Physical and rehabilitation medicine intervention in stroke in the acute hospital setting: A cross-sectional study.

INTRODUCTION: Stroke represents the main cause of death and disability in Portugal. Resulting functional deficits are widely recognized. This work aims to evaluate the variation in functionality of stroke patients in the acute hospital setting under a rehabilitation program. MATERIAL AND METHODS: Cross-sectional study of patients admitted to the Neurology department, from January to June 2019, with acute stroke. The variation in functionality was assessed using the Barthel index. Statistical analysis used Student's t-test and Spearman's correlation coefficient, with a p-value≤0.05 as significant. RESULTS: 106 patients with mean age of 63.7±14.2 years and a male predominance (60.4%) were included. Patients started rehabilitation program at 1.37±1.19 days after admission. A gain in functionality between admission and discharge was identified (50.18±32.37 versus 68.73±28.94, p<0.001). A significantly greater increase was observed in patients diagnosed under code stroke protocol (CSP) (p=0.021) and undergoing some type of acute phase treatment (p=0.017). From 90.5% of the patients that pursued rehabilitation after discharge, 40.6% were referred to an inpatient unit on average 12.7±7.0 days after admission. DISCUSSION: In this study, Physical and Rehabilitation Medicine (PRM) provided early rehabilitation care to stroke patients. According to international evidence this is associated with greater functional gains. The variation in functionality verified during hospitalization demonstrates the importance of PRM in the acute hospital, assessing the rehabilitation needs after hospital discharge and maximizing outpatient rehabilitation. Diagnosis under CSP and undergoing acute treatment were determinants of greater functional improvement. CONCLUSION: PRM plays a central role in the early management of functional impairment resulting from stroke and in the post-discharge guidance of patients.

[Factors determining hyperhomocysteinemia in the chronic phase of strokes]. / Factores determinantes de la hiperhomocisteinemia en la fase crónica del ictus.

INTRODUCTION: Several prospective and case-control studies have pointed to an association between hyperhomocysteinemia and ischaemic stroke. AIM: To analyse the main factors determining hyperhomocysteinemia in the chronic phase of strokes. PATIENTS AND METHODS: We studied 280 patients with ischaemic stroke (130 subjects < 45 years old; 150 > 45 years old; 50.7% males) who were admitted to the Neurology Service consecutively over the years 2002 and 2003. Both plasma levels of homocysteine (Hc) and the mutation of the gene for 5, 10-methylenetetrahydrofolate reductase (MTHFR) were determined. An analysis was conducted to determine the distribution of the mean levels of Hc according to the aetiological subtype of stroke (TOAST classification) and the presence of vascular risk factors. RESULTS: Hc levels were found to be above normal (> 13 micromol/L) in 44.3% of cases. Hyperhomocysteinemia was more frequent in those above the age of 45 (55.3 versus 31.5%; p < 0.01). The mean Hc value was 16.3 micromol/L and was high both in young patients (15.1 +/- 14.9 micromol/L) and in adults (17.4 +/- 9.1 micromol/L). Results showed that 42.5% were carriers of the C677T mutation (7.1% in homozygosis and 35.4% in heterozygosis). There were more young patients carrying the homozygotic mutation than adults (9.2 versus 5.3%; p = 0.05). Hc levels in plasma were significantly higher (p < 0.01) in patients who were carriers of the homozygotic mutation (29.4 versus 14.2 micromol/L). The main factors determining hyperhomocysteinemia in the multiple linear regression analysis were: age, mutation of the gene for MTHFR, smoking and being male (R = 0.386). CONCLUSION: Genetic and environmental factors determine the levels of Hc in the chronic phase of strokes.

[Thrombophilia and patent foramen ovale in young stroke patients]. / Trombofilia y foramen oval permeable en pacientes jóvenes afectos de ictus isquémico.

INTRODUCTION: Patent foramen ovale (PFO) is a vascular risk factor in young stroke patients. OBJECTIVE: [corrected] We sought to analyze the prevalence of thrombophilia in young stroke patients with patent foramen ovale (PFO). METHODS: Prospective study; a total of 130 consecutive young stroke patients (female: 58.5 %; mean age: 34; range: 15-45 years) consecutively admitted to the hospital during 2002-2003. All patients underwent a diagnostic protocol including echocardiogram, carotid echodoppler, transcranial doppler with bubble test, brain tomography scan or magnetic resonance imaging. Thrombophilia studies included fasting plasma levels of protein C, protein S, antithrombin III, lupus anticoagulant, anticardiolipin antibodies, lupus anticoagulant, antinuclear antibodies, and genetic testing for the factor V Leiden and C677T methylene tetrahydrofolate reductase mutations. Stroke subtype classification was done according to TOAST criteria. RESULTS: Etiology of stroke was: cryptogenic (67 %), cardioembolism (14.6 %), large artery atherosclerosis (8.5 %), small vessel occlusion (3.8 %) and other causes (5.4 %). 42 patients (32.3 %) had a PFO; 41 % of cryptogenic stroke patients had a PFO while 14.3 % of known cause stroke patients had a positive PFO (p = 0.003; OR: 4.15; IC 95%: 1.47-12.29). 23.8 % of positive PFO patients (10/42) had migraine, while 9.1 % negative PFO patients suffered migraine (OR: 3.13; CI 95 %: 1.02- 9.69; p=0.023). Prevalence of thrombophilia in positive and negative PFO patients, in young with cryptogenic stroke and stroke patients with known etiology, and in cryptogenic stroke patients with and without PFO was similar. CONCLUSIONS: Thrombophilia does not seem to be an additional factor to the excess of risk observed in young patients with cryptogenic stroke and PFO.

[Tourettism, hemiballism and juvenile Parkinsonism: expanding the clinical spectrum of the neurodegeneration associated to pantothenate kinase deficiency (Hallervorden Spatz syndrome)]. / Touretismo, hemibalismo y parkinsonismo juvenil: expandiendo el espectro clínico de la neurodegeneración asociada a deficiencia de pantotenato cinasa (síndrome de Hallervorden-Spatz).

INTRODUCTION: Pantothenate kinase deficiency (Hallervorden-Spatz syndrome, HSS) triggers cerebral neurodegeneration with iron deposition in the basal ganglia. The classical form has an early onset in infancy, a progressive course, the presence of extrapyramidal symptoms (dystonia, chorea, rigidity) and pigmentary retinitis. There are atypical late onset forms with predominance of symptoms of Parkinsonism and dementia, which progress slowly and course somewhat less progressively. CASE REPORT: We describe three patients with HSS and an atypical presentation, with onset during the second decade of life. In all cases magnetic resonance imaging showed areas of hyposignal in T2 sequences in medial globus pallidus, with central hypersignal, which gave rise to a tiger's eye image. Other aetiologies, such as Wilson's disease, gangliosidosis GM1, hypoprebetalipoproteinemia, hexosaminidase A deficiency, aminoacidurias and infantile Huntingdon's chorea, were precluded. In the 20-year-old male the initial manifestations at the age of 17 were superposed over Gilles de la Tourette syndrome, with complex motor and vocal tics, palilalia, behavioural disorders and postural instability. The 13-year-old patient presented symptoms of chorea, hemiballic movements and dystonia in the lower limbs, which limited walking at the age of 12. The 28-year-old female patient presented a progressive rigid akinetic syndrome, with dementia and partial response to levodopa. CONCLUSIONS: The clinical spectrum of HSS is broad and its differential diagnosis must include hemiballism, Tourette syndrome and juvenile Parkinsonism.

Purification of a N-acetyl-D-galactosamine specific lectin from the orchid Laelia autumnalis.

From the pseudobulbs of the orchid L. autumnalis a lectin was purified on immobilized porcine mucin with A + H blood group substance. This lectin is a dimeric glycoprotein of M(r) 12,000 with an Sw,20 of 2.2, showing haemagglutinating activity directed mainly to human A1 desialylated erythrocytes. The lectin possesses sugar specificity for N-acetyl-D-galactosamine and also shows high specificity for glycoproteins containing the T (galactose beta 1,3GA1NAc alpha 1,0 Ser/Thr) or the Tn antigen (GalNAc alpha 1,0 Ser/Thr).

Megaesophagus and seroreactivity to Trypanosoma cruzi in a rural community in northeast Brazil.

The relationship of symptoms and radiographic abnormalities suggestive of esophageal motility disorders with electrocardiographic (ECG) alterations and seroreactivity to Trypanosoma cruzi was studied in a defined population in a rural area endemic for Chagas' disease in Bahia, Brazil. Between January and June 1981, 680 individuals 5 years of age or older were examined with serologic tests, ECGs and questionnaires for esophageal motility disorder. Of these, 39.9% were seropositive for Chagas' disease. Symptoms of dysphagia occurred 2.5 times more frequently among seropositive individuals than among seronegative individuals. Radiographic esophageal abnormalities were 3.6 times more frequent among seropositive individuals than among seronegative individuals in the symptomatic group. Symptoms and radiographic abnormalities were more common in men than in women although this was not statistically significant. Among seropositive individuals the percentage with symptoms of dysphagia increased with age, with a peak prevalence rate of 23.9% in the 45- to 64-year-old age group. Also, in the seropositive group, 41.7% with X-ray abnormalities of the esophagus and 26.3% with symptoms of dysphagia presented an abnormal ECG.