Delay in Hospital Admission of Patients with Cerebral Vein and Dural Sinus Thrombosis

sociated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41-14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00-0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97-7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61-13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome. Copyright © 2005 S. Karger AG, Basel Factors infl uencing early hospital referral and admission have been described for several stroke types [1-6] , including subarachnoid haemorrhage [7-10] , but not for cerebral vein and dural sinus thrombosis (CVT). This type of stroke is far less frequent and has more diverse presenting patterns than arterial stroke, and these factors Key Words Dural sinus thrombosis ؒ Admission delay ؒ Intracranial hypertension Abstract Factors infl uencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more diffi cult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that infl uence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively as

The role of environmental stressors and genetic information on the antimicrobial tolerance of Ralstonia pickettii

info:eu-repo/semantics/draf

Variants in the inflammatory IL6 and MPO genes modulate stroke susceptibility through main effects and gene-gene interactions

A complex interplay between genetic background, clinical and life-style factors and the environment is expected to ultimately regulate the onset, acute phase and outcome of stroke. There is substantial evidence that inflammation within the Central Nervous System contributes to stroke risk, and known clinical risk factors for stroke, like atherosclerosis, diabetes, obesity, hypertension, and peripheral infection, are associated with an elevated systemic inflammatory profile. The inflammatory response is equally of major importance in recovery and healing processes after stroke. In this study we tested the genetic association of major inflammatory players IL1B (2q14), IL6 (7p21), TNF (6p21.3) and MPO (17q23.1) with stroke susceptibility and with stroke outcome at three months, in a population sample of 672 patients and 530 controls, adjusting for demographic, clinical and life-style risk factors and/or stroke severity parameters. The apparent complexity of the inflammatory mechanisms in stroke, and the multiplicity of players involved suggest a concerted process, in which implicated molecules interact to tightly regulate each other. We therefore examined both independent gene effects and the occurrence of gene-gene interactions among the tested inflammatory genes in stroke risk and stroke recovery. Two IL6 and one MPO SNP were significantly associated with stroke risk after multiple testing correction (0.022 correctedP 0.042), highlighting gene variants of low to moderate effect in stroke risk. An epistatic interaction between the IL6 and MPO genes was also identified in association with stroke susceptibility (P=0.031 after 1000 permutations). In the subset of 546 patients assessed for stroke outcome at three months using the modified Rankin Scale (mRS), we found one IL6 haplotype associated with stroke outcome (correctedP=0.024). In the present study we present supporting evidence for a role of the IL6 and MPO inflammatory genes in stroke susceptibility, and show that stroke risk is modulated by main gene effects together with clinical and life-style factors as well as by gene-gene interactions. Our findings are compatible and strengthen previous genetic and biological observations, highlighting the need of further functional studies, particularly in view of the possible utility of IL-6 as a diagnostic and/or prognostic biomarker for stroke

Estudo da Sensibilização aos Aeroalergenos Phl p 1, Phl p 5, Ole e 1 e Ole e 2 em Doentes com Patologia Alérgica Sazonal

Estudo da Sensibilização aos Aeroalergenos Phl p 1, Phl p 5, Ole e 1 e Ole e 2 em Doentes com Patologia Alérgica Sazonal Cátia Coelho2, Elsa Caeiro2,4, Maria Luísa Lopes1, Ana Filipa Lopes3, Raquel Ferro2, José Eduardo Moreira3, Célia Antunes3,4, Rui Brandão4,5 1Hospital de Santa Luzia, Elvas, Portugal; 2Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisboa, Portugal; 3Departamento de Química, Universidade de Évora, Portugal; 4Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), Universidade de Évora, Portugal; 5 Departamento de Biologia, Universidade de Évora, Portugal Introdução: A sensibilização aos pólenes depende de vários factores nomeadamente do tipo de vegetação local e sabe-se que a sintomatologia não está apenas associada à exposição aos pólens mas também a partículas, algumas das quais resultantes da rotura dos grãos de pólen sendo posteriormente aerossolizadas. Objectivos: Relacionar a sensibilização de doentes com a concentração polínica atmosférica e a concentração de alguns dos respectivos aerolergenos. Métodos: Das consultas externas de Imunoalergologia dos hospitais de Évora e Elvas seleccionaram-se doentes que apresentavam queixas sazonais de rinite alérgica e asma brônquica, aos quais foram realizados testes cutâneos em Prick, standardizados, aos pólenes identificados na região. A 55 doentes foram realizados testes ao extracto de Phleum, aos seus alergénios Phl p 1 e Phl p 5, bem como aos extractos das restantes gramíneas e a 47 doentes foram realizados testes ao extracto de Olea, aos seus alergénios Ole e 1 e Ole e 2. Monitorizaram-se diariamente as partículas polínicas e os aeroalergenos mediante 2 colectores específicos para cada tipo. Resultados: A percentagem de doentes que é sensível aos 3 extractos de Phleum (Phleum total, Phl p 1 e Phl p 5) é de 51% , a dos que são sensíveis aos extractos de Phleum total e Phl p 1 é de 16 % e a dos que são sensíveis a Phleum total e Phl p5 é de 2%. A percentagem de doentes que é sensível a somente um dos extractos é de 20% e os que não têm qualquer sensibilidade são 11%. A percentagem de doentes que é sensível aos 3 extractos de Olea (Olea total, Ole e 1 e Ole e 2) é de 23%, a dos que são sensíveis à Olea total e Ole e 1 é de 21 % e a dos que são sensíveis à Olea total e Ole e 2 é de apenas 4%. A percentagem dos que são sensíveis a um dos extractos é de 19% e a dos que não apresentaram qualquer sensibilidade é de 32%. Conclusões: Podemos concluir que 89% dos doentes mostraram ser sensíveis aos alergénios da gramínea Phleum pratense pois mostraram positividade tanto ao extracto de Phleum e/ou aos seus alergénios Phl p 1 e Phl p 5. Em relação à oliveira, 44% dos doentes são alérgicos a este pólen pois são sensíveis ao seu alergénio major, Ole e 1. Em ambos os casos estão correlacionados com os aeroalergenos detectados nas amostras de ar, sendo a sensibilidade aos pólenes de gramíneas maior que a sensibilidade ao pólen de oliveira. Mais estudos devem ser realizados para despiste de reacções cruzadas nomeadamente quanto à Olea com outras plantas da região

Metric properties of the portuguese version of the apathy evaluation scale

The clinical-rated and self-rated versions of the Apathy Evaluation Scale are validated for English language. The Apathy Evaluation Scale is useful to characterize and quantify apathy. We analyzed the metric properties of the Portuguese version of the Apathy Evaluation Scale-Clinical and of a new 10-item short version of the clinical-rated and self-rated versions Apathy Evaluation Scale. We included, 156 “healthy participants”, 40 healthy “elderly participants”, 21 patients with dementia, and 21 patients with depression, comprising a sample of 238 individuals. We studied reliability using Cronbach Alpha (α) and Split-half method, and construct validity using principal component analysis with Varimax rotation. The clinical-rated and self-rated Portuguese versions of the AES are valid instruments to measure apathy in Portuguese speaking individuals. Both the clinical-rated and the self-rated versions Apathy Evaluation Scale can be used instead of the long versions of the Apathy Evaluation Scale.RESUMO: As versões clínica e de auto-avaliação da Escala de Avaliação da Apatia estão validadas na versão original inglesa. A Escala de Avaliação da Apatia é utilizada para caracterizar e quantificar a apatia. Nós analisámos as propriedades métricas das versões portuguesas da Escala de Avaliação da Apatia, e também de uma versão reduzida da escalas clínica e de auto-avaliação , mas com apenas 10-items. Incluímos 156 “participantes saudáveis”, 40 “participantes idosos saudáveis”, 21 pacientes com demência, e 21 pacientes com depressão, fazendo uma amostra total de 238 indivíduos. Estudámos o nível de fidelidade suportado pelo Alpha (α) de Cronbach e com o método Split-half, e a validade de construto através da análise dos componentes principais com rotação de Varimax. Na sua versão Portuguesa, tanto a Escala de Avaliação da Apatia clínica como a de auto-avaliação são instrumentos válidos para medir a apatia em sujeitos portugueses. As versões clínica e de auto-avaliação reduzidas de 10-items podem ser utilizadas em substituição das versões mais longas da Escala de Avaliação da Apatia

A perturbação das capacidades construtivas nos doentes afásicos

Inexistent

One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

BACKGROUND Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. METHODS We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD2 score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year. RESULTS From 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan–Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan–Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD2 score of 6 or 7 were each associated with more than a doubling of the risk of stroke. CONCLUSIONS We observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD2 score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke. (Funded by Sanofi and Bristol-Myers Squibb.)Supported by an unrestricted grant from Sanofi and Bristol-Myers Squibb

Potential and limitations of computed tomography images as predictors of the outcome of ischemic stroke events: a review

The prediction of functional outcome after a stroke remains a relevant, open problem. In this article, we present a systematic review of approaches that have been proposed to predict the most likely functional outcome of ischemic stroke patients, as measured by the modified Rankin scale. Different methods use a variety of clinical information and features extracted from brain computed tomography (CT) scans, usually obtained at the time of hospital admission. Most studies have concluded that CT data contains useful information, but the use of this information by models does not always translate into statistically significant improvements in the quality of the predictions

MHC class I stability is modulated by cell surface sialylation in human dendritic cells

PD/BD/52472/2014 project (Ref. 38870) POCI-01-0145-FEDER-007728Maturation of human Dendritic Cells (DCs) is characterized by increased expression of antigen presentation molecules, and overall decreased levels of sialic acid at cell surface. Here, we aimed to identify sialylated proteins at DC surface and comprehend their role and modulation. Mass spectrometry analysis of DC’s proteins, pulled down by a sialic acid binding lectin, identified molecules of the major human histocompatibility complex class I (MHC-I), known as human leucocyte antigen (HLA). After desialylation, DCs showed significantly higher reactivity with antibodies specific for properly folded MHC-I-β2-microglobulin complex and for β2-microglobulin but showed significant lower reactivity with an antibody specific for free MHC-I heavy chain. Similar results for antibody reactivities were observed for TAP2-deficient lymphoblastoid T2 cells, which express HLA-A*02:01. Using fluorescent peptide specifically fitting the groove of HLA-A*02:01, instead of antibody staining, also showed higher peptide binding on desialylated cells, confirming higher surface expression of MHC-I complex. A decay assay showed that desialylation doubled the half-life of MHC-I molecules at cell surface in both DCs and T2 cells. The biological impact of DC´s desialylation was evaluated in co-cultures with autologous T cells, showing higher number and earlier immunological synapses, and consequent significantly increased production of IFN-γ by T cells. In summary, sialic acid content modulates the expression and stability of complex MHC-I, which may account for the improved DC-T synapses.publishersversionpublishe