Investigação de neuropatia periferica no periodo recente do transplante de medula ossea

Resumo: O transplante de medula ossea tem se desenvolvido, principalmente nas ultimas duas decadas, como um importante metodo de tratamento para anemia aplastica e para uma variedade de doencas hematologicas, linforeticulares, tumores, erros inatos de metabolismo e doencas imunologicas. Infelizmente existem riscos inerentes a esse procedimento, e complicacoes neurologicas tem sido diagnosticadas em 59 a 79% dos casos. A afeccao de nervos perifericos tem sido relacionada a toxicidade das terapias utilizadas para a preparacao e sustentacao deste procedimento. Realizamos o presente estudo a fim de verificar a incidencia de neuropatia periferica em pacientes no periodo recente do transplante de medula ossea. Investigamos prospectivamente a incidencia de neuropatia periferica em 43 pacientes atraves do estudo da velocidade de conducao nervosa realizado antes e apos o transplante de medula ossea, durante os primeiros 90 dias do procedimento. A duracao e doenca de base, sexo, media de idade, sintomatologia clinica, niveis sericos de creatinoquinase, glicemia, albumina e creatinina foram analisados. Realizou-se teste de limiar de sensibilidade vibratoria utilizando palestesiometro. Foram estudadas as velocidades de conducao nervosa nos nervos mediano motor, fibular, tibial, mediano sensitivo e sural. Apesar de obtermos alteracoes significativas na duracao do potencial composto proximal do nervo mediano motor, na amplitude distai do nervo tibial posterior e na amplitude proximal do nervo sural, nao houve correlacao clinica. Acreditamos que o esquema de drogas utilizadas atualmente nesse servico nao provoca toxicidade neurologica periferica no periodo recente do transplante de medula ossea

Investigação de neuropatia periferica no periodo recente do transplante de medula ossea

Resumo: O transplante de medula ossea tem se desenvolvido, principalmente nas ultimas duas decadas, como um importante metodo de tratamento para anemia aplastica e para uma variedade de doencas hematologicas, linforeticulares, tumores, erros inatos de metabolismo e doencas imunologicas. Infelizmente existem riscos inerentes a esse procedimento, e complicacoes neurologicas tem sido diagnosticadas em 59 a 79% dos casos. A afeccao de nervos perifericos tem sido relacionada a toxicidade das terapias utilizadas para a preparacao e sustentacao deste procedimento. Realizamos o presente estudo a fim de verificar a incidencia de neuropatia periferica em pacientes no periodo recente do transplante de medula ossea. Investigamos prospectivamente a incidencia de neuropatia periferica em 43 pacientes atraves do estudo da velocidade de conducao nervosa realizado antes e apos o transplante de medula ossea, durante os primeiros 90 dias do procedimento. A duracao e doenca de base, sexo, media de idade, sintomatologia clinica, niveis sericos de creatinoquinase, glicemia, albumina e creatinina foram analisados. Realizou-se teste de limiar de sensibilidade vibratoria utilizando palestesiometro. Foram estudadas as velocidades de conducao nervosa nos nervos mediano motor, fibular, tibial, mediano sensitivo e sural. Apesar de obtermos alteracoes significativas na duracao do potencial composto proximal do nervo mediano motor, na amplitude distai do nervo tibial posterior e na amplitude proximal do nervo sural, nao houve correlacao clinica. Acreditamos que o esquema de drogas utilizadas atualmente nesse servico nao provoca toxicidade neurologica periferica no periodo recente do transplante de medula ossea

Is the patent foramen ovale closure the best option?

Patent foramen ovale (PFO) closure is indicated in some cases to protect patients against embolic events. The aim of this study was to certify that the method of PFO closure to prevent microemboli (MES) is reliable, using contrast enhanced transcranial Doppler (cTCD) as a diagnostic and follow-up tool. METHODS: cTCD was performed before and after PFO closure in 20 patients. Results obtained a minimum of 12 months after the procedure were analyzed in this study. RESULTS: After the procedure, 14 patients (82%) showed no microemboli in cTCD at rest, but after provocative Valsalva maneuver (VM) microembolic phenomenon were still detected in 14 (70%): 7 (35%) <10 MES, 3 (15%) 10-20 MES and 4 (20%) had more than 20 MES ("curtain"). Only six of the total patients presented no MES in both resting and VM. CONCLUSION: These results showed a large percentage of patients with MES detection in a bubble study with transcranial Doppler more than one year after the procedure of PFO closure, showing right-to-left residual shunting. Despite the small number of patients, this study provides important data about this therapeutic decision

Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods. We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results. There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] −11.7 to −11.3, p \u3c 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI −13.8 to −12.7, p \u3c 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI −13.7 to −10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2–9.8, p \u3c 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions. The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months