Bilateral versus ipsilesional cortico-subcortical activity patterns in stroke show hemispheric dependence

Background Understanding of interhemispheric interactions in stroke patients during motor control is an important clinical neuroscience quest that may provide important clues for neurorehabilitation. In stroke patients, bilateral overactivation in both hemispheres has been interpreted as a poor prognostic indicator of functional recovery. In contrast, ipsilesional patterns have been linked with better motor outcomes. Aim We investigated the pathophysiology of hemispheric interactions during limb movement without and with contralateral restraint, to mimic the effects of constraint-induced movement therapy. We used neuroimaging to probe brain activity with such a movement-dependent interhemispheric modulation paradigm. Methods We used an fMRI block design during which the plegic/paretic upper limb was recruited/mobilized to perform unilateral arm elevation, as a function of presence versus absence of contralateral limb restriction ( n = 20, with balanced left/right lesion sites). Results Analysis of 10 right-hemispheric stroke participants yielded bilateral sensorimotor cortex activation in all movement phases in contrast with the unilateral dominance seen in the 10 left-hemispheric stroke participants. Superimposition of contralateral restriction led to a prominent shift from activation to deactivation response patterns, in particular in cortical and basal ganglia motor areas in right-hemispheric stroke. Left-hemispheric stroke was in general characterized by reduced activation patterns, even in the absence of restriction, which induced additional cortical silencing. Conclusion The observed hemispheric-dependent activation/deactivation shifts are novel and these pathophysiological observations suggest short-term neuroplasticity that may be useful for hemisphere-tailored neurorehabilitation.info:eu-repo/semantics/publishedVersio

Doença de Kawasaki: casuística do Hospital Fernando da Fonseca

Introdução: A doença de Kawasaki (DK) é a doença cardíaca adquirida mais importante da infância, em países desenvolvidos. Vinte por cento das crianças não tratadas desenvolvem doença das coronárias, sendo as complicações a nível cardiovascular que determinam a morbilidade e mortalidade da doença. Objectivo: Avaliar a epidemiologia, clínica e alterações laboratoriais e ecocardiográficas dos casos de DK diagnosticados no H. Fernando Fonseca e identificar os eventuais factores que possam influenciar o prognóstico da doença. População e Métodos: Estudo retrospectivo, Junho 1996 a Dezembro de 2003, das crianças internadas no Hospital Fernando Fonseca com Doença Kawasaki. O diagnóstico baseou-se na presença de febre associada a 4 dos 5 critérios clássicos ou 3 deles em associação com aneurismas coronários. Analisaram-se parâmetros demográficos, clínica, exames complementares, terapêutica e evolução. A análise estatística foi realizada em SPSS, utilizando os testes de Mann-whitney e Teste Exacto de Fisher. Resultados: Registaram-se 23 crianças com DK. A incidência foi de 8,2 por 100 000 crianças < 5 anos. A idade variou entre os 6 meses e os 5 anos (mediana - 20 meses) Vinte e uma (91 %) tinham < 5 anos, dos quais 13 tinham < 2 anos. Houve um predomínio do sexo masculino (74 %) e da raça caucasiana (83 %). Nove casos residiam na mesma área geográfica. Foi documentada patologia infecciosa concomitante em 10 (43%)crianças (Parvovirus, Chlamydia pneumoniae, Vírus sincicial respiratório, Enterovirus e Herpes vírus 6). Vinte crianças preenchiam os critérios de DK clássica. Em 22 crianças foi administrada terapêutica combinada com aspirina e imunoglobulina endovenosa, em média foi administrada ao 7.º dia de doença. Sete (30 %) crianças apresentaram envolvimento das artérias coronárias. A idade inferior a 2 anos foi significativa para a lesão coronária. O tempo médio de seguimento foi de 16 meses. Não se registou mortalidade e actualmente apenas uma criança mantém aneurisma. Conclusões: O risco de lesões cardíacas associou-se à idade inferior a 2 anos, como descrito em outras séries. A origem geográfica em comum e a presença de diversos agentes infecciosos, pode indiciar, a importância da causa infecciosa como desencadeadora do processo

Endothelial Progenitor Cells influence acute and subacute stroke hemodynamics

BACKGROUND: Endothelial Progenitor Cells (EPCs) are a circulating stem cell population with in vivo capacity of promoting angiogenesis after ischemic events. Despite the promising preclinical data, their potential integration with reperfusion therapies and hemodynamic evolution of stroke patients is still unknown. Our aim was to determine the association of EPCs with acute, subacute and chronic hemodynamic features. METHODS: In this prospective study, we included consecutive patients with ages between 18 and 80years and non-lacunar ischemic stroke within the territory of a middle cerebral artery. All patients were subject to hemodynamic evaluation by ultrasound at baseline, seven days and three months. We quantified cerebral blood flow (CBF) and assessed early recanalization and collateral flow. Hemorrhagic transformation was graded in Magnetic Resonance imaging performed at seven days. EPCs were isolated from peripheral venous blood collected in the first 24h and seven days, counted and submitted to functional in vitro tests. RESULTS: We included 45 patients with a median age of 70±10years. The angiogenic and migratory capacities of EPCs were associated with increased collateral flow in the acute stage and day seven CBF, without statistically significant associations with recanalization nor haemorrhagic transformation. The number of EPCs was not associated with any hemodynamic variable. CONCLUSIONS: The functional properties of EPCs are associated with acute and subacute stroke hemodynamics, with no effect on haemorrhagic transformation.info:eu-repo/semantics/publishedVersio

Elderly persons in a situation of dependence: informal caregiver stress and coping

Objective: Study the relationship between psychological (stress) and psychological (coping) of the informal caregiver of the elderly in a situation of dependence. Methods: Cross-sectional study involving a sample selected by convenience, of 110 informal caregivers of "Conselho de Faro", Portugal. Data was collected in the homes by application of four instruments to these caregivers (sociodemographic data, assessment of stress intensity; abbreviated scale of coping and Barthel's dependence assessment. Results: The coping strategies centered on the problem (Chi-square = 10.243, p <= 0.037) and on the medium (Chi-square = 9.574, p <= 0.048) were used by the informal caregivers of the more dependent elderly. However, strategies centered on the caregiver were those that generated less stress (beta = -0.378, p <= 0.000). Conclusion: The "coping strategies centered on the caregiver" are those that generate less perception of stress in the informal caregivers

Patients' satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan – a cross sectional study

<p>Abstract</p> <p>Background</p> <p>It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients.</p> <p>Methods</p> <p>It was a cross sectional study carried out at a major tertiary care hospital of Karachi. Patients between the ages of 18 and 80 years admitted to the hospital for at least one day were included. Patients in the maternity, psychiatry and chemotherapy wards and those in the ICU/CCU were excluded. A pretested, peer reviewed translation of a validated patient satisfaction scale developed by the Picker Institute of Europe was administered.</p> <p>Results</p> <p>A total of 173 patients (response rate: 78.6 %) filled the questionnaire. Patient satisfaction was at levels comparable to European surveys for most aspects of hospital care. However, nearly half the patients (48%) felt they had to wait too long to get a bed in the hospital after presenting to the ER. 68.6% of the patients said that they were never asked for views on the quality of care provided. 20% of the patients did not find anyone in the staff to talk to about their worries and fears while 27.6% felt that they were given emotional support to only some extent. Up to one third of the patients said they were not provided enough information regarding their operative procedures beforehand.</p> <p>Conclusion</p> <p>Although several components of patient care equal the quality levels of the west, many sections require considerable improvement in order to improve health care provision. The healthcare team needs to get more involved with the patients, providing them greater support and keeping them informed and involved with their medical treatment. Efforts should be made to get regular feedback from the patients.</p