ANÁLISE DO MANEJO AGUDO DO ACIDENTE VASCULAR CEREBRAL NO HOSPITAL DE CLÍNICAS DE PORTO ALEGRE

Introdução: Acidente vascular cerebral (AVC) é a segunda causa de óbito no mundo e a terceira nos países industrializados. O objetivo deste estudo é avaliar a qualidade do atendimento prestado aos pacientes vítimas de AVC no Hospital de Clínicas de Porto Alegre (HCPA). Poucos trabalhos descrevem o modo de atendimento ideal do AVC agudo, e a ausência de padronização de condutas muitas vezes implica em retardo diagnóstico e terapêutico. Materiais e métodos: trabalho retrospectivo onde foram analisados 55 pacientes (n: 55) admitidos na emergência do HCPA com diagnóstico de AVC agudo, através de suas características demográficas (sexo e idade), tempo de internação e mortalidade geral, indicadores de atendimento inicial (glicemia capilar [GC], pressão arterial [PA], perfil lipídico, eletrocardiograma [ECG], tomografia computadorizada [TC] de crânio), avaliação complementar (ecocardiograma,ecografia com doppler de carótidas, tomografia após 48 horas) e tratamento instituído (AAS, estatina, anticoagulação, trombolítico). Resultados: dos 55 pacientes, 45 (81,8%) apresentaram diagnóstico de AVC isquêmico e10 (18,2%) de AVC hemorrágico, sendo que a mortalidade do AVC hemorrágico foi significativamente maior (40% vs 4%). Mais de 90% obtiveram medidas de PA e ECG na chegada, e 100% dos pacientes realizaram TC de crânio nas primeiras 24 horas; medidas de GC foram feitas em 60% dos pacientes, e perfil lipídico em apenas 11%. Dos exames complementares destaca-se o ecocardiograma realizado em quase 90% dos casos (69% transtorácico e 18%transesofágico [TE]) e a ecodoppler de carótidas feita em 90%; menos de 30% dos pacientes obtiveram TC após 48 horas. Quanto ao tratamento, aproximadamente 80% receberam AAS e estatina; 20% receberam anticoagulação e nenhum recebeu trombolítico. As análises dos examescomplementares e do tratamento foram realizadas apenas nos pacientes com AVC isquêmico. Discussão: a análise dos dados demográficos e a caracterização do AVC (hemorrágico X isquêmico) foram similares aos encontrados na literatura. A falha do estudo foi não ter excluído os pacientes que foram a óbito na análise do tempo de internação, desta forma subestimando o resultado principalmente do AVC hemorrágico, que obteve maior mortalidade. A avaliaçãocomplementar foi satisfatória e condizente com a descrição da literatura. Quanto ao tratamento, apesar de fortes evidências validando o uso de trombolíticos, este não foi praticado neste hospital por norma interna do serviço; a prescrição de AAS e estatina foi adequada ao recomendado na literatura.Unitermos: acidente vascular cerebral; AVC; manejo agudo; indicadores assistenciais

Management of acute stroke in Hospital de Clínicas de Porto Alegre

Introdução: Acidente vascular cerebral (AVC) é a segunda causa de óbito no mundo e a terceira nos países industrializados. O objetivo deste estudo é avaliar a qualidade do atendimento prestado aos pacientes vítimas de AVC no Hospital de Clínicas de Porto Alegre (HCPA). Poucos trabalhos descrevem o modo de atendimento ideal do AVC agudo, e a ausência de padronização de condutas muitas vezes implica em retardo diagnóstico e terapêutico. Materiais e métodos: trabalho retrospectivo onde foram analisados 55 pacientes (n: 55) admitidos na emergência do HCPA com diagnóstico de AVC agudo, através de suas características demográficas (sexo e idade), tempo de internação e mortalidade geral, indicadores de atendimento inicial (glicemia capilar [GC], pressão arterial [PA], perfil lipídico, eletrocardiograma [ECG], tomografia computadorizada [TC] de crânio), avaliação complementar (ecocardiograma, ecografia com doppler de carótidas, tomografia após 48 horas) e tratamento instituído (AAS, estatina, anticoagulação, trombolítico) Resultados: dos 55 pacientes, 45 (81,8%) apresentaram diagnóstico de AVC isquêmico e 10 (18,2%) de AVC hemorrágico, sendo que a mortalidade do AVC hemorrágico foi significativamente maior (40% vs 4%). Mais de 90% obtiveram medidas de PA e ECG na chegada, e 100% dos pacientes realizaram TC de crânio nas primeiras 24 horas; medidas de GC foram feitas em 60% dos pacientes, e perfil lipídico em apenas 11%. Dos exames complementares destaca-se o ecocardiograma realizado em quase 90% dos casos (69% transtorácico e 18% transesofágico [TE]) e a ecodoppler de carótidas feita em 90%; menos de 30% dos pacientes obtiveram TC após 48 horas. Quanto ao tratamento, aproximadamente 80% receberam AAS e estatina; 20% receberam anticoagulação e nenhum recebeu trombolítico. As análises dos exames complementares e do tratamento foram realizadas apenas nos pacientes com AVC isquêmico. Discussão: a análise dos dados demográficos e a caracterização do AVC (hemorrágico X isquêmico) foram similares aos encontrados na literatura. A falha do estudo foi não ter excluído os pacientes que foram a óbito na análise do tempo de internação, desta forma subestimando o resultado principalmente do AVC hemorrágico, que obteve maior mortalidade. A avaliação complementar foi satisfatória e condizente com a descrição da literatura. Quanto ao tratamento, apesar de fortes evidências validando o uso de trombolíticos, este não foi praticado neste hospital por norma interna do serviço; a prescrição de AAS e estatina foi adequada ao recomendado na literatura.Background: Stroke is the second cause of death in the world and the third in industrialized countries. The main target of this study is to evaluate the quality of the management of stroke at the Hospital de Clínicas de Porto Alegre (HCPA). There are very few studies in the literature describing the ideal management of the acute stroke, and the lack of management pattern implies in a late diagnosis and treatment. Materials and methods: analysed 55 patients (n: 55) received at emergency room at HCPA with stroke diagnosed, patient´s demographic details (age and sex), internment time and general mortality, fist management impressions (fingerstick glucose [FSG], blood pressure [BP], lipidic profile, eletrocardiogram [ECG], head CT scan), complementary evaluation (echocardiography, carotid US Doppler, head CT scan after 48 hours) and treatment applied (aspirin, statin, anticoagulation, thrombolytic). Results: from the 55 patients, 45 (81,8%) showed ischemic stroke and 10 (18,2%) the hemorrhagic stroke, and the number of deaths from hemorrhagic was significantly higher (40% vs 4%). More than 90% of the patients got BP and ECG measurements upon arrival, and 100% of them had head CT scan on the first 24 hours; FSG measurements were made in 60% of the patients, lipidic profile in only 11%. From the complementary exhaminations the echocardiography is highlighted as the one made in almost 90% of the cases (69% transthoracic and 18% transesophagic [TE]) and the carotide US doppler in 89%; less than 30% had CT scan after 48 hours. Regarding the treatment, approximately 80% received aspirin and statin; 20% received anticoagulation and none received thrombolytic. The analysis of the complementary exhaminations and of the treatment were made only in the patients with ischemic stroke. Discussion: the analysis of the demographic data and stroke type (hemorrhagic X ischemic) was similar to the ones found in the literature. The study failure was to use the patients that died at the internation time - this fact underestimated the results (number of days at the hospital) specially in hemorragic stroke, which got more number of deaths. The complementary evaluation was satisfactory and according to the literature. Regarding to the treatment, in spite of the strong evidences of the use of trombolitics, this was not used in this hospital following internal rules; the prescription of aspirin and statins was as per as recommended in the literature

Leisingera sp. JC1, a Bacterial Isolate from Hawaiian Bobtail Squid Eggs, Produces Indigoidine and Differentially Inhibits Vibrios

Female members of many cephalopod species house a bacterial consortium that is part of their reproductive system, the accessory nidamental gland (ANG). These bacteria are deposited into eggs that are then laid in the environment where they must develop unprotected from predation, pathogens and fouling. In this study, we characterized the genome and secondary metabolite production of Leisingera sp. JC1, a member of the roseobacter clade (Rhodobacteraceae) of Alphaproteobacteria isolated from the jelly coat of eggs from the Hawaiian bobtail squid, Euprymna scolopes. Whole genome sequencing and MLSA analysis revealed that Leisingera sp. JC1 falls within a group of roseobacters associated with squid ANGs. Genome and biochemical analyses revealed the potential for and production of a number of secondary metabolites, including siderophores and acyl-homoserine lactones involved with quorum sensing. The complete biosynthetic gene cluster for the pigment indigoidine was detected in the genome and mass spectrometry confirmed the production of this compound. Furthermore, we investigated the production of indigoidine under co-culture conditions with Vibrio fischeri, the light organ symbiont of E. scolopes, and with other vibrios. Finally, both Leisingera sp. JC1 and secondary metabolite extracts of this strain had differential antimicrobial activity against a number of marine vibrios, suggesting that Leisingera sp. JC1 may play a role in host defense against other marine bacteria either in the eggs and/or ANG. These data also suggest that indigoidine may be partially, but not wholly, responsible for the antimicrobial activity of this squid-associated bacterium.

Sex differences in wild-type transthyretin amyloidosis: An analysis from the Transthyretin Amyloidosis Outcomes Survey (THAOS)

INTRODUCTION: Wild-type transthyretin amyloidosis (ATTRwt amyloidosis) is a progressive disease resulting from the accumulation of wild-type transthyretin (TTR) amyloid fibrils, and is diagnosed primarily in males. This analysis examined sex differences in patients with ATTRwt amyloidosis from the Transthyretin Amyloidosis Outcomes Survey (THAOS). METHODS: THAOS is an ongoing, global, longitudinal, observational survey of patients with transthyretin amyloidosis, including both inherited and wild-type disease, and asymptomatic carriers of TTR mutations. THAOS data were analyzed to identify potential differences in demographic and clinical characteristics between males and females with ATTRwt amyloidosis (data cutoff: August 1, 2021). RESULTS: Of 1386 patients with ATTRwt amyloidosis, 84 (6%) were female and 1302 (94%) were male. Females had a higher median age at enrollment (80 vs. 78 years; p = 0.002) and symptom onset (75 vs. 73 years; p = 0.045) than males. Mean left ventricular (LV) ejection fraction was higher (53% vs. 48%; p = 0.001) and mean LV diastolic diameter lower (42 vs. 46 mm; p \u3c 0.001) in females versus males, but sex was not identified as a predictor of LV mean wall thickness adjusted for height (beta coefficient - 0.22; p = 0.460) or a predominantly cardiac phenotype (odds ratio 1.60; p = 0.191). Modified polyneuropathy disability scores differed between groups (p \u3c 0.001), with a larger proportion of scores ≥ IIIa among females (23% vs. 7%). CONCLUSIONS: Females with ATTRwt amyloidosis in THAOS tended to present at a later age and showed signs of less severe cardiac impairment and more severe walking impairment. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00628745

A developmental approach to diversifying neuroscience through effective mentorship practices: perspectives on cross-identity mentorship and a critical call to action.

Many early-career neuroscientists with diverse identities may not have mentors who are more advanced in the neuroscience pipeline and have a congruent identity due to historic biases, laws, and policies impacting access to education. Cross-identity mentoring relationships pose challenges and power imbalances that impact the retention of diverse early career neuroscientists, but also hold the potential for a mutually enriching and collaborative relationship that fosters the mentee\u27s success. Additionally, the barriers faced by diverse mentees and their mentorship needs may evolve with career progression and require developmental considerations. This article provides perspectives on factors that impact cross-identity mentorship from individuals participating in Diversifying the Community of Neuroscience (CNS)-a longitudinal, National Institute of Neurological Disorders and Stroke (NINDS) R25 neuroscience mentorship program developed to increase diversity in the neurosciences. Participants in Diversifying CNS were comprised of 14 graduate students, postdoctoral fellows, and early career faculty who completed an online qualitative survey on cross-identity mentorship practices that impact their experience in neuroscience fields. Qualitative survey data were analyzed using inductive thematic analysis and resulted in four themes across career levels: (1) approach to mentorship and interpersonal dynamics, (2) allyship and management of power imbalance, (3) academic sponsorship, and (4) institutional barriers impacting navigation of academia. These themes, along with identified mentorship needs by developmental stage, provide insights mentors can use to better support the success of their mentees with diverse intersectional identities. As highlighted in our discussion, a mentor\u27s awareness of systemic barriers along with active allyship are foundational for their role

Supramolecular binding and separation of hydrocarbons within a functionalised porous metal-organic framework

Supramolecular interactions are fundamental to host-guest binding in chemical and biological processes. Direct visualisation of such supramolecular interactions within host-guest systems is extremely challenging but crucial for the understanding of their function. We report a comprehensive study combining neutron scattering with synchrotron X-ray and neutron diffraction, coupled with computational modelling, to define the detailed binding at a molecular level of acetylene, ethylene and ethane within the porous host NOTT-300. This study reveals the simultaneous and cooperative hydrogen-bonding, π···π stacking interactions and inter-molecular dipole interactions in the binding of acetylene and ethylene to give up to twelve individual weak supramolecular interactions aligned within the host to form an optimal geometry for intelligent, selective binding of hydrocarbons. We also report, for the first time, the cooperative binding of a mixture of acetylene and ethylene within the porous host together with the corresponding breakthrough experiment and analysis of mixed gas adsorption isotherms

Active children through individual vouchers – evaluation (ACTIVE): protocol for a mixed method randomised control trial to increase physical activity levels in teenagers

BackgroundMany teenagers are insufficiently active despite the health benefits of physical activity (PA). There is strong evidence to show that inactivity and low fitness levels increase the risk of non-communicable diseases such as coronary heart disease (CHD), type 2 diabetes and breast and colon cancers (Lee et al. Lancet 380:219–29, 2012). A major barrier facing adolescents is accessibility (e.g. cost and lack of local facilities). The ACTIVE project aims to tackle this barrier through a multi-faceted intervention, giving teenagers vouchers to spend on activities of their choice and empowering young people to improve their fitness and PA levels.DesignACTIVE is a mixed methods randomised control trial in 7 secondary schools in Swansea, South Wales. Quantitative and qualitative measures including PA (cooper run test (CRT), accelerometery over 7 days), cardiovascular (CV) measures (blood pressure, pulse wave analysis) and focus groups will be undertaken at 4 separate time points (baseline, 6 months,12 months and follow-up at 18 months). Intervention schools will receive a multi-component intervention involving 12 months of £20 vouchers to spend on physical activities of their choice, a peer mentor scheme and opportunities to attend advocacy meetings. Control schools are encouraged to continue usual practice. The primary aim is to examine the effect of the intervention in improving cardiovascular fitness.DiscussionThis paper describes the protocol for the ACTIVE randomised control trial, which aims to increase fitness, physical activity and socialisation of teenagers in Swansea, UK via a voucher scheme combined with peer mentoring. Results can contribute to the evidence base on teenage physical activity and, if effective, the intervention has the potential to inform future physical activity interventions and policy

The high comorbidity burden of the hepatitis C virus infected population in the United States

<p>Abstract</p> <p>Background</p> <p>Chronic hepatitis C (HCV) disease can be complicated with comorbid conditions that may impact treatment eligibility and outcomes. The aim of the study was to systematically review comorbidities and symptoms in an HCV infected population, specifically assessing comorbidities associated with HCV anti-viral treatment and disease, as well as comparing comorbidities between an HCV infected and uninfected control population.</p> <p>Methods</p> <p>This was a retrospective cohort study within a United States medical claims database among patients with chronic HCV designed to estimate the two-year period prevalence of comorbidities. Patients with two HCV diagnosis codes, 24 months of continuous health insurance coverage, and full medical and pharmacy benefits were included.</p> <p>Results</p> <p>Among a chronic HCV cohort of 7411 patients, at least one comorbid condition was seen in almost all patients (> 99%) during the study period. HCV-infected patients reported almost double the number of comorbidities compared to uninfected controls. Of the 25 most common comorbidities, the majority of the comorbidities (n = 22) were known to be associated with either HCV antiviral treatment or disease. The five most frequent comorbidities were liver disease [other] (37.5%), connective tissue disease (37.5%), abdominal pain (36.1%), upper respiratory infections (35.6%), and lower respiratory disease (33.7%). Three notable comorbidities not known to be associated with antiviral treatment or disease were benign neoplasms (24.3%), genitourinary symptoms & ill-defined conditions (14.8%), and viral infections (13.8%).</p> <p>Conclusions</p> <p>This US medically insured HCV population is highly comorbid. Effective strategies to manage these comorbidities are necessary to allow wider access to HCV treatment and reduce the future burden of HCV disease and its manifestations.</p

Inverse Association between Dietary Iron Intake and Gastric Cancer: A Pooled Analysis of Case-Control Studies of the Stop Consortium

Background: Inconsistent findings have been reported regarding the relationship between dietary iron intake and the risk of gastric cancer (GC). Methods: We pooled data from 11 case-control studies from the Stomach Cancer Pooling (StoP) Project. Total dietary iron intake was derived from food frequency questionnaires combined with national nutritional tables. We derived the odds ratios (ORs) and 95% confidence intervals (CIs) for quartiles of dietary iron through multivariable unconditional logistic regression models. Secondary analyses stratified by sex, smoking status, caloric intake, anatomical subsite and histological type were performed. Results: Among 4658 cases and 12247 controls, dietary iron intake was inversely associated with GC (per quartile OR 0.88; 95% CI: 0.83-0.93). Results were similar between cardia (OR = 0.85, 95% CI = 0.77-0.94) and non-cardia GC (OR = 0.87, 95% CI = 0.81-0.94), and for diffuse (OR = 0.79, 95% CI = 0.69-0.89) and intestinal type (OR = 0.88, 95% CI = 0.79-0.98). Iron intake exerted an independent effect from that of smoking and salt intake. Additional adjustment by meat and fruit/vegetable intake did not alter the results. Conclusions: Dietary iron is inversely related to GC, with no difference by subsite or histological type. While the results should be interpreted with caution, they provide evidence against a direct effect of iron in gastric carcinogenesis