3.671-69.479, P < .001, respectively) after stroke, adjusted by sex, age, stroke subtype, entrance NIH, previous mRs score, and stroke thrombolysis. CONCLUSION: Strain pattern and T-wave alterations were predictors of mortality and poor neurologic outcome 90 days after stroke.

Relationship of spontaneous microembolic signals to risk stratification, recurrence, severity, and mortality of ischemic stroke: a prospective study.

INTRODUCTION: The presence of microembolic signals (MES) during the acute phase of stroke is poorly understood, and its role and clinical application in relation to risk stratification and prognosis in patients remain uncertain. We assessed the prevalence of spontaneous MES in acute stroke and their relationship with risk stratification, stroke recurrence, morbidity, and mortality. PATIENTS AND METHODS: This was a prospective cohort study conducted in the Stroke Unit. The MES presence was evaluated by transcranial Doppler (TCD) in patients with ischemic stroke within 48 h. The outcomes (risk stratification, morbidity, mortality, and recurrence of a stroke) were followed up for 6 months. The relationship between risk stratification and MES was obtained by odds ratios and that between MES and stroke recurrence, morbidity, and mortality using multiple logistic regression; considering statistical significance at P < 0.05. RESULTS: Of the 111 patients studied, 70 were men (63.1%) and 90 were white (81.1%), with a median age of 68 years. The MES frequency was 7%. There was a significant relationship between MES and symptomatic carotid disease (OR = 22.7; 95% CI 4.1-125.7; P < 0.001), a shorter time to monitoring (OR = 12.4; 95% CI 1.4-105.4; P = 0.02), and stroke recurrence (OR = 16.83; 95% CI 2.01-141; P = .009). DISCUSSION: It was observed that the stroke recurrence adjusted for prior stroke was higher and earlier among patients with MES detection. In conclusion, MES demonstrated a significant correlation with symptomatic carotid disease and a shorter DELAY until monitoring, and could be a predictor for the early recurrence of stroke in the long term.

Latin American Consensus Statement for the Use of Contrast-Enhanced Transcranial Ultrasound as a Diagnostic Test for Detection of Right-to-Left Shunt.

BACKGROUND: The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients' management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information. SUMMARY: a group of experts from the Latin American participants of the Neurosonology Research Group (NSRG) of World Federation of Neurology created a task force to review literature and describe the better methodology of contrast TCD (c-TCD). All signatories of the present consensus statement have published at least one study on TCD as an author or co-author in an indexed journal. Two meetings were held while the consensus statement was being drafted, during which controversial issues were discussed and voted on by the statement signatories. The statement paper was reviewed and approved by the Executive Committee of the NSRG of the World Federation of Neurology. The main objective of this consensus statement is to establish a standardization of the c-TCD technique and its interpretation, in order to improve the informative quality of the method, resulting in expanding the application of TCD in the clinical setting. These recommendations optimize the comparison of different diagnostic methods and encourage the use of c-TCD for RLS screening and complementary diagnosis in multicenter studies.

Association between blood pressure and acute phase stroke case fatality rate: a prospective cohort study.

OBJECTIVE: ed to investigate the association between blood pressure and acute phase stroke lethality in a Brazilian intensive care unit. METHODS: This was an observational, prospective cohort study of hemorrhagic and ischemic stroke intensive care patients. The primary outcome was all-cause mortality during the first seven days. RESULTS: There were 146 patients, aged 66 ± 13.4 years, 56% men, 89% Caucasian, 69% had ischemic stroke, and 80% were hypertensive. The median of the National Institutes of Health Stroke Scale score was 16. There were 101 ischemic stroke patients and 45 hemorrhagic stroke patients. In the ischemic stroke patients, logistic regression analysis identified low systolic blood pressure as an independent ominous prognostic factor and the optimal cut off was a mean of systolic blood pressure ≤ 131 mmHg during the first 48 hours from admission for prediction of death. No association was found for hemorrhagic stroke. CONCLUSIONS: There was a negative association between systolic blood pressure and case fatality ratio of acute phase stroke in ischemic stroke intensive care patients.

Association between blood pressure and acute phase stroke case fatality rate: a prospective cohort study / Associação entre níveis de pressão arterial e letalidade na fase aguda do acidente vascular cerebral: estudo de coorte prospectivo

ABSTRACT Objective ed to investigate the association between blood pressure and acute phase stroke lethality in a Brazilian intensive care unit. Methods This was an observational, prospective cohort study of hemorrhagic and ischemic stroke intensive care patients. The primary outcome was all-cause mortality during the first seven days. Results There were 146 patients, aged 66 ± 13.4 years, 56% men, 89% Caucasian, 69% had ischemic stroke, and 80% were hypertensive. The median of the National Institutes of Health Stroke Scale score was 16. There were 101 ischemic stroke patients and 45 hemorrhagic stroke patients. In the ischemic stroke patients, logistic regression analysis identified low systolic blood pressure as an independent ominous prognostic factor and the optimal cut off was a mean of systolic blood pressure ≤ 131 mmHg during the first 48 hours from admission for prediction of death. No association was found for hemorrhagic stroke. Conclusions There was a negative association between systolic blood pressure and case fatality ratio of acute phase stroke in ischemic stroke intensive care patients.

RESUMO Objetivo Investigar a associação entre pressão arterial e letalidade do acidente vascular cerebral (AVC) em uma unidade de terapia intensiva brasileira. Métodos estudo de coorte prospectivo de pacientes com AVC hemorrágico (AVC-H) ou isquêmico (AVC-I) internados em terapia intensiva. O desfecho primário foi a letalidade por todas as causas nos primeiros sete dias. Resultados Avaliados 146 pacientes, idade: 66 ± 13,4 anos, 56% homens, 89% brancos, 69% AVC-I e 80% hipertensos. A mediana do NIH foi de 16. Os pacientes com AVC-I foram 101 e 45 com AVC-H. Para AVC-I, a análise de regressão logística identificou baixa pressão arterial sistólica como um fator prognóstico negativo e o melhor corte foi uma média da pressão arterial sistólica nas primeiras 48 h de admissão ≤ 131 mmHg para a predição da morte. Para o AVC-H, nenhuma correlação foi encontrada. Conclusões houve associação negativa entre a pressão arterial sistólica e a letalidade do AVC-I em fase aguda em pacientes de terapia intensiva.

Influence of Intradialytic Aerobic Training in Cerebral Blood Flow and Cognitive Function in Patients with Chronic Kidney Disease: A Pilot Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Changes in cerebral blood flow may play an important role in cognitive impairment among hemodialysis (HD) patients. Physical activity has a promising role in delaying cognitive impairment in general population, but there are only a few studies in HD to confirm this finding. We aimed to evaluate the effects of intradialytic aerobic training on cerebral blood flow and cognitive impairment in HD. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: This is a pilot, controlled, randomized trial. Fifteen patients underwent intradialytic aerobic training 3 times a week for 4 months. The control group was comprised of another 15 patients. RESULTS: Trained patients had a statistically significant improvement of cognitive impairment and basilar maximum blood flow velocity. The proportion of arteries with increased flow velocity was statistically significant between groups. CONCLUSIONS: Intradialytic aerobic training improves cognitive impairment and cerebral blood flow of patients in HD, suggesting a possible mechanism improving cognitive impairment by physical training in HD. These data still need to be confirmed by major trials.

Adductor Pollicis Muscle Thickness and Obesity Are Associated with Poor Outcome after Stroke: A Cohort Study.

BACKGROUND: Nutritional status may influence outcome after stroke. It is possible that some obese individuals present reduced fat-free mass. AIMS: We aimed to determine if bedside evaluation of body composition by the body mass index (BMI), adductor pollicis muscle thickness (APMT) and arm muscle area (AMA), and the combination of low APMT or AMA with obesity are associated with disability 90 days after stroke. METHODS: A cohort study evaluating 120 patients hospitalized at the Stroke Unit was carried out. Data were expressed as average ± standard deviation or median and percentiles. Obesity was evaluated by BMI and fat-free mass by the APMT and AMA. Receiver operating characteristic (ROC) curves and multivariate logistic regression analysis were used to measure whether APMT and obesity were associated with modified Rankin Scale (mRS) ≥3 (disability) within 90 days of stroke. The data were adjusted for National Institutes of Health Stroke Scale (NIHSS), sex, age, type of stroke, and thrombolysis. The significance level was 5%. RESULTS: Of 120 patients, we came up with the following demographics: men: 66 (55.0%); mean age: 66.6 ± 13.2 years; ischemic stroke: 109 (90.8%); mean NIHSS: 4 (2-10); thrombolysis: 18 (16.5%). Considering mRS ≥3, ROC curve analysis showed that the value of the cutoff for APMT was <12.5 mm. In multivariate analysis adjusted for the above factors, each 1 mm of increase in APTM reduced the chance of disability by 31%. The intersection of obesity with APMT <12.5 mm increased by 37-fold the risk of disability. AMA was not associated with mRS ≥3. CONCLUSION: Lower APMT alone or in combination with obesity was associated with poor functional status.