Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil.

Background: The global COVID-19 pandemic has had a devastating effect on global health, resulting in a strain on healthcare services worldwide. The faster a patient with acute ischemic stroke (AIS) receives reperfusion treatment, the greater the odds of a good functional outcome. To maintain the time-dependent processes in acute stroke care, strategies to reorganize infrastructure and optimize human and medical resources were needed. Methods: Data from AIS patients who received thrombolytic therapy were prospectively assessed in the emergency department (ED) of Hospital de Clínicas de Porto Alegre from 2019 to 2021. Treatment times for each stage were measured, and the reasons for a delay in receiving thrombolytic therapy were evaluated. Results: A total of 256 patients received thrombolytic therapy during this period. Patients who arrived by the emergency medical service (EMS) had a lower median door-to-needle time (DNT). In the multivariable analysis, the independent predictors of DNT >60 min were previous atrial fibrillation (OR 7) and receiving thrombolysis in the ED (OR 9). The majority of patients had more than one reason for treatment delay. The main reasons were as follows: delay in starting the CT scan, delay in the decision-making process after the CT scan, and delay in reducing blood pressure. Several actions were implemented during the study period. The most important factor that contributed to a decrease in DNT was starting the bolus and continuous infusion of tPA on the CT scan table (decreased the median DNT from 74 to 52, DNT ≤ 60 min in 67% of patients treated at radiology service vs. 24% of patients treated in the ED). The DNT decreased from 78 min to 66 min in 2020 and 57 min in 2021 (p = 0.01). Conclusion: Acute stroke care continued to be a priority despite the COVID-19 pandemic. The implementation of a thrombolytic bolus and the start of continuous infusion on the CT scan table was the main factor that contributed to the reduction of DNT. Continuous monitoring of service times is essential for improving the quality of the stroke center and achieving better functional outcomes for patients.

Disparities in Stroke Patient-Reported Outcomes Measurement Between Healthcare Systems in Brazil.

Introduction: Acute stroke interventions, such as stroke units and reperfusion therapy, have the potential to improve outcomes. However, there are many disparities in patient characteristics and access to the best stroke care. Thus, we aim to compare patient-reported outcome measures (PROMs) after stroke in two stroke centers representing the public and private healthcare systems in Brazil. Methods: PROMs through the International Consortium for Health Outcomes Measures (ICHOM) were assessed at 90 days after the stroke to compare two Brazilian hospitals in southern Brazil: a public university and a private stroke center, both with stroke protocols and stroke units. Results: When compared with the private setting (n = 165), patients from the public hospital (n = 175) were younger, had poorer control of risk factors, had more frequent previous strokes, and arrived with more severe strokes. Both hospitals had a similar percentage of IV thrombolysis treatment. Only 5 patients received mechanical thrombectomy (MT), all in the private hospital. Public hospital patients presented significantly worse outcomes at 3 months, including worse quality of life and functional dependence (60 vs. 48%, p = 0.03). Poor outcome, as measured by the mRS score, was significantly associated with older age, higher NIHSS score, and the presence of heart failure. However, the public practice was a strong predictor of any self-reported disability. Conclusion: Patients assisted at a good quality public stroke center with the same protocol used in the private hospital presented worse disability as measured by mRS and patient-reported outcome measures, with greater inability to communicate, dress, toilet, feed, and walk.

Mal de Pott: uma doença milenar em um novo século / Pott's disease: an ancient disease in a new century

A tuberculose espinhal, também conhecida como Mal de Pott ou Doença de Pott, caracteriza-se como a forma mais frequente de tuberculose extrapulmonar. Apresentamos aqui o caso de uma paciente encaminhada ao Serviço de Neurologia do Hospital de Clínicas de Porto Alegre com um quadro de dois meses de evolução, apresentando sintomas de compressão medular. O diagnóstico de tuberculose espinhal foi realizado por punção guiada por tomografia computadorizada e a paciente foi submetida à drenagem do abscesso. Concomitantemente, foi iniciado o tratamento com RHZ e a paciente evoluiu com melhora dos sintomas neurológicos. Esse caso ilustra que mesmo pacientes com alterações neurológicas importantes devido à tuberculose medular podem apresentar melhora significativa com tratamento.

Spinal tuberculosis, also known as Pott's disease, is the most common form of extra-pulmonary tuberculosis. We report on a patient referred to the Division of Neurology of Hospital de Clínicas de Porto Alegre presenting with spinal cord compression symptoms for two months. The diagnosis of spinal tuberculosis was rapidly done by a computerized tomography guided biopsy. The patient was submitted to abscess surgical draining and complementary RHZ treatment, with recovery of neurological symptoms. This case illustrates that even patients with severe neurological deficits due to spinal tuberculosis may have a good outcome with the appropriate treatment.

Evaluation of the limited participation by university students in a smoking cessation program.

OBJECTIVE: To evaluate the limited participation by university students in a smoking cessation program. METHODS: A cross-sectional, comparative study was conducted at the University of Caxias do Sul, located in Caxias do Sul, Brazil, involving students who enrolled in a smoking cessation program, together with those who did not. RESULTS: Of the 108 student who did not enroll in the program, 102 (94.4%) stated that they had no intention to quit smoking (95% confidence interval: 88.29-97.93%. Comparisons between the enrolled and nonenrolled students revealed the following statistical differences: in mean age (35 vs. 23 years, p < 0.01); mean duration of the smoking habit (19.42 vs. 7.36 years, p < 0.01); considering oneself addicted (100% vs. 58.5%, p = 0.047); believing oneself able to stop smoking at any time (7.1% vs. 22.6%, p = 0.02); having no knowledge of any reasons to quit smoking (37.5% vs. 12%, p = 0.03); having suffered discrimination (42.9% vs. 9.3%, p < 0.01). CONCLUSION: Among the university students evaluated, there was a phase, classified as precontemplative or contemplative, during which they were refractory to smoking cessation. Although all of the students were aware of the diseases caused by smoking, 41.5% did not consider themselves addicted. The concept of substance dependence does not apply to these students. It would seem more appropriate to define nicotine dependence as resulting from the lifetime consumption of at least 100 cigarettes. These students do not perceive that they are passing through the initial phase of the natural history of tobacco use disorder and do not realize that they are increasing their risk of presenting smoking-related diseases in the future.

Avaliação da participação de pequeno número de estudantes universitários em um programa de tratamento do tabagismo / Evaluation of the limited participation by university students in a smoking cessation program

OBJETIVO: Avaliar a participação de pequeno número de estudantes da Universidade de Caxias do Sul em um programa de tratamento do tabagismo. MÉTODOS: Delineamento transversal e comparativo entre alunos que se inscreveram em um programa de tratamento do tabagismo e alunos que não se inscreveram. RESULTADOS: De 108 alunos não inscritos, 102 não mostraram intenção de parar de fumar (94,4 por cento, intervalo de confiança de 95 por cento de 88,29 por cento a 97,93 por cento). As comparações entre inscritos e não inscritos mostraram diferenças estatísticas, respectivamente: nas idades 35 e 23 anos, p < 0,01; tempo de tabagismo em anos, 19,42 e 7,36, p < 0,01; considerarem-se viciados, 100 por cento e 58,5 por cento, p = 0,047; acreditarem que podem parar de fumar quando querem, 7,1 por cento e 22,6 por cento, p = 0,02; desconhecerem os motivos de fumar, 37,5 por cento e 12 por cento, p = 0,03; sofrerem discriminações, 42,9 por cento e 9,3 por cento, p < 0,01. CONCLUSÃO: Identificou-se, nos estudantes universitários, uma fase refratária ao abandono do vício, classificada como pré-contemplativa e contemplativa. Os alunos conheciam as doenças provocadas pelo cigarro, contudo 41,5 por cento deles não reconheciam ser viciados. O conceito de dependência de drogas não se aplica a esses estudantes. Parece mais adequado considerar dependência à nicotina a partir do consumo de 100 cigarros ao longo da vida. Outros fatos que passam despercebidos a esses alunos são que eles estão vivendo a primeira fase da história natural do tabagismo e que estão apostando em não ter doenças futuras.

OBJECTIVE: To evaluate the limited participation by university students in a smoking cessation program. METHODS: A cross-sectional, comparative study was conducted at the University of Caxias do Sul, located in Caxias do Sul, Brazil, involving students who enrolled in a smoking cessation program, together with those who did not. RESULTS: Of the 108 student who did not enroll in the program, 102 (94.4 percent) stated that they had no intention to quit smoking (95 percent confidence interval: 88.29-97.93 percent. Comparisons between the enrolled and nonenrolled students revealed the following statistical differences: in mean age (35 vs. 23 years, p < 0.01); mean duration of the smoking habit (19.42 vs. 7.36 years, p < 0.01); considering oneself addicted (100 percent vs. 58.5 percent, p = 0.047); believing oneself able to stop smoking at any time (7.1 percent vs. 22.6 percent, p = 0.02); having no knowledge of any reasons to quit smoking (37.5 percent vs. 12 percent, p = 0.03); having suffered discrimination (42.9 percent vs. 9.3 percent, p < 0.01). CONCLUSION: Among the university students evaluated, there was a phase, classified as precontemplative or contemplative, during which they were refractory to smoking cessation. Although all of the students were aware of the diseases caused by smoking, 41.5 percent did not consider themselves addicted. The concept of substance dependence does not apply to these students. It would seem more appropriate to define nicotine dependence as resulting from the lifetime consumption of at least 100 cigarettes. These students do not perceive that they are passing through the initial phase of the natural history of tobacco use disorder and do not realize that they are increasing their risk of presenting smoking-related diseases in the future.