RESUMO
OBJECTIVES: To determine the incidence, timing, progression, and risk factors for intracranial hemorrhage (ICH) in infants 240/7 to 276/7 weeks of gestational age and to characterize the association between ICH and death or neurodevelopmental impairment (NDI) at 2 years of corrected age. STUDY DESIGN: Infants enrolled in the Preterm Erythropoietin Neuroprotection Trial had serial cranial ultrasound scans performed on day 1, day 7-9, and 36 weeks of postmenstrual age to evaluate ICH. Potential risk factors for development of ICH were examined. Outcomes included death or severe NDI as well as Bayley Scales of Infant and Toddler Development, 3rd Edition, at 2 years of corrected age. RESULTS: ICH was identified in 38% (n = 339) of 883 enrolled infants. Multiple gestation and cesarean delivery reduced the risk of any ICH on day 1. Risk factors for development of bilateral Grade 2, Grade 3, or Grade 4 ICH at day 7-9 included any ICH at day 1; 2 or more doses of prenatal steroids decreased risk. Bilateral Grade 2, Grade 3, or Grade 4 ICH at 36 weeks were associated with previous ICH at day 7-9. Bilateral Grade 2, any Grade 3, and any Grade 4 ICH at 7-9 days or 36 weeks of postmenstrual age were associated with increased risk of death or severe NDI and lower Bayley Scales of Infant and Toddler Development, 3rd Edition, scores. CONCLUSIONS: Risk factors for ICH varied by timing of bleed. Bilateral and increasing grade of ICH were associated with death or NDI in infants born extremely preterm.
Assuntos
Hemorragias Intracranianas/mortalidade , Transtornos do Neurodesenvolvimento/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , UltrassonografiaRESUMO
BACKGROUND: Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischemic stroke (IS) or transient ischemic attack (TIA). No study has evaluated the incidence of early bleeding in patients with moderate to major ischemic stroke. The current study aimed to analyze both the frequency of early bleeding and hospital morbidity related to DAT for either acute IS or TIA regardless of admission National Institute of Health Stroke Scale (NIHSS) score. METHODS: This was a retrospective analysis based on data collected from a prospective data bank of a single center. We included patients who underwent DAT in the first 24 hours of symptom onset with a loading dose (aspirin 300 mgâ¯+â¯clopidogrel 300 mg) on the first day, followed by a maintenance dose (aspirin 100 mgâ¯+â¯clopidogrel 75 mg). We analyzed intracranial and/or extracranial hemorrhage that had occurred during the hospital admission, symptomatic bleeding, modified Rankin Scale (mRS) score at discharge, and death rates as outcomes. RESULTS: Of the 119 patients analyzed, 94 (79 %) had IS and 25 (21 %) had TIA. Hemorrhage occurred in 11 (9.2 %) and four (3.4 %) patients with TIA or NIHSS ≤ 3, respectively, although none were symptomatic. Patients with bleeding as a complication had higher admission NIHSS [4 (3-7) vs. 2 (1-4), pâ¯=â¯0.044] and had higher mRS at discharge (mRS 2 [1-5] vs. mRS 1 [0-2], pâ¯=â¯0.008). These findings did not indicate increased mortality, as one (9 %) patient died from bleeding and two (1.8 %) patients died without bleeding (pâ¯=â¯0.254). CONCLUSION: DAT seems to be a safe therapy in patients regardless of admission NIHSS if started within the first 24 h after symptom onset because only 1.6 % of patients had symptomatic bleeding.
Assuntos
Aspirina/efeitos adversos , Clopidogrel/efeitos adversos , Avaliação da Deficiência , Terapia Antiplaquetária Dupla/efeitos adversos , Hemorragias Intracranianas/induzido quimicamente , Ataque Isquêmico Transitório/tratamento farmacológico , Admissão do Paciente , Inibidores da Agregação Plaquetária/efeitos adversos , Acidente Vascular Cerebral/tratamento farmacológico , Tempo para o Tratamento , Idoso , Aspirina/administração & dosagem , Brasil/epidemiologia , Clopidogrel/administração & dosagem , Bases de Dados Factuais , Esquema de Medicação , Terapia Antiplaquetária Dupla/mortalidade , Feminino , Estado Funcional , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/mortalidade , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/mortalidade , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Intracranial hemorrhage (ICH) is the most common cerebrovascular event in patients with cancer. We sought to evaluate the outcomes of surgical treatment for ICH and to determine possible pre-operative outcome predictors. METHODS: We retrospectively reviewed surgical procedures for the treatment of ICH in patients with cancer. Analysis included clinical and radiological findings of the patients. Primary endpoints were survival and mortality in index hospitalization. RESULTS: Ninety-four emergency neurosurgeries were performed for ICH in 88 different patients with cancer over ten years. 51 patients had chronic subdural hematomas (CSDH: 54.3%), 35 with intraparenchymal hemorrhage (37.2%), 6 with acute subdural hematoma (ASDH: 6.4%), and only 2 with epidural hemorrhages (2.1%). Median patient follow-up was 63 days (IQR = 482.2). 71 patients (75.5%) died at follow-up, with a median survival of 33 days. Overall 30-day mortality was 38.3%; 27.5% for patients with CSDH. Lower survival was associated to higher absolute leucocyte count (HR 1.06; 95%CI 1.04-1.09), higher aPTT ratio (HR 3.02; 95% CI 1.01-9.08), higher serum CRP (HR 1.01; 95%CI 1.01-1.01), and unresponsive pupils (each unresponsive pupil - HR 2.65; 95%CI 1.50-4.68). CONCLUSION: Outcomes following surgical treatment of ICH in patients with cancer impose significant morbidity and mortality. Type of hematoma, altered pupillary reflexes, coagulopathies, and increased inflammatory response were predictors of mortality for any type of ICH.
Assuntos
Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Neoplasias/complicações , Idoso , Feminino , Humanos , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosAssuntos
Doenças do Recém-Nascido/mortalidade , Pediatria/história , Convulsões/mortalidade , Cuidados Críticos , História do Século XX , Humanos , Hipóxia-Isquemia Encefálica/mortalidade , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva , Hemorragias Intracranianas/mortalidade , Convulsões/históriaRESUMO
BACKGROUND: Overall, 75.2% of deaths from stroke occur in low- and middle-income countries. Mexico is a middle-income country with little information about the prognosis of early and late postischemic and hemorrhagic stroke. OBJECTIVE: To evaluate the factors associated with post-stroke survival in the Mexican population. METHODS: Observational study of consecutive stroke cases involving a first-ever hemorrhagic or ischemic stroke, with patients who received care at the National Institute of Neurology and Neurosurgery, in Mexico City, between 2009 and 2012. Patients were followed for up to 4 years after the index event. Exploratory analysis of survival was carried out with Kaplan-Meier and log-rank tests. Factors associated with survival time were determined using Cox models. RESULTS: A total of 300 out of 544 (55.15%) patients had a hemorrhagic stroke, 135 of 544 (24.82%) patients died during the entire follow-up period, and 56 of 544 (10.29%) died in the first 30 days post-stroke (early mortality). Early mortality after stroke was associated with age ≥ 65 years (Adjusted Hazard Ratio - AHRâ¯=â¯2.07, Pâ¯=â¯.02) and ≥ 2 in-hospital medical complications (AHRâ¯=â¯46.13, P < .01). Late mortality was associated with age ≥ 65 years (AHRâ¯=â¯3.43, P < .01), ≥2 in-hospital medical complications (AHRâ¯=â¯2.55, P < .01), high comorbidity (AHRâ¯=â¯5.43, P < .01), and recurrence (AHRâ¯=â¯1.90, Pâ¯=â¯.01). CONCLUSIONS: Patients with hemorrhagic and ischemic stroke who presented in-hospital medical complications, high comorbidity, and were over 65 years old had higher rates of early and late mortality.
Assuntos
Isquemia Encefálica/mortalidade , Isquemia Encefálica/terapia , Hemorragias Intracranianas/mortalidade , Hemorragias Intracranianas/terapia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Adulto , Fatores Etários , Idoso , Isquemia Encefálica/diagnóstico , Comorbidade , Feminino , Seguimentos , Humanos , Hemorragias Intracranianas/diagnóstico , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Little data exist regarding reversal and resumption of antithrombotics after left ventricular assist device (LVAD)-associated intracranial hemorrhage. METHODS: Prospectively collected data of LVAD patients with intracranial hemorrhage were reviewed. Coagulopathy reversal agents, antithrombotic regimens, and thrombotic (venous thromboembolism, ischemic stroke, myocardial infarction) and hemorrhagic (recurrent intracranial hemorrhage, gastrointestinal bleed, anemia requiring transfusion) complications were recorded. RESULTS: Of 405 patients, intracranial hemorrhage occurred in 39 (10%): 23 intracerebral hemorrhages, 10 subarachnoid hemorrhages, and 6 subdural hematomas. Of 27 patients who received antithrombotic reversal, 8 (30%) had inadequate coagulopathy reversal, and 3 of these patients had hemorrhage expansion or died before repeat imaging. One (4%) patient had a thrombotic complication (deep vein thrombosis). Antithrombotic therapy was resumed in 17 (100%) survivors in a median time 8 days for antiplatelet agents and 14 days for warfarin. Recurrent intracranial hemorrhage occurred within a median of 7 days of antithrombotic resumption, while ischemic stroke occurred in a median of 428 days. Patients who resumed antiplatelets alone (n = 4) had a trend toward more thrombotic events (1.37 versus 0.14 events/patient-year [EPPY]; p = 0.08), including more fatal thrombotic events (0.34 EPPY versus 0.08 EPPY; p = 0.89) compared with those resuming warfarin ± antiplatelet (n = 14). Nonfatal hemorrhage event rates were 0.34 EPPY in the warfarin ± antiplatelet versus 0 EPPY in the antiplatelet-alone group (p = 0.16). No fatal hemorrhagic events occurred. CONCLUSIONS: Reversal of anticoagulation appears safe after LVAD-associated intracranial hemorrhage, though inadequate reversal was common. Resumption of warfarin ± antiplatelet was associated with fewer fatal and nonfatal thrombotic events compared with antiplatelets alone, though more nonfatal hemorrhage events occurred.
Assuntos
Fibrinolíticos/uso terapêutico , Coração Auxiliar/efeitos adversos , Hemorragias Intracranianas/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RecidivaRESUMO
OBJECTIVE The authors of this study found that, given the latency period required for arteriovenous malformation (AVM) obliteration after stereotactic radiosurgery (SRS), a study with limited follow-up cannot assess the benefit of SRS for unruptured AVMs. METHODS The authors reviewed their institutional experience with "ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-eligible" AVMs treated with SRS between 1987 and 2016, with the primary outcome defined as stroke (ischemic or hemorrhagic) or death (AVM related or AVM unrelated). Patients with at least 3 years of follow-up in addition to those who experienced stroke or died during the latency period were included. Secondary outcome measures included obliteration rates, patients with new seizure disorders, and those with new focal deficits without stroke. RESULTS Of 233 patients included in this study, 32 had a stroke or died after SRS over the mean 8.4-year follow-up (14%). Utilizing the 10% stroke or death rate at a mean 2.8-year follow-up for untreated AVMs in ARUBA, the rate in the authors' study is significantly lower than that anticipated at the 8.4-year follow-up for an untreated cohort (14% vs 30%, p = 0.0003). Notwithstanding obliteration, in this study, annualized rates of hemorrhage and stroke or death after 3 years following SRS were 0.4% and 0.8%, respectively. The overall obliteration rate was 72%; new seizure disorders, temporary new focal deficits without stroke, and permanent new focal deficits without stroke occurred in 2% of patients each. CONCLUSIONS After a sensible follow-up period exceeding the latency period, there is a lower rate of stroke/death for patients with treated, unruptured AVMs with SRS than for patients with untreated AVMs.
Assuntos
Malformações Arteriovenosas Intracranianas/cirurgia , Procedimentos Neurocirúrgicos , Radiocirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/mortalidade , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/mortalidade , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Convulsões/etiologia , Acidente Vascular Cerebral/etiologia , Resultado do TratamentoRESUMO
BACKGROUND: Over the past decades, the decline in mortality from stroke has been more pronounced in high-income countries than in low- and middle-income countries. We evaluated changes in temporal stroke mortality trends in Mexico according to sex and type of stroke. METHODS: We assessed stroke mortality from Mexico's National Health Information System for the period from 1980 to 2012. We analyzed age-adjusted mortality rates by sex, type of stroke, and age group. The annual percentage change and the average annual percentage change (AAPC) in the slopes of the age-adjusted mortality trends were determined using joinpoint regression models. RESULTS: The age-adjusted mortality rates due to stroke decreased between 1980 and 2012, from 44.55 to 33.47 per 100,000 inhabitants, and the AAPC (95% confidence interval [CI]) was -.9 (-1.0 to -.7). The AAPC for females was -1.1 (-1.5 to -.7) and that for males was -.7 (-.9 to -.6). People older than 65 years showed the highest mortality throughout the period. Between 1980 and 2012, the AAPC (95% CI) for ischemic stroke was -3.8 (-4.8 to -2.8) and was -.5 (-.8 to -.2) for hemorrhagic stroke. For the same period, the AAPC for intracerebral hemorrhage (ICH) was -.7 (-1.6 to .2) and that for subarachnoid hemorrhage (SAH) was 1.6 (.4-2.8). CONCLUSIONS: The age-adjusted mortality rates of all strokes combined, ischemic stroke, hemorrhagic stroke, and ICH, decreased between 1980 and 2012 in Mexico. However, the increase in SAH mortality makes it necessary to explore the risk factors and clinical management of this type of stroke.
Assuntos
Isquemia Encefálica/complicações , Hemorragias Intracranianas , Acidente Vascular Cerebral , Adulto , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/mortalidade , Estudos Longitudinais , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidadeRESUMO
Introdução As doenças cerebrovasculares (DCV) são a principal causa de morte no Brasil, sendo um grande problema de saúde pública em todo o mundo. Métodos Revisão da literatura utilizando o banco de dados do MEDLINE. Buscados os termos "intracerebral" e "hemorrhage" presentes no título e no resumo publicados em qualquer data. Resultados As hemorragias intracranianas (HIC) acometem, principalmente, os lobos cerebrais, gânglios da base, tálamo, tronco cerebral (predominantemente a ponte) e cerebelo como resultado da ruptura de vasos cerebrais afetados pelos efeitos degenerativos da hipertensão arterial sistêmica (HAS) ou da angiopatia amiloide. O diagnóstico pode ser feito através da tomografia computadorizada de crânio (TCC), sendo auxiliado pela ressonância nuclear magnética (RNM) do encéfalo e a angiografia dos quatro vasos cerebrais na investigação etiológica. Tratamento: dividido em clínico e cirúrgico. Atualmente, não há consenso sobre a seleção do tipo de tratamento para pacientes com HIC, e esta decisão deve levar em consideração idade do paciente, estado neurológico, tamanho e profundidade do hematoma, presença de hidrocefalia e de efeito compressivo. Os estudos atuais mostram uma tendência de superioridade dos procedimentos cirúrgicos minimamente invasivos, commenor risco de lesão encefálica secundária decorrente do acesso cirúrgico ao hematoma. Conclusão A escolha da melhor estratégia para o tratamento das HIC permanece um desafio e ainda deve ser feita de forma individualizada.
Introduction Cerebrovascular Diseases are the major cause of death in Brazil and a public health issue in the world. Methods Review of the literature using the MEDLINE's data bank. We have searched the keywords "intracerebral" and "hemorrhages" in the title and abstract. Results Intracranial hemorrhages (ICH) affect, mainly, the cerebral lobes, basal ganglia, thalamus, brain stem and the cerebellum as a result of the rupture of diseased cerebral vessels by the effects of hypertension or amyloid angiopathy. Diagnosis can be done with the use of a non-contrast computed tomography (CT), magnetic resonance imaging (MRI) and cerebral angiogram (useful in investigation of the etiology). Treatment can be divided in clinical and surgical. This decision still should be taken considering individual features, such as patient's age and neurological status, hematoma's size and deep, time between ictus and the procedure, presence of hydrocephalus and compressive effects. The studies has shown a preference for the minimally invasive procedures, since the secondary brain lesions caused by the surgery tend to be less. Conclusion The choice of what would be the best strategy to treat the ICH is still a challenge and this decision should be taken individually.
Assuntos
Pressão Intracraniana , Hemorragias Intracranianas/fisiopatologia , Hemorragias Intracranianas/mortalidade , Hemorragias Intracranianas/terapia , Hemorragias Intracranianas/diagnóstico por imagemRESUMO
OBJECTIVE: Intracerebral hemorrhage (ICH) occurs in 10% to 15% of all strokes and is accompanied by high rates of mortality, disability, and neurological sequelae. Our aim was to assess the presence and prognostic implications of the active extravasation of contrast within the hemorrhage (spot sign) in a series of patients with secondary ICH. METHODS: We analysed 59 subjects who arrived at a tertiary hospital with secondary ICH and a brain parenchyma hemorrhage greater than 2.0 cm in any axis. RESULTS: Spot sign was observed in 11 subjects, including 8 patients with saccular aneurysm, 1 with arteriovenous malformation, 1 with coagulation disorder and 1 with venous sinus thrombosis. A 37.5% mortality rate was documented in the spot sign-negative group, whereas the presence of this imaging finding was followed by an 81.8% in-hospital mortality rate. CONCLUSIONS: Spot sign was correlated with vascular etiology and was a predictor of mortality in our series of patients.
Assuntos
Angiografia Cerebral , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Tomografia Computadorizada Multidetectores , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
This study aimed to evaluate the weekday and weekend distribution of stroke case hospital admissions and their respective prognosis based on a sample from the Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral (EMMA), a cohort of stroke patients admitted to a community hospital in the city of São Paulo, Brazil. We ascertained all consecutive cases of first-time strokes between April 2006 and December 2008 and performed a subsequent one-year follow-up. No association was found between frequency of hospital admissions due to ischemic and hemorrhagic strokes and the specific day of the week on which the admission occurred. However, ten-day and twelve-month case-fatality was higher in hemorrhagic stroke patients admitted at the weekend. We also found that intracerebral hemorrhage patients admitted on weekends had a worse survival rate (50%) compared with those admitted during weekdays (25.6%, P log-rank = 0.03). We found a multivariate hazard ratio of 2.49 (95%CI: 1.10-5.81, P trend = 0.03) for risk of death at the weekend compared to weekdays for intracerebral hemorrhage cases. No difference in survival was observed with respect to the overall sample of stroke or ischemic stroke patients.
Assuntos
Mortalidade Hospitalar , Acidente Vascular Cerebral/mortalidade , Taxa de Sobrevida , Adulto , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de TempoRESUMO
This study aimed to evaluate the weekday and weekend distribution of stroke case hospital admissions and their respective prognosis based on a sample from the Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral (EMMA), a cohort of stroke patients admitted to a community hospital in the city of São Paulo, Brazil. We ascertained all consecutive cases of first-time strokes between April 2006 and December 2008 and performed a subsequent one-year follow-up. No association was found between frequency of hospital admissions due to ischemic and hemorrhagic strokes and the specific day of the week on which the admission occurred. However, ten-day and twelve-month case-fatality was higher in hemorrhagic stroke patients admitted at the weekend. We also found that intracerebral hemorrhage patients admitted on weekends had a worse survival rate (50%) compared with those admitted during weekdays (25.6%, P log-rank = 0.03). We found a multivariate hazard ratio of 2.49 (95%CI: 1.10-5.81, P trend = 0.03) for risk of death at the weekend compared to weekdays for intracerebral hemorrhage cases. No difference in survival was observed with respect to the overall sample of stroke or ischemic stroke patients.
O estudo avaliou a distribuição de casos incidentes de acidente vascular cerebral (AVC) que procuraram hospital de 2ª a 6ª feira ou nos finais de semana no Estudo de Mortalidade e Morbidade do AVC (EMMA). O EMMA é uma coorte de pacientes com AVC em hospital comunitário da cidade de São Paulo, Brasil. Casos consecutivos de primeiro episódio de AVC internados entre abril de 2006 e dezembro de 2008 foram seguidos prospectivamente por um ano. Não houve diferença na frequência das internações por AVC isquêmico ou hemorrágico pelos dias da semana. Entretanto, a letalidade em dez dias e após um ano estava aumentada no AVC hemorrágico. Na análise da sobrevida de um ano, pacientes admitidos nos finais de semana por hemorragia intraparenquimatosa apresentaram menor sobrevida (50%) quando comparados aos admitidos de 2ª a 6ª (22%) (p log-rank = 0.03). Encontrou-se uma razão de risco multivariada de 2,49 (IC95%: 1,10-5,81, p tendência = 0,03) de morrer nos fins de semana em comparação ao período de 2ª a 6ª feira para hemorragia intracerebral. Não houve diferença na sobrevida para amostra total de AVC nem para AVC isquêmico.
El estudio evaluó la distribución de casos incidentes de accidente vascular cerebral (AVC) que fueron al hospital de lunes a viernes o durante los fines de semana en el Estudio de Mortalidad y Morbilidad del AVC (EMMA). El EMMA es una cohorte de pacientes con AVC en un hospital comunitario de la ciudad de São Paulo, Brasil. Casos consecutivos de primer episodio de AVC internados, entre abril de 2006 y diciembre de 2008, fueron seguidos prospectivamente durante un año. No hubo diferencia en la frecuencia de las internaciones por AVC isquémico o hemorrágico durante los días de la semana. Sin embargo, la letalidad en 10 días y tras un año había aumentado en el AVC hemorrágico. En el análisis de supervivencia de un año, pacientes admitidos los fines de semana por hemorragia intraparenquimatosa presentaron menor supervivencia (50%), comparados con los admitidos de Lunes hasta Viernes (22%, p log-rank = 0.03). Se encontró una razón de riesgo multivariada de un 2,49 (IC95%: 1,10-5,81; p tendencia = 0,03) de morir los fines de semana en comparación con los lunes y viernes para la hemorragia intracerebral. No hubo diferencia en la supervivencia para la muestra total de AVC ni para el AVC isquémico.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade Hospitalar , Taxa de Sobrevida , Acidente Vascular Cerebral/mortalidade , Escolaridade , Hospitalização/estatística & dados numéricos , Hemorragias Intracranianas/mortalidade , Prognóstico , Fatores de TempoRESUMO
Case fatality rate is considered a main determinant of stroke mortality trends. We applied the World Health Organization's Stroke STEPS to identify case fatality rates in a community hospital in Brazil. We evaluated all patients with first-ever stroke seeking acute care at the hospital's emergency ward between April 2006 and December 2008 to verify early and late case fatality according to stroke subtype. We used years of formal education as a surrogate for socioeconomic status. Of 430 first-ever stroke events, 365 (84.9%) were ischemic and 65 (15.1%) were intracerebral hemorrhage. After 1 year, we adjudicated 108 deaths (86 ischemic; 22 hemorrhagic). Age-adjusted case fatality rates for ischemic stroke and intracerebral hemorrhage were 6.0% v 19.8% at 10 days, 10.6% v 22.1% at 28 days, 17.6% v 29.1% at 6 months, and 21.0% v 31.5% at 1 year. Illiteracy or no formal education was a predictor of death at 6 months (odds ratio [OR], 4.31; 95% confidence interval [CI] 1.34-13.91) and 1 year (OR, 4.21; 95% CI, 1.45-12.28) in patients with ischemic stroke, as well as at 6 months (OR, 3.19; 95% CI, 1.17-8.70) and 1 year (OR, 3.30; 95% CI, 1.30-8.45) for all stroke patients. Other variables, including previous cardiovascular risk factors and acute medical care, did not change this association to a statistically significant degree. In conclusion, case fatality, particularly up to 6 months, was higher in hemorrhagic stroke, and lack of formal education was associated with increased stroke mortality.
Assuntos
Isquemia Encefálica/mortalidade , Hemorragias Intracranianas/mortalidade , Acidente Vascular Cerebral/mortalidade , Organização Mundial da Saúde , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Escolaridade , Feminino , Hospitais Comunitários , Humanos , Hemorragias Intracranianas/diagnóstico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Fatores de TempoRESUMO
BACKGROUND: The National Transplant Center in Mexico has ruled that deceased-donor kidney allocation is a function of each hospital's Internal Transplant Committee. The aim of this study was to compare and analyze results for of the traditional method and a point-score system in the allocation of deceased patient's kidneys. METHODS: The 12 major kidney transplant centers in the country having a deceased-donor program were invited to participate. Only 3 of them replied to the invitation during 2010. A point-score system was proposed to them, comprising blood group, waiting list time, HLA type, and donor and recipient ages. Once the final recipient was chosen, an explanation of reasons for the choice was requested. Thirty-eight transplants were presented. Kappa coefficient was used to measure degree of agreement in both allocation systems. Organs donated for transplantation came from patients between 4 and 54 years old, including 52% female, 52% O+ blood type, 31% A+, and 11% B+, 44% cranial-encephalic trauma, and 44% brain hemorrhage. RESULTS: Global agreement was 52.6% (kappa = 0.343), and partial agreement was 76.3% (weighted kappa = 0.204), assigning more intensity to extreme values, but with a lower correlation index. A more intense agreement, without discriminating by hospital, was found for "A" category (blood group), followed by "B" category (waiting list time). DISCUSSION: Taking into consideration the determining factors for long-term graft survival, it is indispensable to include criteria such as donor and recipient ages and HLA typife in the allocation process. This first draft of a point-score system in organ allocation included waiting list time, blood group, urgency related to vascular/peritoneal access for dialysis, clinical condition, donor/recipient age ratio, and HLA antigenic compatibility.
Assuntos
Transplante de Rim/métodos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Ética Médica , Feminino , Antígenos HLA/metabolismo , Humanos , Hemorragias Intracranianas/mortalidade , Masculino , México , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Obtenção de Tecidos e Órgãos/normasAssuntos
Humanos , Recém-Nascido , Maternidades/estatística & dados numéricos , Índice de Apgar , América do Sul/epidemiologia , Hipóxia/mortalidade , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/mortalidade , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/mortalidade , Mortalidade Infantil , MorbidadeAssuntos
Humanos , Recém-Nascido , Maternidades/estatística & dados numéricos , Índice de Apgar , Mortalidade Infantil , Morbidade , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/mortalidade , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/mortalidade , Hipóxia/mortalidade , América do Sul/epidemiologiaRESUMO
O declínio da mortalidade pela doença cerebrovascular no Brasil é conhecido, porém há poucos dados sobre a evolução temporal dos dois principais subtipos, a hemorragia parenquimatosa e o infarto cerebral. As modificações temporais dos subtipos de doença cerebrovascular foram estudadas na cidade de São Paulo entre 1996 e 2003 por gênero e faixa etária decenal entre os 30 e 79 anos. Para os homens detectou-se redução anual para todo os tipos (-3,9%), para hemorragia parenquimatosa (-3,0%), para infarto cerebral (-2,7%) bem como para os casos mal definidos (-7.4%). Para as mulheres somente houve variação significativa para todos os tipos da doença cerebrovascular (-3,3%) e para os casos mal definidos (-12%). Concluindo, as taxas de doença cerebrovascular estão em queda, porém entre as mulheres devido à melhoria do diagnóstico clínico houve migração de casos mal definidos para casos bem definidos. Devido a isso não foi possível detectar declínio nas taxas de mortalidade pelos subtipos de doença cerebrovascular.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Cerebrovasculares/mortalidade , Distribuição por Idade , Brasil/epidemiologia , Causas de Morte/tendências , Transtornos Cerebrovasculares/classificação , Hemorragias Intracranianas/mortalidade , Distribuição por Sexo , Acidente Vascular Cerebral/mortalidadeRESUMO
The aim of this study was to verify the gender difference in sudden cardiovascular death, mainly comparing brain infarction and hemorrhagic stroke. We analyzed 970 autopsy cases from a total of 3,802 nonviolent deaths (448 considered as sudden deaths, 296 undetermined, and 226 non-sudden deaths) including patients aged 30-69 years. All cardiovascular diseases were responsible for 69% of sudden deaths, and all types of stroke for only 14%. The proportions of sudden death for all cardiovascular diseases, coronary heart disease and ischemic stroke deaths were similar for both sexes. However, sudden deaths due to all types of stroke (women 20.0%; men 11.1%; p = 0.012) and hemorrhagic stroke (women 15.6%; men 7.9%; p = 0.019) were significantly more frequent among women when compared to men, the main cause being subarachnoid hemorrhage (women 5.6%; men 1.0%; p = 0.011). Hemorrhagic stroke deaths were usually sudden deaths among women.
Assuntos
Morte Súbita/epidemiologia , Hemorragias Intracranianas/mortalidade , Acidente Vascular Cerebral/mortalidade , Adulto , Idoso , Autopsia , Brasil/epidemiologia , Causas de Morte , Feminino , Humanos , Hemorragias Intracranianas/complicações , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Acidente Vascular Cerebral/etiologiaRESUMO
The decline of stroke mortality rates has been described in Brazil; however, there is no data about stroke subtypes. We described the changes of stroke mortality rates in the city of Sao Paulo (1996-2003) emphasizing intracerebral hemorrhage and cerebral infarction. We categorized mortality data by gender and 10-year age-strata from 30 to 79 years-old. For men, an annual reduction of all types of stroke (-3.9%), and of stroke subtypes as intracerebral hemorrhage (-3.0%) and cerebral infarction was observed (-2.7%) as well as, a decline of ill-defined stroke (-7.4%). For women, a decline was observed for all types of stroke (-3.3%) and for ill-defined stroke (-12%). However, the switch of ill-defined cases to stroke subtype categories due to a better clinical diagnosis blurred a real decline of both cerebral infarction and intracerebral hemorrhagic stroke among women.
Assuntos
Transtornos Cerebrovasculares/mortalidade , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Causas de Morte/tendências , Transtornos Cerebrovasculares/classificação , Feminino , Humanos , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Acidente Vascular Cerebral/mortalidadeRESUMO
OBJECTIVE: To evaluate the role of serum enzymes for defining the pancreatic phenotype in Shwachman-Diamond syndrome (SDS), an inherited multisystem condition. STUDY DESIGN: Serum pancreatic trypsinogen and isoamylase were measured in 164 patients known or presumed to have SDS. The diagnosis was confirmed in 90 patients. Among 74 unconfirmed cases, 35 ("probable SDS") had hematologic dysfunction but lacked documented pancreatic dysfunction, whereas 39 patients ("improbable SDS") lacked both documented pancreatic and hematologic dysfunction. Classification and regression tree (CART) analysis was performed in 90 patients with SDS and 134 control patients to establish a rule for defining the pancreatic phenotype of SDS; the rule was then applied to the patients with unconfirmed diagnosis. RESULTS: In the control patients, serum trypsinogen showed little variation with age, whereas serum isoamylase values rose from birth on, attaining adult values by 3 years. For patients with SDS, serum trypsinogen values were low in young patients and tended to increase with age, whereas serum isoamylase values remained low at all ages. The CART rule combined results from both enzymes and classified the pancreatic phenotype in all but one SDS patient, who was <3 years of age. Excluding patients <3 years of age, CART identified the pancreatic phenotype in 82% and 7% of the "probable SDS" and "improbable SDS" cases, respectively. CONCLUSIONS: Serum pancreatic enzymes are useful for determining the pancreatic phenotype and confirming the diagnosis of SDS.