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Introduction and purpose: Basilar artery occlusion (BAO) is still one of the most devastating neurological conditions associated with high morbidity and mortality. In the present study, we aimed to assess the role of posterior circulation collaterals as predictors of outcome in the BASICS trial and to compare two grading systems (BATMAN score and PC-CS) in terms of prognostic value. Methods: We performed a sub-analysis of the BASICS trial. Baseline clinical and imaging variables were analyzed. For the imaging analysis, baseline CT and CTA were analyzed by a central core lab. Only those patients with good or moderate quality of baseline CTA and with confirmed BAO were included. Multivariable binary logistic regression analysis was used to test the independent association of clinical and imaging characteristics with a favorable outcome at 3 months (defined as a modified Rankin Score of ≤3). ROC curve analysis was used to assess and compare accuracy between the two collateral grading systems. Results: The mean age was 67.0 (±12.5) years, 196 (65.3%) patients were males and the median NIHSS was 21.5 (IQR 11-35). Median NCCT pc-ASPECTS was 10 (IQR10-10) and median collateral scores for BATMAN and PC-CS were 8 (IQR 7-9) and 7 (IQR 6-8) respectively. Collateral scores were associated with favorable outcome at 3 months for both BATMAN and PC-CS but only with a modest accuracy on ROC curve analysis (AUC 0.62, 95% CI [0.55-0.69] and 0.67, 95% CI [0.60-0.74] respectively). Age (OR 0.97, 95% CI [0.95-1.00]), NIHSS (OR 0.91, 95% CI [0.89-0.94]) and collateral score (PC-CS - OR 1.2495% CI [1.02-1.51]) were independently associated with clinical outcome. Conclusion: The two collateral grading systems presented modest prognostic accuracy. Only the PC-CS was independently associated with a favorable outcome at 3 months.

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The unsustainable increases in healthcare expenses and waste have motivated the migration of reimbursement strategies from volume to value. Value-based healthcare requires detailed comprehension of cost information at the patient level. This study introduces a clinical risk- and outcome-adjusted cost estimate model for stroke care sustained on time-driven activity-based costing (TDABC). In a cohort and multicentre study, a TDABC tool was developed to evaluate the costs per stroke patient, allowing us to identify and describe differences in cost by clinical risk at hospital arrival, treatment strategies and modified Rankin Score (mRS) at discharge. The clinical risk was confirmed by multivariate analysis and considered patients' National Institute for Health Stroke Scale and age. Descriptive cost analyses were conducted, followed by univariate and multivariate models to evaluate the risk levels, therapies and mRS stratification effect in costs. Then, the risk-adjusted cost estimate model for ischaemic stroke treatment was introduced. All the hospitals collected routine prospective data from consecutive patients admitted with ischaemic stroke diagnosis confirmed. A total of 822 patients were included. The median cost was I$2210 (interquartile range: I$1163-4504). Fifty percent of the patients registered a favourable outcome mRS (0-2), costing less at all risk levels, while patients with the worst mRS (5-6) registered higher costs. Those undergoing mechanical thrombectomy had an incremental cost for all three risk levels, but this difference was lower for high-risk patients. Estimated costs were compared to observed costs per risk group, and there were no significant differences in most groups, validating the risk and outcome-adjusted cost estimate model. By introducing a risk-adjusted cost estimate model, this study elucidates how healthcare delivery systems can generate local cost information to support value-based reimbursement strategies employing the data collection instruments and analysis developed in this study.

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This study aimed to develop a short version of an instrument to detect cognitive impairment in stroke patients, investigate which cognitive dimensions best discriminate between stroke patients and healthy adults and to graphically analyze the relationships among the neuropsychological variables and groups. This pilot study included 94 adults (49 post-stroke and 45 neurologically healthy) who answered the Brief Neuropsychological Assessment Battery NEUPSILIN for patients with expressive aphasia (NEUPSILIN-Af) to assess orientation, perception, memory, praxis, executive functions, oral language, and academic achievement (written language and arithmetic). The IRT Rasch model for dichotomous data indicated the exclusion of items that could not be used to discriminate performances. ROC curves indicated that only the orientation, oral language, academic achievement, and executive function dimensions could be used to differentiate between the clinical and healthy groups. Graphical analysis indicated that independently of the relation among variables, orientation and executive functions tasks are essentials in the neuropsychological assessments. This study contributes to the development of specific and sensitive neuropsychological instruments to assess stroke patients and to better understand the common deficits present in this clinical population.

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Objective: To analyze the cost-effectiveness and cost-utility of dabigatran compared with warfarin in patients with non valvular atrial fibrillation with moderate to high risk of ischemic stroke or systemic embolism and eligible for treatment with anticoagulants. Methods: Markov-based economic analysis was performed to estimate treatment costs and outcomes. Epidemiologicalandefficacy data were determined after a critical revision of the medical literature. Unit costs were taken from Brazilian official databases. Only direct medical costs were covered. Costs and benefits were discounte data rate of 5% per year. Outcomes were expressed as life-year (LY) and quality-adjusted life-year (QALY). Results: Dabigatranuseis cost-effective intermsofLYandQALY considering a willingness-to-pay thresholdof 3times gross domestic product per capita of 2010 (Brazilian rea l57,048/US$24,275.74) perLYand QALY saved in both analyzed perspectives (private and public health care systems). Conclusions: Dabigatran use improves patient survival and quality of life compared with warfarin. This represents the best therapeutic option in terms of cost and effectiveness in the prevention of ischemi cstroke and systemic embolism in patients with non valvular atrial fibrillation.

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O angioedema é uma reação inflamatória local potencialmente grave. Estudos evidenciam uma incidência destes casos após uso de alteplase entre 0,02% e 5,1%. Relatamos um caso de acidente vascular cerebral isquêmico agudo tratado com alteplase que evoluiu com angioedema e piora clínica. Este paciente teve expressiva melhora neurológica com posterior declínio clínico após o angioedema. O mecanismo inflamatório neste caso pode ter desempenhado papel determinante na reoclusão.

Angioedema is a potentially severe local inflammatory reaction. There is an incidence of 0.02% to 5.1% in patients treated with alteplase. We report a case of acute ischemic stroke that was treated with alteplase and presented a life threatening allergic reaction. This patient had an important neurologic improvement in the beginning, but this benefit was lost after angioedema. The inflammatory mechanism that causes angioedema is sometimes decisive in re-occlusion.

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As alteracoes hematologicas geradas pelo etanol devem-se a sua toxidade direta, tanto na medula ossea quanto nos elementos sanguineos perifericos, ou indireta, devido aos disturbios metabolicos. Atraves de um estudo transversal quantitativo retrospectivo sobre dados secundarios, com a medida dos elementos sanguineos em pacientes dependentes ou abusadores de alcool, verificou-se a prevalencia e a medida da magnitude ou grau das alteracoes no leucograma dos pacientes internados no Centro do Dependente Quimico (CDQUIM) de Porto Alegre. A amostra foi de 543 pacientes, sendo 504 homens (92,8 por cento ) e 39 mulheres (7,2 por cento ). Do total, 264 (48,6 por cento ) apresentaram alguma alteracao na serie leucocitaria. Nos leucocitos, o achado mais frequente foi monocitopenia (45,1 por cento ), seguido de linfopenia (15,1 por cento ) e neutrocitose (14,9 por cento ). Salienta-se a importancia de se conhecer estas alteracoes, para que o manejo do alcoolista seja mais adequado e preciso

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Apos a instituicao do novo curriculo da Faculdade de Medicina da UFRGS, no segundo semestre de 1990, a atividade de Monitoria do Departamento de Medicina Interna permanece um importante instrumento de ensino/aprendizagem, tendo sido ampliado seu campo de atuacao. Das 6 disciplinas do Departamento de Medicina Interna, em 3 sao desenvolvidas atividades didaticas pelo grupo de 9 monitores deste departamento. As adaptacoes do programa de monitoria para o novo curriculo da Medicina e as atividades desenvolvidas pelo monitor, tradicionalmente com otima aceitacao por parte de alunos e professores, sao descritas neste artigo. Salienta-se a importancia deste processo de aquisicao e transmissao de conhecimentos para a formacao do monitor como aluno, alem de seu papel de intregracao entre os corpos docente e discente nas atividades de ensino

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