Performance of four ischemic stroke prognostic scores in a Brazilian population

Objective: Ischemic stroke (IS) prognostic scales may help clinicians in their clinical decisions. This study aimed to assess the performance of four IS prognostic scales in a Brazilian population. Method: We evaluated data of IS patients admitted at Hospital Paulistano, a Joint Commission International certified primary stroke center. In-hospital mortality and modified Rankin score at discharge were defined as the outcome measures. The performance of National Institutes of Health Stroke Scale (NIHSS), Stroke Prognostication Using Age and NIHSS (SPAN-100), Acute Stroke Registry and Analysis of Lausanne (ASTRAL), and Totaled Health Risks in Vascular Events (THRIVE) were compared. Results: Two hundred six patients with a mean +/- SD age of 67.58 +/- 15.5 years, being 55.3% male, were included. The four scales were significantly and independently associated functional outcome. Only THRIVE was associated with in-hospital mortality. With area under the curve THRIVE and NIHSS were the scales with better performance for functional outcome and THRIVE had the best performance for mortality. Conclusion: THRIVE showed the best performance among the four scales, being the only associated with in-hospital mortality.CAPESHosp Paulistano, AMIL, Sao Paulo, SP, BrazilPrograma Integrado AVC PIAVEN, AMIL, Sao Paulo, SP, BrazilFac Med ABC, Dept Neurol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Neurol, Sao Paulo, SP, BrazilUniv Fed Minas Gerais, Programa Neurociencias, Belo Horizonte, MG, BrazilUniv Fed Sao Paulo, Dept Neurol, Sao Paulo, SP, BrazilWeb of Scienc

Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS), transient ischemic attack (TIA), and intracerebral hemorrhage (ICH) admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil

Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Insomnia: A Randomized-Controlled-Trial

This was a prospective, randomized, three-arm, parallel-group, controlled clinical trial comparing ACT with CBT for chronic insomnia in adults. Outcomes were assessed post-treatment (one week after completion of treatment) and at the six-month follow-up. ClinicalTrials.gov Identifier: NCT0486691

Remoção biológica de fósforo em reatores em bateladas sequenciais com diferentes tempos de retenção de sólidos Biological phosphorus removal in sequencing batch reactors with different solid retention times

Nos últimos anos, tem surgido a necessidade de se projetarem sistemas de tratamento de águas residuárias que, além de remover carga orgânica, sejam capazes de remover nutrientes, particularmente nitrogênio e fósforo. Este trabalho avaliou a remoção biológica de fósforo em sistemas de lodo ativado, tratando esgoto doméstico por meio de reatores em bateladas sequenciais (RBS), monitorado com diferentes tempos de retenção celular (TRC): 20, 5 e 3 dias. Esses experimentos foram avaliados em escala de bancada com o uso da respirometria, utilizando-se acetato como fonte de carbono orgânico. Os resultados mostraram satisfatória remoção de fósforo total nos três experimentos, com valores médios entre 79 a 82%, sendo que o sistema RBS que operou com TRC de cinco dias obteve resultados melhores.<br>In recent years, there has been an increasing need to design wastewater treatment systems that are capable of removing both organic material and nutrients, notably nitrogen and phosphorus. This study evaluated biological phosphorus removal by activated sludge systems fed with domestic sewage and operating as sequencing batch reactors (SBR) with different solids retention times (SRT) namely 20, 5 and 3 days. This was supported by respirometry experiments at bench scale using acetate as the source of organic carbon. The results showed satisfactory total phosphorus removal efficiencies mean values between 79-82% for the three regimes with the best removal efficiency occurring in the SBR operating with a five-day SRT