Test-Retest Reliability, Clinical Usefulness, and Telephone Application of the Work Limitation Questionnaire in Individuals Who Returned to Work After Stroke.

PURPOSES: To measure the test-retest reliability and the clinical usefulness of the Work Limitation Questionnaire, and to compare the in-person with the telephone application. METHODS: Cross-sectional, exploratory study. The Work Limitation Questionnaire was answered three times: twice in person, to measure test-retest reliability and clinical usefulness, and once, by telephone, to measure the validity of the telephone application. RESULTS: Fifty-six individuals (32 men) with mild to moderate disabilities after stroke were included. Test-retest reliability was very high (ICC 0.96; 95% CI 0.94 to 0.98; p < 0.01), the clinical usefulness was high (9 out of 12 points), and the correlation between in-person and telephone applications was high (ρ = 0.7; 95% CI 0.5 to 0.9; p < 0.01). The average productivity loss was 4% (SD 5, min-max 0 to 15%). CONCLUSIONS: The Work Limitation Questionnaire showed adequate test-retest reliability and clinical usefulness in individuals with stroke. The telephone application produced comparable results to in-person applications. The participants reported low productivity loss, which may be related to the mild impairments of the included sample.

A Falls Prevention Program for People After Stroke in Guyana: An International Collaboration.

OBJECTIVE: The objective was to describe the social, environmental, and cultural adaptations to an existing falls program and assess acceptability and preliminary effectiveness of the program in reducing fear, reducing falls, and improving function among individuals poststroke in Guyana. METHODS: A quasi-experimental pilot study with a pretest/posttest in-group design was developed through a collaboration of researchers in Guyana and the US. Participants took part in the falls prevention program for 8 weeks. Outcome measures included a 10-m walk test, the Five Times Sit to Stand Test, and subjective questionnaires for falls incidence and balance confidence at the beginning and end. RESULTS: Twenty participants completed the study. One participant experienced medical complications, and their data were excluded from analysis. Fifteen participants (78.9%) demonstrated improvements in comfortable and fast walking speed. Twelve participants completed the Five Times Sit to Stand Test. Eleven (91.67%) improved their time at the posttest, with 9 (81.8%) demonstrating a clinically important improvement. Nineteen participants had sustained at least 1 fall prior to the study. Only 1 participant reported a fall during the program. Initially, the majority of participants (11/19) were very concerned about falling. At the end, only 1 was very concerned about falling, and the majority (15/19) were not concerned at all. Posttest surveys of participants indicated acceptability of the program. CONCLUSIONS: This pilot program helped reduce fall risk and improve confidence, gait speed, and community mobility of the study participants. Future research at other rehabilitation departments in Guyana would help increase the generalizability of the program. IMPACT: The program can be used clinically by physical therapists in Guyana, both in departments and as a home program. Shared knowledge and experience of researchers considering research evidence and the environmental, social, and economic conditions of people living in Guyana were important in developing an effective program.

Effectiveness of Virtual Reality in Occupational Therapy for Post-Stroke Adults: A Systematic Review.

Background: In recent years, there has been a growing use of technological advancements to enhance the rehabilitation of individuals who have suffered from cerebrovascular accidents. Virtual reality rehabilitation programs enable patients to engage in a customized therapy program while interacting with a computer-generated environment. Therefore, our goal was to investigate the effectiveness of virtual reality in occupational therapy for people's rehabilitation after a cerebrovascular accident. Methods: We systematically searched databases (Pubmed/Medline, Scopus, Web of Science, and Science Direct) for randomized controlled trials published within the last 10 years. Studies involving adult stroke survivors undergoing virtual reality-based interventions aimed at improving upper-extremity motor function were included. The quality assessment followed PRISMA guidelines, with the risk of bias assessed using the Cochrane tool (version 6.4) and methodological quality evaluated using GRADEpro. Results: We selected sixteen studies that met the main criteria for the implementation of virtual reality technology. The interventions described in the articles focused mainly on the upper extremities and their fine motor skills. Conclusions: When used in conventional treatments to improve people's motor and cognitive functions after a cerebrovascular accident, virtual reality emerges as a beneficial tool. Additionally, virtual reality encourages adherence to the interventional process of rehabilitation through occupational therapy.

Evaluación antropométrica biomédica y diseño mecánico conceptual de un sistema robótico para la rehabilitación pasiva de miembros inferiores en pacientes post-accidente cerebrovascular / Biomedical anthropometric evaluation and conceptual mechanical design of robotic system for lower limbs passive-rehabilitation on post-stroke patients

RESUMEN Antecedentes: El accidente cerebrovascular (ACV) es una de las principales causas de discapacidad permanente, ya que puede provocar lesiones cerebrales graves con secuelas físicas significativas, limitando la capacidad de realizar actividades diarias. Objetivo: Esta investigación tuvo como objetivo diseñar un sistema robótico de movimiento pasivo-continuo para la rehabilitación de miembros inferiores en pacientes adultos con ACV, mejorando así las probabilidades de recuperación de su movilidad de marcha. Metodología: Se llevó a cabo el modelado y simulación del sistema robótico mediante Diseño Asistido por Computadora (CAD), utilizando el software de ingeniería Autodesk Inventor Professional 2023. Resultados: Se obtuvieron las posiciones iniciales y finales del sistema robótico, así como la simulación de movimiento pasivo-continuo. Conclusiones: La toma de medidas precisas de un paciente maximiza la posibilidad de implementar un prototipo funcional que contribuya en el proceso de rehabilitación.

ABSTRACT Background: Cerebrovascular accident (CVA) is one of the main causes of permanent disability, as it can cause serious brain injuries with significant physical consequences, limiting the ability to perform daily activities. Objective: This research aimed to design a robotic system of passive-continuous movement for the rehabilitation of lower limbs in adult patients with stroke, thus improving the chances of recovery of their walking mobility. Methodology: Modeling and simulation of the robotic system using Computer Aided Design (CAD), using the engineering software Autodesk Inventor Professional 2023. Results: The initial and final positions of the robotic system were obtained, as well as the simulation of passive-continuous movement. Conclusions: Taking precise measurements of a patient maximizes the possibility of implementing a functional prototype that contributes to the rehabilitation process.

Peripheral electrical stimulation on neuroplasticity and motor function in stroke patients: a systematic review and meta-analysis.

INTRODUCTION: The use of electrotherapy has been presented as a great resource for the professional physiotherapist in the most diverse pathologies. Stroke is a neurological condition responsible for sequelae such as hemiplegia that directly impair the quality of life of patients. OBJECTIVE: This study aimed to review the literature on the effects of electrotherapeutic resources on motor function and neuroplasticity in individuals with post-stroke sequelae. MATERIALS AND METHODS: 2427 articles were found in databases according to search criteria for each base according to the included descriptors (EndNote Web). After exclusion of duplicate articles, automatically and manually, Phase 1 was performed - reading of titles and abstracts of 1626 articles according to eligibility criteria by two blinded reviewers using the programme Rayyan QCRI (Qatar Computing Research Institute), conflicts were resolved in consensus between the two reviewers. Thus, 13 articles were selected for Phase 2-13 articles were selected for reading in full, leaving 8 articles in this review. To assess the quality of bias of the selected studies, the PEDro Scale was used. RESULTS: In the assessment of neuroplasticity, statistically significant results were found in two studies (p < 0.05). However, the effects of electrostimulation stood out significantly in the motor function of these individuals (p < 0.05). It can be considered with neuroplasticity, since improved functionality can be related to electrostimulation-induced neuroplasticity. Conclusions Electrostimulation is able to promote neuroplasticity and increase motor function, generating positive effects in the treatment of individuals with post-stroke sequelae.

Determinación del riesgo de muerte por afecciones vasculares en hipertensos de la población peruana 2021-2022

Objetivo: determinar el riesgo de muerte inmediata por eventos vasculares en hipertensos de la población peruana en el periodo 2021-2022 Metodología: estudio observacional, de casos y controles basado en datos del sistema nacional de defunciones del instituto nacional de estadística e informática del Perú entre enero de 2021 a agosto de 2022. Fueron incluidos todos los pacientes, hipertensos y no hipertensos, que fallecieron por alguna de las afecciones vasculares seleccionadas en las variables las cuales fueron, además de la presencia de hipertensión: paro cardiaco, accidente cerebrovascular isquémico y hemorrágico, choque cardiogénico, Se realizó la prueba de Chi-cuadrado de Pearson y la razón de probabilidades para la estimación del riesgo. Resultados: de 5385 muertes por infarto de miocardio, 54,80% tuvieron hipertensión arterial; de 1425 muertes por choque cardiogénico, 45,12% fueron hipertensos; de 434 fallecidos por accidente cerebrovascular isquémico, 52,76% padecieron hipertensión arterial; de los 746 fallecidos por accidente cerebrovascular hemorrágico, 56,97% fueron hipertensos; de los 4401 fallecidos por paro cardiaco, 25,61% también tuvieron hipertensión arterial. Se encontró que los hipertensos tuvieron un riesgo 7,52 veces mayor de morir por infarto agudo de miocardio, 3,39 veces por choque cardiogénico, 5,75 veces por accidente cerebrovascular isquémico, 10,27 accidente cerebrovascular hemorrágico y 1,94 veces por paro cardiaco. Conclusiones: las afecciones vasculares de mayor a menor riesgo de provocar la muerte en hipertensos son el accidente cerebrovascular, el infarto de miocardio, el accidente cerebrovascular isquémico, el choque cardiogénico y el paro cardiaco.

Objective: To determine the risk of immediate death due to vascular events in hypertensive patients in the Peruvian population in the period 2021-2022. Methodology: Observational, case-control study based on data from the national death system of the National Institute of Statistics and Informatics of Peru between January 2021 and August 2022. All patients, hypertensive and non-hypertensive, who died from any of the vascular affections selected in the variables which were, in addition to the presence of hypertension: cardiac arrest, ischemic and hemorrhagic cerebrovascular accident, cardiogenic shock. The Pearson's Chi-square test and the odds ratio were performed for the estimation of the risk. Results: Of 5385 deaths due to myocardial infarction, 54.80% had arterial hypertension; of 1425 deaths due to cardiogenic shock, 45.12% were hypertensive; of 434 deaths from ischemic stroke, 52.76% suffered arterial hypertension; of the 746 who died from hemorrhagic stroke, 56.97% were hypertensive; of the 4,401 deaths from cardiac arrest, 25.61% also had arterial hypertension. It was found that hypertensive patients had a 7.52 times higher risk of dying from acute myocardial infarction, 3.39 times from cardiogenic shock, 5.75 times from ischemic stroke, 10.27 times from hemorrhagic stroke and 1.94 times from heart attack. Conclusions: Vascular conditions from highest to lowest risk of causing death in hypertensives are cerebrovascular accident, myocardial infarction, ischemic cerebrovascular accident, cardiogenic shock and cardiac arrest.

Factores de riesgo asociados a enfermedades cerebrovasculares en mujeres / Risk Factors Associated with Cerebrovascular Diseases in Women

Introducción: La enfermedad cerebrovascular es la tercera causa de muerte en el mundo y representa la causa más frecuente de discapacidad permanente en adultos. Objetivo: Determinar los factores de riesgo asociados a enfermedades cerebrovasculares en mujeres. Métodos: Se realizó un estudio analítico observacional, de tipo caso-control, a partir de 35 pacientes del sexo femenino con diagnóstico de enfermedad cerebrovascular (casos) y otro grupo de pacientes que no presentaban dicha enfermedad (controles). Se utilizó el porcentaje como medida resumen de las variables cualitativas. Se determinó la razón de productos cruzados, el intervalo de confianza y la prueba de ji al cuadrado, así como el riesgo atribuible en expuesto porcentual para identificar los factores que se asociaron a la presencia de la enfermedad. Resultados: La hipercolesterolemia, la obesidad, el sedentarismo, los hábitos nutricionales inadecuados y el uso de anticonceptivos orales fueron los factores de riesgo modificable más significativos, con valores de razón de productos cruzados de 10,15; 9,08 y 8,17 y un riesgo atribuible en expuesto de 90,1 por ciento, 89 por ciento; 87,8 por ciento respectivamente. Por otra parte, la enfermedad cardíaca, la hipertensión arterial y la enfermedad cerebrovascular previa fueron los padecimientos asociados de mayor significación con razón de productos cruzados en expuesto de 3,55 y 2,97 y un riesgo atribuible en expuesto de 71,8 y 66,3 por ciento, respectivamente. Conclusiones: Los factores de riesgos modificables como hipercolesterolemia, obesidad, sedentarismo, hábitos nutricionales inadecuados y el uso de métodos anticonceptivos aumentaron la probabilidad de sufrir enfermedad cerebrovascular en las mujeres estudiadas(AU)

Introduction: Cerebrovascular disease is the third cause of death in the world, representing the most frequent cause of permanent disability in adults. Objective: To determine the risk factors associated with cerebrovascular diseases in women. Methods: A case-control observational analytical study was carried out in 35 female patients diagnosed with cerebrovascular disease (cases) and another group of patients who did not have said condition (controls). The percentage was used as a summary measure of the qualitative variables. The ratio of cross products, the confidence interval and the chi-square test were determined, as well as the attributable risk in percentage exposed to identify the factors that were associated with the presence of the disease. Results: Hypercholesterolemia, obesity, a sedentary lifestyle, inadequate nutritional habits, and the use of oral contraceptives were the most significant modifiable risk factors, with cross-product ratio values of 10.15, 9.08, and 8.17 and attributable risk in exposed of 90.1percent, 89percent, 87.8percent respectively. On the other hand, heart disease, hypertension and previous cerebrovascular disease were the most significant associated conditions with a ratio of cross products in exposed of 3.55 and 2.97 and attributable risk in exposed of 71.8 and 66.3percent, respectively. Conclusions: Modifiable risk factors such as hypercholesterolemia, obesity, sedentary lifestyle, inadequate nutritional habits and the use of contraceptive methods increased the probability of suffering cerebrovascular disease in the women studied(AU)

Multimodal physical training combined with tDCS improves physical fitness components in people after stroke: a double-blind randomized controlled trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) seems to be a potential tool to optimize the long-term effects of multimodal physical training (MPT) on fitness components in post-stroke patients. OBJECTIVE: We investigated the effects of cortical tDCS combined with MPT on motor function reflected by strength, motor performance, and cardiorespiratory capacity in chronic stroke patients. METHODS: This double-blind randomized controlled trial included 18 volunteers (55 ± 10 y, 72 ± 13 kg), who underwent MPT preceded by either sham stimulation (SHAM) or 2 mA bi-hemispheric tDCS. MPT consisted of 24 sessions of 60-70 min performed 2 d/wk within 12-16 weeks, with individualized intensity. Outcomes were Fugl-Meyer scores for lower limbs (FM-LL), and total (FM-Total); speed in the 10-m walk test (10MWT); oxygen uptake and work output at maximal effort (VO2max and Wmax), and gas exchange threshold (VO2-GET and W-GET); peak torque of isokinetic knee extension (PT-EXT) and flexion (PT-FLEX) of paretic and non-paretic limbs; bilateral strength deficit during knee extension (DS-EXT) and flexion (DS-FLEX). RESULTS: Pre- vs. post-intervention improvements were detected in tDCS vs. SHAM (p < 0.05) for FM-total (29.6% vs. 15.9%; effect size [ES] = 0.78), FM-LL (35.9% vs. 9.0%; ES = 1.23), 10MWT (10.6% vs. 3.8%; ES = 0.67), Wmax (75.0% vs. 4.3%; ES = 1.68), W-GET (91.6% vs. 12.4%; ES = 1.62), PT-EXT (25.6% vs. -6.5%; ES = 1.94) and PT-FLEX (26.3% vs. 9.8%; ES = 0.65) of the paretic limb, and DS-EXT (-13.7% vs. 2.5; ES = 1.43). CONCLUSION: Bi-hemispheric cortical tDCS optimized the effects of MPT performed with moderate volume and intensity upon muscle strength, motor function, and cardiorespiratory performance in stroke hemiparetic survivors. (Registration number RBR-22rh3p).

Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review.

BACKGROUND: Stroke is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet. OBJECTIVE: To identify body structure/function impairments and activity limitations in post-stroke that predict social participation restrictions in the community. METHODS: cohort studies were selected, involving adult post-stroke participants, which investigated body structure and function impairments or activity limitations of post-stroke individuals as predictors of social participation in the community. Studies that included individuals with subarachnoid hemorrhage, other neurological disorders and participants in long-term care facilities were excluded. The Newcastle-Ottawa quality assessment scale was applied to assess the methodological quality. The results were synthesized according to the found exposures, considering the used statistical models. RESULTS: Eleven articles were included, with a total of 2,412 individuals, 58.4% men, 83.7% ischemic stroke. Seven exposures were assessed across studies, in which 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function), and 8 studies assessed activity exposures (daily living activity and walking ability). CONCLUSION: There is some evidence that stroke severity, mental and motor deficits, limitations in activities of daily living and the ability to walk after a stroke can predict social participation in the community. PROSPERO registration CRD42020177591.

The ontogenetic model for CVA rehabilitation with transcranial stimulation

Currently, transcranial stimulation for CVA treatment is based on the interhemispheric rivalry model. This model has proven to have many anomalies, necessitating a new paradigm. Spontaneous recovery from post-CVA hemiplegia has an ontogenetic pattern. We reanalyzed the 2008 longitudinal London study and found that cortical disinhibition is the mechanism for ontogenetic CVA recovery. We propose that transcranial stimulation with 10 Hz rTMS or anode electrical microstimulation can produce CVA recovery similar to spontaneous recovery. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2466).

Actualmente la aplicación de la estimulación transcraneal para el tratamiento del ACV se realiza con base en el modelo de rivalidad interhemisférica. Este modelo ha mostrado muchas anomalías que hacen necesario un nuevo paradigma. La recuperación espontánea de la hemiplejia post-ACV tiene patrón ontogénico. Reanalizamos el estudio longitudinal de Londres 2008 y encontramos que su propuesta corresponde al mecanismo de recuperación ontogénica del ACV. Planteamos que la estimulación transcraneal, utilizando EMTr a 10 Hz o microestimulación eléctrica anódica, podría recuperar el ACV de manera similar a la recuperación espontánea. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2466).

Validity evidence for the Cognitive Screening test in stroke patients / Evidências de validade para o instrumento Triagem Cognitiva em pacientes com acidente vascular cerebral / Evidencias de validez del instrumento de Cribado de Deterioro Cognitivo en pacientes con accidente cerebrovascular

Cognitive deficits are common among post-stroke patients. Cognitive impairments of this sort are mediated by age and education. In Brazil, the only specific cognitive screening tool designed for post-stroke patients is the Cognitive Screening Test (Triagem Cognitiva - TRIACOG). The goal of this study was to investigate validity evidence related to external variables for the TRIACOG. Our sample included 153 adults and elderly people (M = 60.08, SD = 9.61) from Porto Alegre and metropolitan area, comprising 87 post-stroke patients and 66 healthy individuals. Three-way ANOVAs were used to assess main effects and interactions between the variables group (clinical/control), age and education. An influence of group and age on scores in the TRIACOG was found. We emphasize the relevance of these results to the selection of cut-off points for the tasks and cognitive functions assessed by the instrument, considering education and age, so as to allow more accurate identification of deficits in post-stroke patients. (AU)

Déficits cognitivos são comuns em pacientes após acidente vascular cerebral (AVC). O prejuízo cognitivo causado por esse evento é mediado por variáveis etárias e de escolaridade. No Brasil, o único instrumento de rastreio cognitivo específico para o pós-AVC é a Triagem Cognitiva (TRIACOG). O objetivo deste estudo é investigar evidências de validade relacionadas a variáveis externas da TRIACOG. Participaram do estudo 153 adultos e idosos (M = 60,08; DP = 9,61) de Porto Alegre e região metropolitana, sendo 87 pacientes pós-AVC e 66 saudáveis. Three-way ANOVA foi utilizada para indicar os efeitos e interações entre variáveis de grupo, etárias e educacionais. Observou-se a influência dos fatores de grupo e idade nos escores da TRIACOG. Ressalta-se a relevância dos resultados para a construção de pontos de corte para tarefas e funções do instrumento, considerando aspectos educacionais e etários, aumentando a precisão na identificação de déficits em pacientes pós-AVC. (AU)

Los déficits cognitivos son comunes en pacientes después de un accidente cerebrovascular. El deterioro cognitivo causado por este evento está mediado por variables de edad y educación. En Brasil, la única herramienta de detección cognitiva específica para después de un accidente cerebrovascular es el Cribado de Deterioro Cognitivo (TRIACOG). El propósito de este estudio fue investigar evidencias de validez relacionadas con las variables externas de TRIACOG. Participaron en el estudio un total de 153 adultos y ancianos (M = 60.08; DS= 9.61) de Porto Alegre y región metropolitana, de los cuales, 87 eran pacientes posictus y 66 eran sanos. Se utilizó Three-way ANOVA para indicar los efectos y las interacciones entre las variables de grupo, edad y escolarización. Se observó la influencia de factores de grupo y edad en las puntuaciones del TRIACOG. Se enfatiza la relevancia de los resultados para la construcción de puntos de corte para tareas y funciones del instrumento, teniendo en cuenta aspectos educativos y de edad, aumentando la precisión en la identificación de déficits en pacientes posictus. (AU)

Nonvalvular atrial fibrillation in anticoagulated patients

Objective: to analyze the epidemiological and clinical characteristics of a population with nonvalvular atrial fibrillation (NVAF) treated with oral anticoagulation at Instituto Cardiovascular del Tolima in Ibagué, Colombia. Reference framework: NVAF is a prevalent disease in Colombian patients over the age of 60, who are at greater risk of a cerebrovascular accident, which is preventable with anticoagulation treatment. However, complications inherent or secondary to the disease may occur despite treatment. Methods: a cross-sectional study which describes the baseline characteristics of a total of 146 participants with NVAF being treated with oral anticoagulants, using information from their clinical charts between 2018 and 2019. Results: of the participants, 53% were female, and 57% of the participants had permanent NVAF, this being the most frequent type in the study cohort. Ninety-nine percent were treated with non-vitamin K oral anticoagulants (NOACs) (76% with rivaroxaban), and 1% with a VKA (warfarin). Eighty-nine percent of the participants had a CHADS2 classification between 1-3 and 87% fell in the HASBLED 1-3 categories; of these, 95% did not have a CVA/TIA, 99% did not have a systemic embolism and 97% did not have major bleeds, respectively for each classification. There were no fatal outcomes in any of the patients. Conclusions: an association was confirmed between CHADS2, CHADS2VASC2 and HASBLED classifications and CVA/TIA and hemorrhages in the study population (p<0.05). (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2202).

Objetivo: analizar las características epidemiológicas y clínicas de una población con fibrilación auricular no valvular (FANV) tratada con anticoagulación oral en el Instituto Cardiovascular del Tolima (Ibagué, Colombia). Marco de referencia: la FANV es una patología prevalente en pacientes colombianos mayores de 60 años, quienes tienen mayor riesgo de accidente cerebrovascular, el cual es prevenible con el tratamiento de anticoagulación; sin embargo, a pesar de la terapia se pueden presentar complicaciones propias de la patología o secundarias a él. Metodología: estudio de corte transversal, que describe las características basales de un total de 146 participantes con FANV en manejo con anticoagulantes orales, con seguimiento a través del registro de su historia clínica entre 2018 y 2019. Resultados: de los participantes, el 53% corresponde a mujeres, el 57% de los participantes presentaron FANV tipo permanente siendo la más frecuente en la cohorte estudiada; recibieron manejo en 99% con anticoagulante oral no antagonista de la vitamina K (NOAC) (76% con rivaroxabán) y 1% con AVK (warfarina). El 89% de los participantes tuvo una clasificación dentro de CHADS2 de 1-3 y 87% dentro de HASBLED de 1-3; de estos, el 95% no presentó ACV/AIT, el 99% no presentó embolismo sistémico y 97% no presentó sangrados mayores, respectivamente con cada clasificación. No se documentaron eventos fatales para el 100% de los pacientes. Conclusiones: se confirma asociación para las clasificaciones de tipo CHADS2, CHADS-2VASC2, HASBLED y el desarrollo de ACV/AIT y hemorragias en la población estudiada (p<0.05). (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2202).

Simultaneous thromboses in patients with SARS-CoV-2 infection

COVID-19 infection has a high morbidity and mortality rate. Although there is mainly pulmonary involvement, SARS-CoV-2 infection is considered to be a true endothelial disease, given these patients' increased risk of developing both arterial and venous thrombotic phenomena. We present three cases of patients with active SARS-CoV-2 infection and simultaneous thromboses in different vascular territories: cerebrovascular disease and pulmonary embolism, cerebrovascular disease and peripheral arterial embolism, and cerebrovascular disease plus deep vein thrombosis. We emphasize the scant evidence on the topic in the current literature and the importance of being alert to the onset of these events during the clinical course of patients with acute infection with the new coronavirus. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2347).

La infección por COVID-19 tiene una alta tasa de morbimortalidad, si bien existe principalmente compromiso pulmonar, se considera que la infección por SARS-CoV-2 es una verdadera endoteliopatía, dado el riesgo aumentado que tienen estos pacientes de desarrollar fenómenos trombóticos como arteriales y venosos. Presentamos tres casos de pacientes con infección activa por SARS-CoV-2 y trombosis simultáneas en diferentes territorios vasculares: enfermedad cerebrovascular y embolismo pulmonar, enfermedad cerebrovascular y embolismo arterial periférico, enfermedad cerebrovascular más trombosis venosa profunda. Enfatizamos en la poca evidencia de la literatura actual al respecto y la importancia de estar atentos al desarrollo de estos eventos durante la evolución de los pacientes con infección aguda por nuevo coronavirus. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2347).

Awareness towards stroke among high school students in Brazil: a cross-sectional study

ABSTRACT BACKGROUND: Stroke is one of the main causes of death worldwide. Educational interventions on stroke are potentially effective in reducing the period between the onset of symptoms and the initial emergency medical assistance. OBJECTIVES: To assess high school students' knowledge of stroke. DESIGN AND SETTING: Cross-sectional study conducted in high schools in northeastern Brazil. METHODS: A self-structured questionnaire survey regarding stroke awareness was applied among high school students in northeastern Brazil. Data were collected between 2018 and 2019. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 1,788 students were analyzed. Eighty percent (n = 1430) of them did not have the minimum knowledge on how to act in a stroke situation. Only 10% (n = 179) presented the ideal knowledge on how to act. Males presented lower levels of knowledge on risk factors (odds ratio, OR: 0.62%; 95% confidence interval, CI: 0.49-0.79) and signs and symptoms of stroke (OR: 0.63%; 95% CI: 0.52-0.77). Students with ≥ 10 years of schooling (OR: 1.64%; 95% CI: 1.30-2.07) demonstrated greater knowledge of signs and symptoms of stroke. Students aged 18 years (OR: 1.70%; 95% CI: 1.14-2.52) demonstrated greater knowledge than other ages regarding the telephone number of the emergency medical services. CONCLUSIONS: There was a knowledge deficit with regard to recognizing stroke and activating the emergency medical services. The findings apply to the sample investigated and suggest that there is a need for stroke educational interventions, starting in high school.

Efectos del Ejercicio Físico Aeróbico sobre los Factores de Riesgo Modificables que Predisponen a un Segundo Evento de Accidente Cerebrovascular. Revisión Sistemática / Effects of Aerobic Physical Exercise on Modifiable Risk Factors that Predispose to a Second Stroke Event. Systematic review

Introducción. El accidente cerebrovascular (ACV) es una condición de salud que ha aumentado su prevalencia en los últimos años, la cual se encuentra intrínsecamente asociada a la presencia de enfermedades crónicas no transmisibles (ECNT), como lo son la diabetes mellitus, dislipidemia e hipertensión, las que, de no ser controladas tras la instauración del primer episodio, predisponen a la afección de un segundo evento de ACV. Es sabido que el ejercicio físico aeróbico juega un rol fundamental en el control de las ECNT, junto con otros factores, como lo son los cambios de hábitos y adherencia a los tratamientos farmacológicos. Objetivo. Analizar los efectos que tiene el ejercicio físico aeróbico en población secuelada de un ACV sobre las ECNT que predisponen a sufrir un segundo evento cerebrovascular. Método. Se realizó una exhaustiva búsqueda en las bases de datos EBSCO, Scielo, PubMed y PEdro, utilizando las palabras claves "stroke and modifiable risk factors and aerobic physical exercise"; obteniendo un total de 56438 artículos. Para la selección, se consideraron los siguientes criterios de inclusión: pacientes entre 45 y 65 años con secuelas de ACV de más de 6 meses, que analizaran el efecto del ejercicio físico sobre las ECNT tras un evento cerebrovascular. Resultados. Se seleccionaron tres artículos científicos tipo ensayo clínico aleatorizados controlados, los cuales analizan los efectos que produce el ejercicio físico aeróbico sobre las ECNT tras un ACV. Entre los resultados con mayor significancia estadística (P entre 0.01 y 0.05) se encuentra el aumento en el consumo peak de oxígeno y el aumento en el colesterol HDL. Conclusiones. Es indispensable sistematizar la información de los programas de rehabilitación neurológica, que permitan levantar datos de las intervenciones, y así poder potenciar el ejercicio físico aeróbico de forma segura para poder controlar las ECNT subyacentes y así prevenir futuros eventos cerebrovasculares.

Background. Cerebrovascular accident (CVA) is a health condition that has suspected its prevalence in recent years, which is intrinsically associated with the presence of chronic non-communicable diseases (CNCD), such as diabetes mellitus, dyslipidemia and hypertension, which, if not controlled after the establishment of the first episode, predispose to the condition of a second stroke event. It is known that aerobic physical exercise plays a fundamental role in the control of NCDs, along with other factors, such as changes in habits and adherence to pharmacological treatments. Objective. To analyze the effects of aerobic physical exercise in the population after a stroke on NCDs that predispose to a second cerebrovascular event. Method. An exhaustive search was carried out in the EBSCO, Scielo, PubMed and PEdro databases, using the keywords "stroke and modifiable risk factors and aerobic physical exercise"; obtaining a total of 56438 articles. For selection, consider the following inclusion criteria: patients between 45 and 65 years of age, stroke sequelae of more than 6 months, who will analyze the effect of physical exercise on NCDs after a cerebrovascular event. Results. Three controlled randomized clinical trial were selected, which analyze the effects produced by aerobic physical exercise on NCDs after a stroke. Among the results with the highest statistical significance (P between 0.01 and 0.05) is the increase in peak oxygen consumption and the increase in HDL cholesterol. Conclusion. It is essential to systematize the information on neurological rehabilitation programs, to collect data from the interventions, and thus be able to promote aerobic physical exercise safely to control the underlying NCDs and thus prevent future cerebrovascular events.

Serum activity of matrix metalloproteinase-2 and -9 is increased in chronic post-stroke individuals: a cross-sectional exploratory study.

BACKGROUND: High concentrations of matrix metalloproteinase-2 (MMP-2) and -9 (MMP-9) are associated with inflammation early after stroke. In chronic stages, the elevation of some cytokines is related to the presence of co-morbid conditions in these individuals. In addition to this, some characteristics such as sensorimotor impairment, atrophy, and sedentary lifestyle predispose the system to an inflammatory response. OBJECTIVE: To quantify MMP-2 and -9 serum activity in chronic post-stroke individuals and correlate it with variables of physical activity level, body composition, functional and walking capacity, and with inflammatory biomarkers. Additionally, gelatinase activity was characterized according to motor impairment. METHODS: Fourteen patients with stroke onset >6 months and seven healthy individuals were enrolled in this study. The clinical assessment included: body composition, measure by bioelectrical impedance analyzer; Fugl-Meyer Motor Assessment Scale; six-minute and ten-meter walk tests, and physical activity level assessed by the StepWatch® Activity Monitor. Blood samples were collected from antecubital vein and serum MMP-2 and -9 activity was analyzed using gelatin Zymography, and the TNFα, IL-6, IL-1ß, IL-10 biomarkers using ELISA kits. RESULTS: Chronic post-stroke individuals presented an increased activity of MMP-2 and -9 compared to healthy individuals. Positive correlations with time and steps in low cadence and negative ones with medium cadence and peak activity index were observed. According to the motor impairment, the MMP-2 activity was increased in the mild-moderate group compared to the control group. CONCLUSION: Increased gelatinases in chronic post-stroke individuals could describe an inflammation process related to the limited capacity of walking in high intensities.

Specific health-related quality of life in Cerebrovascular accident survivors: associated factors / Calidad de vida relacionada a la salud específica de supervivientes de accidente cerebrovascular: factores relacionados / Qualidade de vida relacionada à saúde específica de sobreviventes de acidente vascular encefálico: fatores associados

ABSTRACT Objectives: to identify factors associated with specific health-related quality of life in cerebrovascular accident, or stroke, survivors. Methods: cross-sectional study, carried out with 160 cerebrovascular accident survivors. Data were collected using the Barthel Index, Cerebrovascular Accident Specific Quality of Life Scale, and semi-structured instruments for sociodemographic and clinical data, analyzed by descriptive and inferential statistics. Results: health-related quality of life was associated with work activity (p=0.027), physical activity (p=0.007), functional capacity (p=0.001), presence of caregiver (<0.001), motor alteration (p = 0.001) and rehabilitation (p=0.003). The functionally dependent people were 14.61 times more likely to present low health-related quality of life, and those with motor impairment were 3.07 times more likely. Conclusions: it was evidenced that functional dependence and motor impairment increase the chance of low health-related quality of life in cerebrovascular accident survivors.

RESUMEN Objetivos: identificar factores relacionados a calidad de vida relacionada a salud específica de supervivientes de accidente cerebrovascular. Métodos: estudio transversal, realizado con 160 supervivientes de accidente cerebrovascular. Los datos fueron recolectados mediante el Índice de Barthel, Escala de Calidad de Vida Específica para Accidente Cerebrovascular e instrumento semiestructurado para los datos sociodemográficos y clínicos, analizados por estadística descriptiva e inferencial. Resultados: la calidad de vida relacionada a salud se relacionó a la actividad laboral (p=0,027), actividad física (p=0,007), capacidad funcional (p=0,001), presencia de cuidador (<0,001), alteración motora (p = 0,001) y rehabilitación (p=0,003). Las personas funcionalmente dependientes demostraron 14,61 veces más chance de presentar baja calidad de vida relacionada a salud; y aquellas con alteración motora demostraron 3,07 veces más chance. Conclusiones: se evidenció que la dependencia funcional y la alteración motora elevan la chance de una baja calidad de vida relacionada a la salud en supervivientes de accidente cerebrovascular.

RESUMO Objetivos: identificar os fatores associados à qualidade de vida relacionada à saúde específica de sobreviventes de acidente vascular encefálico. Métodos: estudo transversal, realizado com 160 sobreviventes de acidente vascular encefálico. Os dados foram coletados por meio do Índice de Barthel, Escala de Qualidade de Vida Específica para Acidente Vascular Encefálico e instrumento semiestruturado para os dados sociodemográficos e clínicos, analisados por estatística descritiva e inferencial. Resultados: a qualidade de vida relacionada à saúde associou-se à atividade laboral (p=0,027), atividade física (p=0,007), capacidade funcional (p=0,001), presença de cuidador (<0,001), alteração motora (p = 0,001) e reabilitação (p=0,003). As pessoas funcionalmente dependentes demonstraram 14,61 vezes mais chance de apresentar baixa qualidade de vida relacionada à saúde; e aquelas com alteração motora demonstraram 3,07 vezes mais chance. Conclusões: evidenciou-se que a dependência funcional e a alteração motora elevam a chance de uma baixa qualidade de vida relacionada à saúde em sobreviventes de acidente vascular encefálico.

Repetitive Peripheral Sensory Stimulation as an Add-On Intervention for Upper Limb Rehabilitation in Stroke: A Randomized Trial.

INTRODUCTION: Repetitive peripheral sensory stimulation (RPSS) followed by 4-hour task-specific training (TST) improves upper limb motor function in subjects with stroke who experience moderate to severe motor upper limb impairments. Here, we compared effects of RPSS vs sham followed by a shorter duration of training in subjects with moderate to severe motor impairments in the chronic phase after stroke. METHODS: This single-center, randomized, placebo-controlled, parallel-group clinical trial compared effects of 18 sessions of either 1.5 h of active RPSS or sham followed by a supervised session that included 45 min of TST of the paretic upper limb. In both groups, subjects were instructed to perform functional tasks at home, without supervision. The primary outcome measure was the Wolf Motor Function Test (WMFT) after 6 weeks of treatment. Grasp and pinch strength were secondary outcomes. RESULTS: In intention-to-treat analysis, WMFT improved significantly in both active and sham groups at 3 and 6 weeks of treatment. Grasp strength improved significantly in the active, but not in the sham group, at 3 and 6 weeks. Pinch strength improved significantly in both groups at 3 weeks, and only in the active group at 6 weeks. CONCLUSIONS: The between-group difference in changes in WMFT was not statistically significant. Despite the short duration of supervised treatment, WMFT improved significantly in subjects treated with RPSS or sham. These findings are relevant to settings that impose constraints in duration of direct contact between therapists and patients. In addition, RPSS led to significant gains in hand strength.Trial Registry Name: Peripheral Nerve Stimulation and Motor Training in Stroke Clinical Trials.gov identifier: NCT0265878 https://clinicaltrials.gov/ct2/show/NCT02658578.

Factores de riesgo para enfermedad cerebrovascular en el adulto mayor / Risk Factors for Cerebrovascular Disease in the Older Adult

Introducción: La vejez está subvalorada, poco se piensa en el bienestar físico y psicosocial del anciano. La enfermedad cerebrovascular tiene como factores de riesgo comorbilidades como la hipertensión arterial, la diabetes mellitus, la dislipidemia, cardiopatías o malos estilos de vida como el consumo de cigarrillo, la obesidad y la poca actividad física, todos estos comunes en esta etapa de la vida. Objetivo: Identificar los factores de riesgo que presentan los adultos mayores para sufrir enfermedad cerebrovascular de un centro gerontológico de la ciudad de Medellín. Métodos: Fue una investigación descriptiva, de tipo transversal; se indagaron 37 adultos mayores con historias clínicas y exámenes de laboratorio. Se midieron los niveles de hemoglobina glicosilada, colesterol total, colesterol de baja densidad, colesterol de alta densidad y triglicéridos. Resultados: Se evidenció que la población era en su mayoría de sexo masculino con 51,4 por ciento y el sexo femenino con 48,6 por ciento; con rango de edad entre 60 y 70 años el 51,4 por ciento. Los factores de riesgo más relevantes fueron el índice de masa corporal mayor o igual a 25 con (75,7 por ciento), hipertensión arterial y no realizar actividad física. Conclusiones: Se logró determinar los principales factores de riesgo que tienen estos adultos mayores para sufrir enfermedad cerebrovascular; con resultados algunos similares y otros diferentes a estudios a nivel mundial. Con actividades de promoción y prevención se pueden intervenir estilos de vida de la población(AU)

Introduction: Old age is undervalued; little is thought about the physical and psychosocial well-being of the elderly. Among the risk factors of cerebrovascular disease, there are comorbidities, such as high blood pressure, diabetes mellitus, dyslipidemia and cardiopathies, or poor lifestyles like cigarette smoking, obesity and little physical activity, all of which are common at this stage of life. Objective: To identify, in a gerontological center in Medellín City, the risk factors that older adults present for being affected by cerebrovascular disease. Methods: This was a descriptive and cross-sectional research carried out with 37 older adults with medical antecedents and laboratory tests. The levels of glycated hemoglobin, total cholesterol, low-density and high-density cholesterol, as well as triglycerides were measured. Results: It was evidenced that the population was mostly male (51.4 por ciento), while females accounted for 48.6 por ciento. Their age range was mostly between 60 and 70 years (51.4 por ciento). The most relevant risk factors were body mass index greater than or equal to 25 (75.7 por ciento), arterial hypertension and not doing any physical activity. Conclusions: It was possible to determine the main risk factors for these older adults being affected by cerebrovascular disease; in this respect, some results were similar to and others were different from studies worldwide. With promotion and prevention activities, lifestyles of the population can be intervened(AU)

Factores neurológicos asociados a la mortalidad en pacientes con accidente cerebrovascular y ventilación mecánica artificial / Neurological factors associated to mortality in patients with cerebrovascular accident and artificial mechanical ventilation

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)