Transient ischemic attacks in rural and urban northern Portugal: incidence and short-term prognosis

Abstract BACKGROUND AND PURPOSE: There are no community-based studies on the incidence of transient ischemic attacks (TIAs) in Portugal. This study was designed to determine TIA incidence and the risk of stroke occurrence in rural and urban populations in northern Portugal. METHODS: All suspected first-ever TIAs occurring between October 1998 and September 2000 in 18,677 residents in a rural municipality and 86,023 living in the city of Porto were entered into a population-based registry. Standard definitions and comprehensive sources of information were used for identification of patients who were followed up at 3 and 12 months after the TIA. RESULTS: During a 24-month period, 141 patients with a first-ever TIA were registered, 36 in rural and 104 in urban areas. The vascular territory was carotid in 66.7% of the patients, vertebrobasilar in 29.1%, and undetermined in 4.3%. The overall crude annual incidence rate per 1000 was 0.67 (95% CI, 0.45 to 1.04), 0.61 (95% CI, 0.38 to 1.01) for rural, and 0.96 (95% CI, 0.43 to 2.33) for urban populations. The risk of stroke within the first 7 days of the index event was 12.8% (95% CI, 7.3 to 18.3), reaching 21.4% (95% CI, 14.6 to 28.1) at 1 year. Three factors were associated with stroke occurrence within 120 days after TIA: patients' age > or =65 years and an episode in the carotid distribution lasting > or =3 hours. CONCLUSIONS: The incidence of TIA in northern Portugal, particularly in rural populations, ranks among the highest reported in community-based studies, following closely the stroke incidence trend (ACINrpc). Early recognition of TIA by patients and physicians is crucial for effective stroke prevention

CARACTERIZAÇÃO E PROGNÓSTICO A CURTO PRAZO DOS UTILIZADORES DA VIA VERDE DO AVC NO NORTE DE PORTUGAL

CARACTERIZAÇÃO E PROGNÓSTICO A CURTO PRAZO DOS UTILIZADORES DA VIA VERDE DO AVC NO NORTE DE PORTUGAL Mariana Moutinho1, Rui Magalhães2, Maria Carolina Silva2, Manuel Correia3 1Curso de Mestrado Integrado em Medicina, ICBAS/UP. 2Departamento de Estudo de Populações, ICBAS/UP. 3Serviço de Neurologia, HSA/CHP e ICBAS/UP. Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto. Hospital de Santo António, Centro Hospitalar do Porto (HSA/CHP), Porto. Introdução Em 2002 Portugal detinha ainda uma das mais altas taxas de mortalidade por doenças cerebrovasculares de entre os países europeus. Várias estratégias foram adoptadas para melhorar quer a prevenção da doença quer o seu tratamento, e de entre estas últimas pode salientar-se a criação da Via Verde do AVC. O objectivo deste trabalho é descrever a utilização e resultados desta estratégia no contexto de um registo prospectivo comunitário de acidentes neurológicos. Metodologia Foram registados todos os AVCs ocorridos entre 1 de Outubro de 2009 e 30 de Setembro de 2010 nos utentes inscritos no agrupamento de centros de saúde do Porto Ocidental e nos centros de saúde de Mirandela e Vila Pouca de Aguiar. Para a detecção de casos utilizaram-se múltiplas fontes de informação: notificação via plataforma WEB, e-mail e Alerta P1 e pesquisas sistemáticas em registos disponibilizados pelas entidades envolvidas no estudo - urgências hospitalares, listas de altas, procedimentos de diagnóstico, óbitos, Via Verde do AVC e serviço de atendimento em situações de urgência (SASU). Resultados Ocorreram 600 AVCs em 241.000 habitantes (taxa de ataque de 2,5/1.000) e 434 primeiros na vida (taxa de incidência de 1,8/1.000). Foram registados 72 acessos à VV nesta população, dos quais 48 (66,7%) foram diagnosticados como AVC. Considerando os quatro critérios de activação da VV (idade≤80 anos, independência funcional, um de três sinais e tempo após episódio≤3 horas), só 95 (15,9%) doentes a poderiam utilizar, e dos actuais utilizadores, apenas 56,3% satisfaziam esses critérios. A janela terapêutica (19,5%) ou a idade> 80 anos (7,3%) só por si impediriam 154 (26,8%) doentes de accionar a VV. Nos doentes com critérios de activação (n=95), foram internados 96,3% pela VV externa, 83,3% pela VV intra-hospitalar e 64,0% dos restantes; a fibrinólise foi realizada em 77,3%, 36,4% e 17,4% dos doentes com enfarte cerebral, respectivamente. O Rankin pós-AVC é mais grave (4/5) nos utilizadores da VV externa (70,3% vs. 35,3%), mas estes apresentam mais assiduamente os três sinais de AVC (44,4% vs. 16,2%). Ajustando para a idade, sexo e número de sinais, o risco de incapacidade grave pós-AVC não é significativamente diferente no acesso pela VV externa (RP=2,9; IC 95%: 0,8-10,2), bem como a taxa de letalidade. Conclusões Os critérios de activação da VV do AVC são muito restritivos. Embora seja accionada mais frequentemente nas situações clínicas mais graves, impedindo a eventual realização de fibrinólise, a proporção de doentes que a realizou é relativamente alta em comparação com outros estudos. Apresentador: Mariana Moutinho, Aluna do Curso de Mestrado Integrado em Medicina, ICBAS/UP

A community-based study of stroke code users in northern Portugal

Introdução: Em 2002 Portugal detinha uma das mais altas taxas de mortalidade por doenças cerebrovasculares entre os países europeus. Várias estratégias foram adoptadas para melhorar a prevenção da doença e o seu tratamento na fase aguda, entre as quais a criação da Via Verde do Acidente Vascular Cerebral. O objectivo deste trabalho é descrever a utilização e resultados desta estratégia no contexto de um registo prospectivo comunitário na Região Norte de Portugal. Material e Métodos: Foram registados todos os AVCs ocorridos entre 1 de Outubro de 2009 e 30 de Setembro de 2010 nos utentes inscritos no agrupamento de centros de saúde do Porto Ocidental e nos de Mirandela e Vila Pouca de Aguiar. Para a detecção de casos utilizaram-se múltiplas fontes de informação: notificação via WEB, e-mail, Alerta P1 e pesquisas sistemáticas em registos disponibilizados pelas entidades envolvidas - urgências hospitalares, listas de altas, procedimentos de diagnóstico, óbitos, Via Verde do Acidente Vascular Cerebral e serviço de atendimento de situações urgentes. Resultados: Ocorreram 600 AVCs em 241 000 habitantes (taxa de incidência de 250 / 100 000), dos quais 434 foram primeiros na vida (180 / 100 000). Foram registados 72 acessos à Via Verde do Acidente Vascular Cerebral, dos quais 66,7% foram diagnosticados como AVC. Considerando os quatro critérios de activação (idade ≤ 80 anos, independência funcional, sinais/sintomas do AVC e tempo após episódio ≤ 3 horas), só 15,9% dos doentes a poderiam utilizar e, dos utilizadores, apenas 56,3% satisfaziam esses critérios. Dos doentes com critérios de activação, foram internados 96,3% pela VV pré-hospitalar, 83,3% pela VV intra/inter-hospitalar e 64,0% dos restantes; a fibrinólise foi realizada em 77,3%, 36,4% e 17,4% dos doentes com enfarte cerebral, respectivamente. O Rankin pós- AVC é mais grave nos utilizadores da VV pré-hospitalar (70,3% vs. 35,3%), mas estes apresentam mais assiduamente os três sinais/ sintomas de AVC (44,4% vs. 16,2%). Ajustando para a idade, sexo e número de sinais, o risco de incapacidade grave pós-AVC não é significativamente diferente no acesso pela VV pré-hospitalar (RP = 2,9; IC 95%: 0,8 - 10,2), bem como a taxa de letalidade. Conclusões: Os critérios para activação da Via Verde do Acidente Vascular Cerebral são muito restritivos. Embora esta seja mais vezes accionada em situações clínicas graves, a proporção de doentes que realizou fibrinólise é relativamente alta em comparação com outros estudos.A informação usada neste artigo é parte integrante do Projecto PIC/IC/82858/2007 financiado pela Fundação para a Ciência e a Tecnologi

Are Stroke Occurrence and Outcome Related to Weather Parameters? Results from a Population-Based Study in Northern Portugal

Background: Changes in meteorological parameters have been associated with cardiovascular mortality and stroke. The high incidence of stroke in Portugal may be modelled by short- or long-term weather changes whose effect may be different across stroke types and severity. Methods: Data include all patients with a first-ever-in-a-lifetime stroke registered in a population of 86,023 residents in the city of Porto from October 1998 to September 2000. Specific stroke types were considered and ischaemic stroke (IS) subtype was defined according to the Oxfordshire Community Stroke Projet classification and the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Information on daily temperature, humidity and air pressure was obtained from the National Meteorological Office. The Poisson distribution was used to model the daily number of events as a function of each weather parameter measured over different hazard periods, and the binomial model to contrast effects across subgroups. Differential effects of meteorological parameters and hazard periods upon stroke occurrence and outcome were analysed in a stepwise model. Results: Among the 462 patients registered, 19.6% had a primary intracerebral haemorrhage (PICH) and 75.3% an IS. Among patients with IS, 21.6% were total anterior circulation infarcts (TACIs), 19.8% partial anterior circulation infarcts (PACIs), 19.5% posterior circulation infarcts (POCIs) and 39.1% were lacunar infarcts (LACIs). The aetiology of IS was large artery atherosclerosis in 6.9%, cardioembolism in 23.3% and small artery occlusion in 35.6%. The incidence of PICH increased by 11.8% (95% CI: 3.8–20.4%) for each degree drop in the diurnal temperature range in the preceding day. The incidence of IS increased by 3.9% (95% CI: 1.6–6.3%) and cardioembolic IS by 5.0% (95% CI: 0.2–10.1%) for a 1 ° C drop in minimum temperature in the same hazard period. The incidence of TACIs followed the IS pattern while for PACIs and POCIs there were stronger effects of longer hazard periods and no association was found for LACIs. The relative risk of a fatal versus a non-fatal stroke increased by 15.5% (95% CI: 6.1–25.4%) for a 1 ° C drop in maximum temperature over the previous day. Conclusions: Outdoor temperature and related meteorological parameters are associated with stroke occurrence and severity. The different hazard periods for temperature effects and the absence of association with LACIs may explain the heterogeneous effects of weather on stroke occurrence found in community- based and hospital admission studies. Emergency services should be aware that specific weather conditions are more likely to prompt calls for more severe strokes

Hydrogels in acellular and cellular strategies for intervertebral disc regeneration

Article first published online: 9 nov. 2011Low back pain is an extremely common illness syndrome causing patient’s suffering and disability which demands for urgent solutions in order to improve life quality of the patients. Treatment options aimed to regenerate the intervertebral disc (IVD) are still under development. The huge cellular complexity of IVD, and consequently its fine regulatory system, makes it a challenge to the scientific community. Biomaterials-based therapies are the most interesting solutions nowadays, wherein tissue engineering and regenerative medicine (TE&RM) strategies are included. By using such strategies, i.e., combining biomaterials, cells and biomolecules, the ultimate goal of reaching a complete integration between native and neo-tissue can be achieved. Hydrogels are promising materials to restore IVD, mainly nucleus pulposus (NP). Herein, an overview of the use of hydrogels in acellular and cellular strategies for intervertebral disc regeneration is presented. To better understand the IVD and its functioning, several topics will be focused, i.e., anatomy, pathophysiology, cellular and biomolecular performance, intrinsic healing processes and current therapies. In this review, the application of hydrogels as NP substitutes will be addressed, due to the similarity to NP mechanical properties and extracellular matrix. These hydrogels can be used in cellular strategies, when combined with cells from different sources,, or in acellular strategies, by performing the functionalization of the hydrogels with biomolecules. In addition, a brief summary of therapies based on simple injection envisaging primarily the biological repair will be tackled. At last, a special emphasis has been given to original works reporting the use of autologous cells and biomolecules (e.g.,Platelet-rich plasma) and envisioning the clinical application.Fundação para a Ciência e tecnologia (FCT) through POCTI and FEDER including Project Proteolight. European Union-funded Collaborative Project Disc Regeneratio

Prospective community-based study of stroke in Northern Portugal: incidence and case fatality in rural and urban populations

Background and Purpose—Mortality statistics indicate that Portugal has the highest stroke mortality in Western Europe. Data on stroke incidence in Northern Portugal, the region with the highest mortality, are lacking. This study was designed to determine stroke incidence and case fatality in rural and urban populations in Northern Portugal. Methods—All suspected first-ever-in-a-lifetime strokes occurring between October 1998 and September 2000 in 37 290 residents in rural municipalities and 86 023 living in the city of Porto were entered in a population-based registry. Standard definitions and comprehensive sources of information were used for identification of patients who were followed-up at 3 and 12 months after onset of symptoms. Results—During a 24-month period, 688 patients with a first-ever stroke were registered, 226 in rural and 462 in urban areas. The crude annual incidence was 3.05 (95% CI, 2.65 to 3.44) and 2.69 per 1000 (95% CI, 2.44 to 2.93) for rural and urban populations, respectively; the corresponding rates adjusted to the European standard population were 2.02 (95% CI, 1.69 to 2.34) and 1.73 (95% CI, 1.53 to 1.92). Age-specific incidence followed different patterns in rural and urban populations, reaching major discrepancy for those 75 to 84 years old, 20.2 (95% CI, 16.1 to 25.0) and 10.9 (95% CI, 9.0 to 12.8), respectively. Case fatality at 28 days was 14.6% (95% CI, 10.2 to 19.3) in rural and 16.9% (95% CI, 13.7 to 20.6) in urban areas. Conclusions—Stroke incidence in rural and urban Northern Portugal is high compared to that reported in other Western Europe regions. The high official mortality in our country, which could be explained by a relatively high incidence, was not because of a high case fatality rate

Understanding oral mucositis: a pilot study

info:eu-repo/semantics/acceptedVersio

Joint detection and channel estimation for OFDM signals with implicit pilots

Accurate channel estimation is mandatory for the performance of OFDM modulations (orthogonal frequency division multiplexing). For this purpose, pilot symbols and/or training sequences are usually multiplexed with data symbols. To avoid the spectral degradation associated to multiplexed pilots, the use of implicit pilots (i.e., pilots superimposed to data) was recently proposed. However, the interference levels between data and pilots might be very high, leading to performance degradation. In this paper we consider OFDM schemes where the channel estimation is based on implicit pilots. To overcome the difficulties inherent to the interference levels between pilots and data, we propose an iterative receiver with joint detection and channel estimation. Our performance results show that we can achieve performances close to the ones with perfect channel estimation, even when low-power pilots or sort frames are employed.info:eu-repo/semantics/acceptedVersio

Finasteride 5 mg/day Treatment of Patterned Hair Loss in Normo-androgenetic Postmenopausal Women

BACKGROUND: There is no consensus on the standard treatment options for female pattern androgenetic alopecia (AGA). Efficacy of finasteride in women is controversial. The purpose of this study was to evaluate the clinical efficacy and safety of 5 mg/day oral finasteride in normoandrogenic postmenopausal woman. MATERIALS AND METHODS: A total of 40 normoandrogenic postmenopausal women with AGA was enrolled in this study. They were treated with oral finasteride 5 mg/day for 18 months. Efficacy was evaluated by patient's satisfaction and global photograph assessment. All the 40 patients completed 18 months of finasteride treatment schedule. RESULTS: After 6 months, 22 patients referred significant improvement, 12 moderate improvement, and 6 no improvement. Regarding to global photo assessment, 8 patients showed no improvement, 16 showed moderate improvement and 16 showed significant improvements at the 6(th) month. A slight improvement was observed over time from 6 to 12 and 18 months observation. Maintained libido reduction was referred by four patients and liver enzymes increase was observed in one patient. Older patients were more prone to worse response. DISCUSSION: Finasteride 5 mg/day is effective and safe for the treatment of female AGA in postmenopausal women in the absence of clinical or laboratory signs of hyper-androgenism