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Vascular cognitive impairment (VCI) is the second most common cause of cognitive impairment after Alzheimer's disease. The VCI spectrum involves a decline in cognition attributable to vascular pathologies (e.g., large infarcts or hemorrhages, microinfarcts, microbleeds, lacunar infarcts, white matter hyperintensities, and perivascular space dilation). Pathophysiological mechanisms include direct tissue injury, small vessel disease, inflammaging (inflammation + aging), atrophy, and altered neurotransmission. VCI is diagnosed using distinct clinical and radiological criteria. It may lead to long-term disability and reduced quality of life. An essential factor for reducing cognitive impairment incidence is preventing stroke by managing traditional and non-traditional cerebrovascular risk factors. This article reviews the spectrum of VCI, epidemiology, risk factors, pathophysiology, diagnosis, available treatment, and preventive strategies.

O comprometimento cognitivo vascular (CCV) é a segunda causa mais comum de comprometimento cognitivo depois da doença de Alzheimer. O espectro do CCV envolve um declínio na cognição atribuível a patologias vasculares (por exemplo, grandes infartos ou hemorragias, microinfartos, micro-hemorragias, infartos lacunares, hiperintensidades da substância branca e dilatação do espaço perivascular). Os mecanismos fisiopatológicos incluem lesão tecidual direta, doença de pequenos vasos, inflammaging (inflamação+envelhecimento), atrofia e neurotransmissão alterada. O CCV é diagnosticado usando critérios clínicos e radiológicos distintos. Pode levar à incapacidade a longo prazo e à redução da qualidade de vida. Um fator essencial para reduzir a incidência de comprometimento cognitivo é prevenir o acidente vascular cerebral através do manejo dos fatores de risco cerebrovasculares tradicionais e não tradicionais. Este artigo revisa o espectro do CCV, epidemiologia, fatores de risco, fisiopatologia, diagnóstico, tratamento disponível e estratégias preventivas.

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BACKGROUND AND PURPOSE: Primary palliative care (PC) aims to improve the quality of life for patients with acute ischemic stroke but is often misinterpreted as withdrawal of care. The self-fulfilling prophecy withdrawal bias is feared in this context of PC's early implementation. This study evaluates stroke patients who died in the hospital to determine the impact of PC evaluation. METHODS: A retrospective descriptive analysis of patients who died from acute ischemic stroke was conducted. The study included patients aged ≥18 years admitted to the Stroke Unit of a quaternary hospital in Brazil from January 2017 to December 2018. The impact of PC assessment on outcomes was analyzed, with significance set at 5%. RESULTS: Among the patients who died during hospitalization as a result of an ischemic stroke (n = 77), 39 (%) were assessed by the palliative care team. There was no difference in the total length of stay or duration of antibiotic therapy. Logistic regression corrected for significant variables from the univariate analysis revealed that PC evaluation was associated with a 31-fold increase in opioid use (P < 0.001), a nearly 14-fold increase in discharges to the ward, and a threefold reduction in ICU length of stay (P = 0.011). CONCLUSION: PC team involvement was associated with higher rates of discharge to the floors, inferring more time spent with family and increased opioid use, suggesting better symptom control, without reducing the overall length of stay or duration of antibiotic therapy. This underscores that PC does not equate to withdrawal of care.

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Background: There is a strong association between hypertension and cerebrovascular diseases, but most of the mechanistic bases to justify this correlation remains misunderstood. Objective: To evaluate intracranial pressure waveform in long-term essential hypertensive patients with a non-invasive device, brain4care (b4c). Methods: Cross-sectional study in patients with hypertension. Office blood pressure was measured with an automatic oscillometric device. Intracranial pressure evaluation was acquired through a strain sensor that could detect and monitor nanometric skull bone displacements for each cardiac cycle. Under normal physiological conditions, P1 is greater than P2, and the normal P2/P1 ratio is <1. Time to peak (TTP) is the measurement in seconds of the beginning of waveform inscription until P1 and normal values are <0.20 s. The cut-off points ≥1.2 and ≥0.25 s were used to define intracranial hypertension (ICHT). Results: 391 consecutive patients were evaluated (75% female, mean age 64.3 ± 12.0 years). Mean value of P2/P1 ratio was 1.18 ± 0.25 and TTP 0.18 ± 0.63 s The obtained P2/P1 ratios were divided in three categories according to results of previous studies of normalcy (<1.0), intracranial compliance disturbance (1.0-1.19) and ICHT (≥1.2). Normal intracranial pressure was observed in 21.7% of patients, intracranial compliance disturbance in 32.7% and intracranial hypertension in 45.6%. Females showed a higher prevalence of ICHT (50.3%). Conclusion: The prevalence of 45.6% intra-cranial hypertension in patients with long-term hypertension, particularly in women, and in those over 65 years old, emphasizes the importance of evaluate intracranial pressure behaviour in these patients and raise a question concerning the real ability of cerebral autoregulation and vascular barriers to protect the brain.

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Introducción:En Cuba, las enfermedades cerebrovasculares (ECV) son padecimientos crónicos no trasmisibles muy frecuentes. Objetivos: Caracterizar a pacientes de la unidad de cuidados intensivos, con diagnóstico anatomopatológico de ECV. Métodos: Estudio observacional, descriptivo y transversal en una muestra de 176 pacientes. Variables estudiadas: edad (19-39 años, 40-59 años, 60-100 años), sexo, tipo de ECV (hemorrágica, isquémica), escala APACHE II (≤ 15, > 15 puntos) y de coma Glasgow al ingreso (≤ 8, > 8 puntos), ventilación mecánica (sí, no), estadía (≤ 7, > 7 días) y causa directa de muerte. Se calcularon las frecuencias, medidas de tendencia central, pruebas de ji cuadrado y t de Student (nivel de significación el 5 por ciento). Resultados: Predominaron la enfermedad cerebrovascular hemorrágica, el sexo masculino (52,8 por ciento) y el grupo de edad de 60-100 años (64,8 por ciento). La edad media fue de 63,8 años. La media del valor de las escalas APACHE II y Glasgow fue de 21,6 y 6,5 puntos. El 97,6 por ciento recibió ventilación mecánica. La estadía media fue de 7,0 días. El edema cerebral intenso constituyó la principal causa de muerte directa (79,3 por ciento). Conclusiones: Existe predominio de la ECV de tipo hemorrágica, en pacientes del sexo masculino, de 60-100 años, con APACHE II > 15 puntos, Glasgow ≤ 8 puntos, ventilados, estadía ≤ 7 días y edema cerebral intenso(AU)

Introduction: In Cuba, cerebrovascular diseases (CVD) are very common non-communicable chronic conditions. Objectives: Characterize patients from intensive care unit with a pathological diagnosis of CVD. Methods: Observational, descriptive and transversal study in a sample of 176 patients. Variables: age (19-39 years, 40-59 years, 60-100 years), sex, type of CVD (hemorrhagic, ischemic), APACHE II scale (≤ 15, > 15 score) and Glasgow coma on admission (≤ 8, > 8 score), mechanical ventilation (yes, no), length of stay (≤ 7, > 7 days) and direct cause of death. Frequencies, measures of central tendency, chi-square and Student's t tests (significance level of 5 percent) were calculated. Results: Hemorrhagic cerebrovascular disease, male sex (52.8 percent) and the age group of 60-100 years (64.8 percent) predominated. The mean age was 63.8 years. The average value of the APACHE II and Glasgow scales was 21.6 and 6.5. 97.6 percent received mechanical ventilation. The mean stay was 7.0 days. Severe cerebral edema was the main cause of direct death (79.3 percent). Conclusions: There is a predominance of hemorrhagic CVD, in male patients, aged 60-100 years, APACHE II score > 15, Glasgow score ≤ 8, ventilated patients, stay ≤ 7 days and intense cerebral edema(AU)

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Fundamento: las enfermedades cerebrovasculares constituyen una de las principales causas de mortalidad en el mundo. En las Américas constituyen la tercera causa de muerte y su incidencia se ve aumentada en los pacientes diabéticos tipo 2. Objetivo: caracterizar los pacientes diabéticos tipo 2 con enfermedad cerebrovascular isquémica aguda. Método: se realizó un estudio descriptivo en pacientes diabéticos que ingresaron en el Hospital Calixto García con diagnóstico de enfermedad cerebrovascular isquémica aguda en el período comprendido entre enero y diciembre 2022. El universo estuvo constituido por la totalidad de pacientes diabéticos tipo 2 que ingresaron en la Institución y la población por 148 pacientes. Las variables analizadas fueron: sexo, color de piel y edad; tensión arterial e índice de masa corporal; colesterol, triacilgliceridos y glicemia; tipo enfermedad cerebrovascular y su gravedad y comorbilidades. Se utilizaron métodos de la estadística descriptiva como frecuencia absoluta y porciento. Los resultados se presentaron en tablas creadas a los efectos. Resultados: predominó el sexo masculino, el color de piel blanca y el grupo etáreo entre los 60 y 69 años con un 58,1 43,9 y 40,5 % respectivamente. Predominaron los pacientes hipertensos y con sobrepeso relacionados con la mayor gravedad de la enfermedad cerebrovascular, los pacientes hiperglicémicos con valores de colesterol y triacilgliceridos altos, en ellos fue más grave el evento isquémico cerebral. La hipertensión arterial y la cardiopatía isquémica prevalecieron en la población estudiada con un 81,8 y 52,7 respectivamente. Conclusiones: la enfermedad cerebrovascular fue más frecuente en el sexo masculino, color de piel blanca y pacientes de edad avanzada. La hipertensión arterial, el sobrepeso, la hiperglucemia así como los valores altos de colesterol y triglicéridos predominaron en la muestra y se relacionaron con la mayor gravedad del evento cerebrovascular isquémico.

Foundation: cerebrovascular diseases are one of the main causes of mortality in the world. In the Americas they constitute the third cause of death and their incidence is increased in type 2 diabetic patients. Objective: to characterize type 2 diabetic patients with acute ischemic cerebrovascular disease. Method: a descriptive study was carried out in diabetic patients who were admitted to the Calixto García Hospital with a diagnosis of acute ischemic cerebrovascular disease in the period between January and December 2022. The universe consisted of all type 2 diabetic patients who were admitted to the Institution and the population of 148 patients. The variables analyzed were: sex, skin color and age; blood pressure and body mass index; cholesterol, triacylglycerides and glycemia; type of cerebrovascular disease and its severity and comorbidities. Descriptive statistical methods such as absolute frequency and percentage were used. The results were presented in tables created for the purpose. Results: the male sex, the white skin color and the age group between 60 and 69 years predominated with 58.1, 43.9 and 40.5 % respectively. Hypertensive and overweight patients related to the greater severity of cerebrovascular disease, hyperglycemic patients with high cholesterol and triacylglyceride values ​​predominated, and in them the cerebral ischemic event was more severe. Arterial hypertension and ischemic heart disease prevailed in the studied population with 81.8 and 52.7 respectively. Conclusions: cerebrovascular disease was more frequent in males, white skin color and elderly patients. Arterial hypertension, overweight, hyperglycemia as well as high cholesterol and triglyceride values ​​predominated in the sample and were related to the greater severity of the ischemic cerebrovascular event.

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Introducción: Las enfermedades no transmisibles se han erigido como las principales causas de muerte en el mundo, representando en 2019, 73,6 % del total de muertes por todas las causas. En Cuba por estas enfermedades fallecieron 81,5 % del total de fallecidos por todas las causas. La mortalidad prematura por enfermedades cardiovasculares, resultó ser 34,7 % del total de fallecidos prematuramente a nivel global. Objetivo: Describir la mortalidad por enfermedades isquémicas del corazón, cerebrovasculares e hipertensivas en Cuba, en el decenio 2011-2020. Material y métodos: Se realizó un estudio ecológico longitudinal descriptivo de la mortalidad anual por enfermedades isquémicas del corazón, cerebrovasculares e hipertensivas en Cuba, en el decenio 2011-2020. Se tuvieron en cuenta, las tasas de mortalidad brutas por esas dolencias. Los anuarios estadísticos publicados por la Dirección de Registros Médicos y Estadísticas de Salud, del Ministerio de Salud Pública de esos años, fueron la fuente de información. Resultados: Las tasas de mortalidad anual por las enfermedades isquémicas del corazón, cerebrovasculares e hipertensivas en Cuba mostraron globalmente tendencias al incremento en el decenio 2011-2020, más pronunciada en el caso de las enfermedades hipertensivas. Se observó un incremento en las tasas de mortalidad prematura por dichas enfermedades. Conclusiones: La hipertensión arterial constituye un severo problema de salud en Cuba, tanto como causa de muerte, como factor de riesgo atribuible para la mortalidad por enfermedades isquémicas del corazón y cerebrovasculares.

Introduction: Non-communicable diseases have emerged as the main causes of death in the world, representing in 2019, 73.6 % of all deaths from all causes. In Cuba, 81.5 % of the total deaths from all causes were caused by these diseases. Premature mortality from cardiovascular diseases turned out to be 34.7 % of the total number of premature deaths globally. Objective: To describe mortality from ischemic heart, cerebrovascular and hypertensive diseases in Cuba, in the 2011- 2020 decade. Material and Methods: A descriptive longitudinal ecological study of annual mortality from ischemic heart, cerebrovascular and hypertensive diseases in Cuba was carried out in the 2011-2020 decade. Crude mortality rates for these diseases were taken into account. The statistical yearbooks published by the Directorate of Medical Records and Health Statistics of the Ministry of Public Health for those years were the source of information. Results: The annual mortality rates from ischemic heart, cerebrovascular and hypertensive diseases in Cuba showed overall increasing trends in the 2011- 2020 decade, more pronounced in the case of hypertensive diseases. An increase in premature mortality rates from these diseases was observed. Conclusions: Arterial hypertension constitutes a severe health problem in Cuba, both as a cause of death and as a risk factor attributable to mortality from ischemic heart and cerebrovascular diseases.

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BACKGROUND: Turner syndrome (TS) is a rare condition associated with a completely or partially missing X chromosome that affects 1 in 2500 girls. TS increases the risk of autoimmune diseases, including Graves' disease (GD). Moyamoya disease is a rare cerebral arteriopathy of unknown etiology characterized by progressive bilateral stenosis of the internal carotid artery and its branches. Both TS and GD have been associated with Moyamoya. Type 2 spinocerebellar ataxia (SCA2) is an autosomal dominant cerebellar ataxia caused by a CAG repeat expansion in ATXN2. We present the first case of Moyamoya syndrome in a patient with a previous diagnosis of TS and GD who tested positive for SCA2 and had imaging findings compatible with an overlap of SCA2 and Moyamoya. CASE PRESENTATION: A 43-year-old woman presented with mild gait imbalance for 2 years. Her family history was positive for type 2 spinocerebellar ataxia (SCA2). She had been diagnosed with Turner Syndrome (45,X) and Graves disease three years before. Brain MRI revealed bilateral frontal and parietal cystic encephalomalacia in watershed zones, atrophy of pons, middle cerebellar peduncles and cerebellum. MR angiography showed progressive stenosis of both internal carotid arteries with lenticulostriate collaterals, suggestive of Moya-Moya disease. Molecular analysis confirmed the diagnosis of SCA2. CONCLUSIONS: With increased availability of tools for genetic diagnosis, physicians need to be aware of the possibility of a single patient presenting two or more rare diseases. This report underscores the modern dilemmas created by increasingly accurate imaging techniques and available and extensive genetic testing.

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BACKGROUND: The COVID-19 epidemic overloaded the São Paulo metropolitan area (SPMA) health system in 2020. The leading hospitals directed their attention to patients with COVID-19. At the same time, the SPMA Health Secretary decreed social isolation (SI), which compromised the care for cardiovascular diseases (CVD), even though higher cardiovascular events were expected. METHODS: This study analyzed mortality from CVD, ischemic heart disease (IHD), and stroke, along with hospital admissions for CVD, IHD, stroke, and SI in the SPMA in 2020. Data regarding hospitalization and mortality from CVD were obtained from the SPMA Health Department, and data regarding SI was obtained from the São Paulo Intelligent Monitoring System. Time-series trends were analyzed by linear regression, as well as comparisons between these trends. RESULTS: there was an inverse correlation between SI and hospitalizations for CVD (R2 = 0.70; p < 0.001), IHD (R2 = 0.70; p < 0.001), and stroke (R2 = 0.39; p < 0.001). The most significant hospitalization reduction was from March to May, when the SI increased from 43.07% to 50.71%. The increase in SI was also associated with a reduction in CVD deaths (R2 = 0.49; p < 0.001), IHD (R2 = 0.50; p < 0.001), and stroke (R2 = 0.26; p < 0.001). CONCLUSIONS: Increased social isolation was associated with reduced hospitalizations and deaths from CVD, IHD, and stroke.

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Resumo Introdução A doença cerebrovascular (DCBV) é a segunda principal causa de morte no mundo e no Brasil. Objetivo Avaliar as tendências da mortalidade por DCBV em duas cidades brasileiras (Maceió e Florianópolis) com diferenças socioeconômicas extremas, entre 1981 e 2015, estimando os efeitos idade, período e coorte. Método Estudo de séries temporais da mortalidade por DCBV em indivíduos com ≥ 40 anos, empregando a ferramenta Web tool. Resultados A mortalidade por DCBV diminuiu com o tempo, aumentou com a idade e foi menor para gerações mais novas. O efeito foi igual para ambos os sexos. Houve diminuição da mortalidade nas duas cidades, mas a diferença foi grande e a mortalidade continua alta em Maceió. Com base na amplitude dos efeitos estimados, foi possível verificar que o efeito de coorte foi o termo mais significativo para explicar a variabilidade temporal das taxas de mortalidade por DCBV no período. Conclusão A comparação da tendência temporal nas duas cidades mostrou a importância da melhora das condições de vida, do acesso a serviços de saúde para prevenção e controle dos fatores de risco, assim como assistência hospitalar aos casos para diminuirmos a mortalidade por DCBV em todo o território nacional.

Abstract Background Cerebrovascular disease (CBVD) is the second leading cause of death in the world and Brazil. Objective To evaluate trends in mortality from CBVD in two Brazilian cities (Maceió and Florianópolis) with extreme socioeconomic differences, between 1981 and 2016, estimating the age, cohort effect. Method Study of CBVD mortality time series in individuals aged ≥40 years, using the Age, Period, Cohort (APC) analysis and the Web tool. Results CBVD mortality decreased with time, increased with age and was lower for younger generations. The effect was the same for both sexes. There was a decrease in mortality in both cities, but the difference was large, and mortality remains high in Maceió. Based on the amplitude of the estimated effects, it was possible to verify that the cohort effect was the most significant term to explain the temporal variability of mortality rates due to CVD in the period. Conclusion The comparison of the time trend in the two cities showed the importance of improving living conditions, access to health services for the prevention and control of risk factors, as well as hospital care for cases to reduce mortality from CVD nationwide.

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Introducción: En Consolación del Sur la enfermedad cerebrovascular constituye la tercera causa de muerte así como para el resto del país, lo que denota una afectación considerable en gran parte de la población. Objetivo: Caracterizar los factores de riesgo de la enfermedad cerebrovascular en pacientes de 60 años y más. Métodos: Se realizó un estudio descriptivo de corte transversal y prospectivo en el Consejo Popular de Alonso Rojas; perteneciente al Policlínico 5 de Septiembre; en el período comprendido entre octubre de 2015 y septiembre de 2019. El universo y la muestra estuvieron constituido por 41 pacientes con el diagnóstico de enfermedad cerebrovascular, los cuales cumplieron con los criterios establecidos en la investigación. Se emplearon métodos de nivel teórico, empírico y procedimientos estadísticos. Resultados: Se analizó el comportamiento de las variables edad, color de la piel, sexo, obesidad, sedentarismo, antecedentes de la enfermedad cerebrovascular, alcoholismo, tabaquismo, hipertensión arterial, tipo de enfermedad cerebrovascular, tipo de discapacidad y grado de validismo. Conclusiones: La enfermedad cerebrovascular se encuentra en pacientes con más de 60 años, con predominio del sexo masculino de tipo isquémico en la raza blanca, cuyo principal factor de riesgo fue el sedentarismo, tiene como secuelas invalidantes, trastornos de la memoria y la parálisis de los miembros inferiores, con un grado de validismo II(AU)

Introduction: In Consolación del Sur, cerebrovascular disease is the third cause of death as well as for the rest of the country, which denotes considerable effect in a large part of the population. Objective: To characterize the risk factors for cerebrovascular disease in patients aged 60 years and over. Methods: A descriptive cross-sectional and prospective study was carried out in Alonso Rojas Popular Council from 5 de Septiembre Polyclinic between October 2015 to September 2019. Fourty one patients with the diagnosis of cerebrovascular disease formed the universe and the sample, they met the inclusion criteria established in the investigation. Theoretical and empirical methods and statistical procedures were used. Results: The behavior of the variables age, skin color, sex, obesity, sedentary lifestyle, history of cerebrovascular disease, alcoholism, smoking, arterial hypertension, type of cerebrovascular disease, type of disability and degree of validism was analyzed. Conclusions: Cerebrovascular disease is found in patients over 60 years of age. We found male predominance of the ischemic type in white skin subjects, whose main risk factor was sedentary lifestyle. This disease has disabling sequelae, memory disorders and paralysis of the the lower limbs, with a degree of validism II(AU)

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Nurses play an important role in healthcare, and the Nursing Outcomes Classification is a key tool for the standardization of care. This study aims to validate the nursing outcome "Neurological Status" for patients with cerebrovascular diseases. A methodological study was performed in four phases. In Phase 1, the relevance of the indicators was evaluated by seven specialists and the modified kappa coefficient and content validity index were calculated. In Phase 2, conceptual and operational definitions were formulated. In addition, their content was validated with a focus group in Phase 3. In Phase 4, the results were applied in clinical practice and convergence with the National Institute of Health Stroke Scale was verified. The reliability was measured by Cronbach's alpha. Of the 22 initial indicators, 6 were excluded. The focus group suggested changes in the definitions and the exclusion of two indicators. In Phase 4, only 13 indicators were validated due to the impossibility of measuring intracranial pressure. A strong correlation between the two scales and agreement among all the indicators were observed. Following the specialists' review, the nursing outcome was reliable and clinically validated with 13 indicators: consciousness, orientation, language, central motor control, cranial sensory and motor function, spinal sensory and motor function, body temperature, blood pressure, heart rate, eye movement pattern, pupil size, pupil reactivity, and breathing pattern.

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BACKGROUND: Objective and reliable measurements to investigate daily behavior patterns in people with stroke could help therapeutic interventions after a stroke. OBJECTIVE: To evaluate whether the Activity Monitoring for Rehabilitation (AMoR) platform has adequate concurrent validity and reliability for step counting and time spent sitting/lying in people post-stroke and to investigate its percentage accuracy for step counting at different walking speeds. METHODS: Cross-sectional observational study. Fifty chronic post-stroke subjects used the AMoR platform and SAM simultaneously while a Video camera recorded the same activities during clinical trials. Spearman's correlation coefficient, the mean absolute percentage error, the intraclass correlation coefficient and Bland-Altman plot analyses were used to estimate the validity and reliability of the AMoR platform and StepWatchTM Activity Monitor (SAM). The accuracy percentage was calculated for each device and plotted as a function of the walking speed during the 10-meter walk test (10MWT). RESULTS: There was a very high correlation for step counting in all tests and a high correlation for time spent sitting/lying. The mean absolute percentage error values remained below 4% for step counting and time sitting/lying. The AMoR platform also showed excellent reliability for step counting and sitting/lying time, with values within the limit of agreement in the Bland-Altman plots. A high percentage of accuracy for step counting in the AMoR platform was observed during the 10MWT. CONCLUSION: The AMoR platform is valid and reliable for step counting and time spent sitting/lying, with a high percentage of accuracy at different walking speeds in the post-stroke population.

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As doenças cardiovasculares (DCV) são a principal causa de morte no Brasil e no mundo. As doenças isquêmicas do coração (DIC) e doenças cerebrovasculares (DCBV) estão entre as dez principais causas de mortes no Brasil. A análise de tendência da mortalidade por DCV permite definir populações prioritárias para intervenções, elaborar e avaliar ações em saúde pública. Nesse sentido, o objetivo do estudo foi analisar a tendência da mortalidade por DIC e DCBV nas 27 capitais brasileiras, no período de 1990 a 2018. Trata-se de um estudo ecológico de série temporal, os dados de óbitos foram obtidos através do Sistema de Informações sobre Mortalidade (SIM). Buscando corrigir problemas na qualidade da informação dos registros de óbito do SIM, realizou-se a correção dos óbitos referentes aos dados com sexo e/ou faixa etária ignorada e aos óbitos registrados com causas "mal definidas". As taxas de mortalidade por DIC e DBCV foram padronizadas pelo método direto, tomando-se como população padrão a população do Brasil no ano de 2010. A análise de tendência da mortalidade por DIC e DCBV para a população total, homens e mulheres foi realizada utilizando o modelo de regressão de Poisson. Os resultados mostraram tendência de redução da mortalidade por DCBV tanto para a população total como para homens e mulheres em todas as capitais brasileiras. Vitória, capital da região Sudeste, apresentou a maior redução da taxa de mortalidade total por DCBV dentre todas as capitais brasileiras, -5,6% ao ano (IC95%: -6,0; -5,1%). No entanto, Macapá, capital da região Norte, teve a menor dentre todas as capitais -1,7% ao ano (IC95%: -2,7; -0,7%). Paras as DIC foi observada tendência de redução da mortalidade tanto para a população total como para homens e mulheres nas capitais das regiões Sul, Sudeste e para a maioria das capitais da região Centro-Oeste. As capitais das regiões Norte e Nordeste apresentaram uma variabilidade na tendência da mortalidade por DIC. Conclui-se que as capitais das regiões Sul e Sudeste apresentaram as maiores reduções da tendência da mortalidade por DIC e DCBV. Os achados desse estudo são importantes para prover informações mais detalhadas buscando auxiliar a gestão local na promoção de políticas de saúde pública, planejamento de estratégias e elaboração de medidas e ações em saúde.

Cardiovascular diseases (CVD) are the leading cause of death in Brazil and worldwide. Ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) are among Brazil's ten main causes of death. The trend analysis of mortality from CVD allows defining priority populations for interventions, designing and evaluating public health actions. In this sense, the study's objective was to analyze the mortality trend from IHD and CBVD in the 27 Brazilian capitals from 1990 to 2018. This is an ecological time-series study with the Mortality Information System (SIM) data. Seeking to correct the quality of the information in the SIM death records, the correction of deaths referring to data with anonymous sex and age group and deaths recorded with "ill-defined" causes was carried out. IHD and CBVD mortality rates were standardized by the direct method, using the population of Brazil in 2010 as the standard population. Trend analysis of IHD and CBVD mortality for the total population, men and women, was performed using the Poisson regression model. The results showed a reduction in the trend of mortality from CBVD for both the total population and for men and women in all Brazilian capitals. Vitória, the capital of the Southeast region, showed the greatest reduction in the total mortality rate from CVD among all Brazilian capitals, -5.6% per year (95%CI: -6.0; -5.1%). However, Macapá, the capital of the North region, had the lowest among all capitals -1.7% per year (95%CI: -2.7; -0.7%). For IHD, a decrease in the mortality trend was observed both for the total population and for men and women in the capitals of the South and Southeast regions and most capitals of the Center-West region. The capitals of the North and Northeast regions showed variability in the trend of IHD mortality. In conclusion, the capitals of the South and Southeast regions showed the greatest reductions in the mortality trend due to IHD and CBVD. The findings of this study are essential to provide more detailed information to assist local management in promoting public health policies, planning strategies, and designing health measures and actions.

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Resumo Fundamento: A mortalidade por doenças cardiovasculares (DCV) vem mostrando tendência à estabilização em alguns países, incluindo o Brasil e o estado do Rio de Janeiro, após décadas de queda. Não encontramos análises detalhadas dessa tendência para o estado do Rio de Janeiro. Objetivo: Analisar as tendências da mortalidade prematura e tardia por doenças do aparelho circulatório (DAC), doença isquêmica do coração (DIC) e doença cerebrovascular (DCBV) por sexo nas regiões de saúde do estado do Rio de Janeiro e capital (1996-2016). Métodos: Dados de óbitos e população foram obtidos no DATASUS/MS. Taxas foram compensadas por códigos mal definidos, corrigidos pelos códigos cardiovasculares mal definidos e ajustadas por sexo e idade pelo método direto. O Joinpoint Trend Analysis Software foi empregado para calcular a variação percentual anual (APC) e variação percentual anual média (AAPC). Foram consideradas para o estudo APC e AAPC significativamente diferentes de zero, calculadas por um teste de student com significância de 5%. Resultados: A mortalidade por DIC estabilizou ou até aumentou em pelo menos 50% das localidades analisadas (EAPC ≥0). Nas regiões Norte e Noroeste, nenhuma mudança foi observada. Para DCBV, apenas uma região apresentou estabilidade na mortalidade (EAPC próximo a 0). Para as outras regiões, a taxa continuou a diminuir (APC <0) até 2016. Conclusão: Esses resultados observados no Rio de Janeiro devem se repetir em várias regiões brasileiras e apontam para a necessidade de uma resposta na abordagem dos comportamentos no estilo de vida. Os médicos da atenção primária devem estar familiarizados com a tendência desfavorável da doença isquêmica do coração entre os adultos mais jovens e rastrear ativamente os fatores de risco para DCV, com atenção especial às mulheres.

Abstract Background: Cardiovascular disease (CVD) mortality, after several decades of decrease, has shown a tendency towards the stabilization in some countries, including Brazil and Rio de Janeiro state. This new tendency was not further analyzed by gender, age group and region of the Rio de Janeiro state. Objective: To analyze the trends of premature and late mortality from CVD, ischemic heart disease (IHD) and cerebrovascular disease (CBVD) by gender in the city of Rio de Janeiro (capital) and the health regions of Rio de Janeiro state (from 1996 to 2016. Methods: Data on deaths and the population were obtained from DATASUS/MS. The rates were compensated by ill-defined codes, corrected by Ill-Defined Cardiovascular codes and gender and age-adjusted by the direct method (reference population - population of the state of Rio de Janeiro - 2000 census). The Joinpoint Trend Analysis Software was employed. Results: IHD mortality stabilized or even increased for at least 50% of the analyzed areas (EAPC≥0). No change was observed. in the "North" and "Northwest" regions For CBVD, just one region showed stability regarding mortality (EAPC close to 0). For the other regions, the rate continued to decrease (APC<0) until 2016. Conclusion: These results observed in Rio de Janeiro are possibly appropriate to various Brazilian regions and demonstrate that a serious public health response is needed to address lifestyle behaviors. Primary care physicians should also be familiar with the unfavorable tendency in coronary heart disease among younger adults in recent years and actively screen for risk factors for cardiovascular disease, paying special attention to women.

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La actual pandemia de COVID-19 causada por el virus SARS-CoV-2, se caracteriza por una alta morbilidad y mortalidad. Algunos estudios han reportado que la frecuencia de ictus en pacientes infectados con el virus oscila entre un 5-20 por ciento. A pesar de estas cifras alarmantes, las vías por las cuales el virus llega al sistema nervioso central y los mecanismos fisiopatológicos por los que puede ocurrir un ictus en estos pacientes no han sido totalmente esclarecidos. Numerosos estudios han demostrado que la infección por SARS-CoV-2 está asociada a un estado protrombótico, capaz de causar un tromboembolismo arterial y venoso. Además, se ha reportado una respuesta inflamatoria exacerbada, con reclutamiento de células sanguíneas y una secreción desproporcionada de citoquinas proinflamatorias. También la hipoxia y fenómenos cardioembólicos han sido propuestos como posibles mecanismos. Es esencial definir con exactitud los mecanismos fisiopatológicos que vincula la infección por SARS-CoV-2 con la ocurrencia del ictus, con la finalidad de aplicar tratamientos más específicos y evitar futuras complicaciones(AU)

The actual Coronavirus Disease 2019 (COVID-19) infection is an ongoing pandemic, characterized by high morbidity and mortality produced by SARS-CoV-2 virus. Studies reported a stroke frequency around 5-20 percent in infected patients; however, SNC invasion and pathophysiological mechanisms related to stroke in COVID-19 patients are still unknown. Several studies have demonstrated that SARS-CoV-2 infection is linked to a prothrombotic state causing venous and arterial thromboembolism. Also, an overstated inflammatory response with recruitment of blood cells and disproportioned secretion of proinflammatory cytokines has been reported. Finally, cardioembolism and hypoxia have been proposed as surrogate mechanisms. It is essential to define the pathophysiological mechanisms of stroke during the infection in order to apply more specific treatments to avoid further stroke complications(AU)

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BACKGROUND: The Renin-Angiotensin System (RAS) comprises a complex molecular cascade with two counter-regulatory axes, the classical and the alternative. Angiotensin II and Angiotensin-(1-7), the main peptides of the RAS, exert opposite effects in multiple organs and systems, including the cardiovascular, renal, pulmonary, and immune systems. Strong evidence supports the hypothesis of a local RAS in the Central Nervous System (CNS) and its modulatory roles in neuroendocrinology and neurotransmission. OBJECTIVE: In this narrative review, we provide a comprehensive approach to experimental and clinical data regarding RAS molecule expression and their possible roles in the physiology and physiopathology of CNS diseases. METHODS: This non-systematic review summarizes evidence on RAS implications in CNS diseases and their possible relationships with COVID-19. RESULTS: We divided the possible RAS mechanisms in distinct conditions during the lifespan, approaching from congenital infections to neurodegenerative alterations, passing through mood disorders and cerebrovascular diseases. We also gathered current evidence about the possible effects of RAS in Covid-19, particularly in cases with neurological manifestations. CONCLUSION: Although there are limitations and controversies, the analysis of RAS mechanisms in the CNS certainly represents an interesting field of research. However, further investigation is necessary to support the noteworthy interactions and provide a better comprehension of the cross-talk between RAS and the CNS. Investigations in this research field may shed light on the novel therapeutic targets.

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