Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis.

BACKGROUND: The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI- at LSC arrival on variables related to workflows using data from the RACECAT Trial. OBJECTIVE: To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. METHODS: We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. RESULTS: Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69-96) vs VI- 76 (IQR 59-98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26-53) vs VI- 54 (IQR 40-70), P<0.001). CONCLUSION: Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.

Accuracy of a Smartwatch to Assess Heart Rate Monitoring and Atrial Fibrillation in Stroke Patients.

(1) Background: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce. The aim of this pilot study from RCT NCT05565781 was to validate the resting heart rate (HR) measurement and the irregular rhythm notification (IRN) feature in stroke patients in sinus rhythm (SR) and AF. (2) Methods: Resting clinical HR measurements (every 5 min) were assessed using continuous bedside ECG monitoring (CEM) and the Fitbit Charge 5 (FC5). IRNs were gathered after at least 4 h of CEM. Lin's concordance correlation coefficient (CCC), Bland-Altman analysis, and mean absolute percentage error (MAPE) were used for agreement and accuracy assessment. (3) Results: In all, 526 individual pairs of measurements were obtained from 70 stroke patients-age 79.4 years (SD ± 10.2), 63% females, BMI 26.3 (IQ 22.2-30.5), and NIHSS score 8 (IQR 1.5-20). The agreement between the FC5 and CEM was good (CCC 0.791) when evaluating paired HR measurements in SR. Meanwhile, the FC5 provided weak agreement (CCC 0.211) and low accuracy (MAPE 16.48%) when compared to CEM recordings in AF. Regarding the accuracy of the IRN feature, analysis found a low sensitivity (34%) and high specificity (100%) for detecting AF. (4) Conclusion: The FC5 was accurate at assessing the HR during SR, but the accuracy during AF was poor. In contrast, the IRN feature was acceptable for guiding decisions regarding AF screening in stroke patients.

SM-COLSARSPROT: Highly Immunogenic Supramutational Synthetic Peptides Covering the World's Population.

Fifty ~20-amino acid (aa)-long peptides were selected from functionally relevant SARS-CoV-2 S, M, and E proteins for trial B-21 and another 53 common ones, plus some new ones derived from the virus' main genetic variants for complementary trial C-21. Peptide selection was based on tremendous SARS-CoV-2 genetic variability for analysing them concerning vast human immunogenetic polymorphism for developing the first supramutational, Colombian SARS-protection (SM-COLSARSPROT), peptide mixture. Specific physicochemical rules were followed, i.e., aa predilection for polyproline type II left-handed (PPIIL) formation, replacing ß-branched, aromatic aa, short-chain backbone H-bond-forming residues, π-π interactions (n→π* and π-CH), aa interaction with π systems, and molecular fragments able to interact with them, disrupting PPIIL propensity formation. All these modified structures had PPIIL formation propensity to enable target peptide interaction with human leukocyte antigen-DRß1* (HLA-DRß1*) molecules to mediate antigen presentation and induce an appropriate immune response. Such modified peptides were designed for human use; however, they induced high antibody titres against S, M, and E parental mutant peptides and neutralising antibodies when suitably modified and chemically synthesised for immunising 61 major histocompatibility complex class II (MHCII) DNA genotyped Aotus monkeys (matched with their corresponding HLA-DRß1* molecules), predicted to cover 77.5% to 83.1% of the world's population. Such chemically synthesised peptide mixture represents an extremely pure, stable, reliable, and cheap vaccine for COVID-19 pandemic control, providing a new approach for a logical, rational, and soundly established methodology for other vaccine development.

A Clinical Trial Comparing Smoking Cessation Interventions at Two Levels of Intensity in Stroke Patients, Stratified by the Presence of Insular Cortex Lesions.

INTRODUCTION: Smoking is a stroke risk factor but the most efficient way to promote cessation is unknown. The smoking behavior in patients during the first 2 years post-stroke is studied comparing brief advice and intensive behavioral counseling interventions, taking into consideration biological, psychological, and social factors. METHODS: Randomized clinical trial of 196 stroke patients, stratified by the presence or not of an insular cortex lesion, with two levels of smoking cessation intervention. RESULTS: The study retention rate was 85.2%. Abstinence point prevalence at three months after stroke was 50% in the brief advice group and 51.7% in the intensive behavioral counseling group (p = .82) and at 24 months, 48.3% in the brief group and 47.5% in the intensive group (p = .92). Most relapses occurred in the first weeks. After 3 months the curves separated with fewer events in the intensive group and at 24 months the Hazard Ratio was 0.91 (95% CI = 0.61 to 1.37; p = .67). Twenty-four months after stroke, patients with an insular lesion were more likely to be abstinent (OR 3.60, 95% CI = 1.27 to 10.14), as were those who lived with a partner (OR 2.31, 95% CI = 1.17 to 4.55) and those who were less dependent (OR 0.84, 95% CI = 0.73 to 0.97). CONCLUSIONS: A high percentage of patients gave up smoking in both intervention groups with no significant differences between the two. The effect of the insular lesion on smoking cessation, which is early and continued after two years, is particularly notable. IMPLICATIONS: This two-year clinical trial compares for the first time the efficacy of two different intensities of smoking cessation intervention in stroke patients, taking into consideration the effect of the insula. Good results are obtained both in the short and medium-term in people with stroke, especially when this is accompanied by an insular cortex lesion, but there is no evidence that better results are obtained with longer, more time-intensive, and possibly more costly follow-ups obtain better results than are obtained with briefer interventions.

The First Chemically-Synthesised, Highly Immunogenic Anti-SARS-CoV-2 Peptides in DNA Genotyped Aotus Monkeys for Human Use.

Thirty-five peptides selected from functionally-relevant SARS-CoV-2 spike (S), membrane (M), and envelope (E) proteins were suitably modified for immunising MHC class II (MHCII) DNA-genotyped Aotus monkeys and matched with HLA-DRß1* molecules for use in humans. This was aimed at producing the first minimal subunit-based, chemically-synthesised, immunogenic molecules (COLSARSPROT) covering several HLA alleles. They were predicted to cover 48.25% of the world's population for 6 weeks (short-term) and 33.65% for 15 weeks (long-lasting) as they induced very high immunofluorescent antibody (IFA) and ELISA titres against S, M and E parental native peptides, SARS-CoV-2 neutralising antibodies and host cell infection. The same immunological methods that led to identifying new peptides for inclusion in the COLSARSPROT mixture were used for antigenicity studies. Peptides were analysed with serum samples from patients suffering mild or severe SARS-CoV-2 infection, thereby increasing chemically-synthesised peptides' potential coverage for the world populations up to 62.9%. These peptides' 3D structural analysis (by 1H-NMR acquired at 600 to 900 MHz) suggested structural-functional immunological association. This first multi-protein, multi-epitope, minimal subunit-based, chemically-synthesised, highly immunogenic peptide mixture highlights such chemical synthesis methodology's potential for rapidly obtaining very pure, highly reproducible, stable, cheap, easily-modifiable peptides for inducing immune protection against COVID-19, covering a substantial percentage of the human population.

Targeting Pro-Oxidant Iron with Deferoxamine as a Treatment for Ischemic Stroke: Safety and Optimal Dose Selection in a Randomized Clinical Trial.

A role of iron as a target to prevent stroke-induced neurodegeneration has been recently revisited due to new evidence showing that ferroptosis inhibitors are protective in experimental ischemic stroke and might be therapeutic in other neurodegenerative brain pathologies. Ferroptosis is a new form of programmed cell death attributed to an overwhelming lipidic peroxidation due to excessive free iron and reactive oxygen species (ROS). This study aims to evaluate the safety and tolerability and to explore the therapeutic efficacy of the iron chelator and antioxidant deferoxamine mesylate (DFO) in ischemic stroke patients. Administration of placebo or a single DFO bolus followed by a 72 h continuous infusion of three escalating doses was initiated during the tPA infusion, and the impact on blood transferrin iron was determined. Primary endpoint was safety and tolerability, and secondary endpoint was good clinical outcome (clinicalTrials.gov NCT00777140). DFO was found safe as adverse effects were not different between placebo and DFO arms. DFO (40-60 mg/Kg/day) reduced the iron saturation of blood transferrin. A trend to efficacy was observed in patients with moderate-severe ischemic stroke (NIHSS > 7) treated with DFO 40-60 mg/Kg/day. A good outcome was observed at day 90 in 31% of placebo vs. 50-58% of the 40-60 mg/Kg/day DFO-treated patients.

Evaluación y uso de un péptido sintético para la detección de anticuerpos específicos contra Plasmodium falciparum / Development and use of a synthetic peptide for the detection of specific antibodies against Plasmodium falciparum

Resumen Introducción. La malaria continúa siendo una de las enfermedades que causa mayor morbi-mortalidad a nivel mundial. Por esta razón es importante desarrollar herramientas diagnósticas eficaces que se implementen como estrategias para el control de la enfermedad. Objetivos. Estandarizar las condiciones del inmunoensayo enzimático (ELISA), para la detección de IgG específica contra Plasmodium falciparum en sueros de pacientes diagnosticados por gota gruesa con malaria no complicada por P. falciparum, empleando como antígeno un extracto proteico obtenido a partir de cultivo de P. falciparum o un péptido sintético derivado de la proteína de superficie de merozoito GLURP (del inglés: glutamate rich protein). Materiales y métodos. Para la estandarización de la técnica, se utilizaron 22 sueros de pacientes positivos para malaria por P. falciparum y 11 diagnosticados positivos para malaria por P. vivax utilizando la técnica de gota gruesa. Como controles negativos se utilizaron 44 sueros de individuos sanos. Los sueros fueron probados contra extracto de proteínas del parásito y el péptido sintético IMT 94 derivado de la proteína GLURP, para evaluar las concentraciones y las diluciones óptimas de cada componente del sistema. Para la validación de la técnica se utilizaron 251 sueros de pacientes positivos para P. falciparum y 44 sueros de individuos sanos, diagnosticados utilizando la técnica de gota gruesa. Resultados. La técnica estandarizada con el péptido sintético permitió observar diferencia significativa en el reconocimiento de sueros de pacientes, controles positivos y negativos por los antígenos (extracto de proteínas y péptidos sintéticos). Conclusiones. La metodología usada permite identificar la respuestas inmune específica contra P. falciparum.

Abstract Introduction. Malaria continues being one of the diseases causing the greatest morbi-mortality around the world. For that reason, effective diagnostic tools must thus be developed which can be used in strategies for controlling the disease. Objectives. To standardise enzyme- linked immunosorbent assay (ELISA) conditions for detecting Plasmodium falciparum specific IgG in sera from patients diagnosed by thick smear as suffering non-complicated malaria caused by P. falciparum. A protein extract obtained from P. falciparum culture or a synthetic peptide derived from glutamate rich protein (GLURP) merozoite surface protein would be used as antigen. Materials and Methods. 22 serum samples from patients diagnosed as suffering from P. falciparum malaria, 11 serum samples from patients diagnosed as suffering from P. vivax and 44 from healthy donors, diagnosed by using the thick smear tecnique were used for standarising the technique. Serum samples were tested against parasite protein extract and GLURP- derived IMT 94 synthetic peptide for standardisign optimum dilutions and concentrations for each component in the system. 251 serum samples from patients diagnosed as suffering from P. falciparum malaria and 44 from healthy donors diagnosed by using the thick smear tecnique were used to validate the technique. Results. The technique led to significant differences being observed in antigens (protein extract and synthetic peptides) recognising serum from positive and negative patients and controls. Conclusions. The methodology used led to identifying specific immune response against P. falciparum.

Biological and Psychological Factors Associated With Smoking Abstinence Six Years Post-Stroke.

Introduction: Tobacco use is a public health problem causing high morbidity and mortality, including stroke. This study evaluates predictive factors of smoking cessation in the long term after stroke. Methods: We followed a cohort of 110 consecutive smokers with stroke for up to 6 years. Sociodemographic variables, stroke severity, insular involvement, stage of change in smoking habit before stroke and disruption of addiction variable (smoking cessation, absence of relapses, having stopped smoking without difficulties and not having had urge) were evaluated. Results: Twenty patients died during follow-up and two patients were lost leaving a final cohort of 88 patients. The prevalence of smoking cessation in the remaining population was 65.9% post-stroke, 54.9% at 3-6 months, 40.9% at 1 year and 37.5% at 6 years. Prevalence was significantly higher in patients with insular involvement during the first year of follow-up, but not at 6 years. Disruption immediately after stroke (OR = 10.1; 95% CI = 2.5 to 40.1) and intention to change before having the stroke (OR = 4.8; 95% CI = 1.0 to 23.0) were predictors of abstinence at 6 years after adjusting for age, sex and stroke severity at baseline. When tobacco abstinence at the 1 year follow-up was included in the model, this factor was the best predictor of tobacco abstinence at 1 year (OR = 10.5; 95% CI = 2.2 to 49.4). Conclusions: Intention of change, having the disruption criteria, and abstinence 1 year after stroke were predictors of abstinence at 6 years. An insular lesion in the acute phase of stroke does not determine the tobacco use status at 6 years. Implications: This study is the first prospective investigation with a cohort of stroke patients to examine the long-term influence of biological and psychological factors on smoking cessation. Tobacco abstinence 1 year after stroke was the strongest predictor of abstinence at 6 years of follow-up. The effect of the insular cortex lesion on tobacco cessation, which had been relevant during the first year, no longer had an influence over the longer period studied here.

A Large Size Chimeric Highly Immunogenic Peptide Presents Multistage Plasmodium Antigens as a Vaccine Candidate System against Malaria.

Rational strategies for obtaining malaria vaccine candidates should include not only a proper selection of target antigens for antibody stimulation, but also a versatile molecular design based on ordering the right pieces from the complex pathogen molecular puzzle towards more active and functional immunogens. Classical Plasmodium falciparum antigens regarded as vaccine candidates have been selected as model targets in this study. Among all possibilities we have chosen epitopes of PfCSP, STARP; MSA1 and Pf155/RESA from pre- and erythrocyte stages respectively for designing a large 82-residue chimeric immunogen. A number of options aimed at diminishing steric hindrance for synthetic procedures were assessed based on standard Fmoc chemistry such as building block orthogonal ligation; pseudo-proline and microwave-assisted procedures, therefore the large-chimeric target was produced, characterized and immunologically tested. Antigenicity and functional in vivo efficacy tests of the large-chimera formulations administered alone or as antigen mixtures have proven the stimulation of high antibody titers, showing strong correlation with protection and parasite clearance of vaccinated BALB/c mice after being lethally challenged with both P. berghei-ANKA and P. yoelii 17XL malaria strains. Besides, 3D structure features shown by the large-chimera encouraged as to propose using these rational designed large synthetic molecules as reliable vaccine candidate-presenting systems.

Blood Biomarkers for the Early Diagnosis of Stroke: The Stroke-Chip Study.

BACKGROUND AND PURPOSE: Stroke diagnosis could be challenging in the acute phase. We aimed to develop a blood-based diagnostic tool to differentiate between real strokes and stroke mimics and between ischemic and hemorrhagic strokes in the hyperacute phase. METHODS: The Stroke-Chip was a prospective, observational, multicenter study, conducted at 6 Stroke Centers in Catalonia. Consecutive patients with suspected stroke were enrolled within the first 6 hours after symptom onset, and blood samples were drawn immediately after admission. A 21-biomarker panel selected among previous results and from the literature was measured by immunoassays. Outcomes were differentiation between real strokes and stroke mimics and between ischemic and hemorrhagic strokes. Predictive models were developed by combining biomarkers and clinical variables in logistic regression models. Accuracy was evaluated with receiver operating characteristic curves. RESULTS: From August 2012 to December 2013, 1308 patients were included (71.9% ischemic, 14.8% stroke mimics, and 13.3% hemorrhagic). For stroke versus stroke mimics comparison, no biomarker resulted included in the logistic regression model, but it was only integrated by clinical variables, with a predictive accuracy of 80.8%. For ischemic versus hemorrhagic strokes comparison, NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) >4.9 (odds ratio, 2.40; 95% confidence interval, 1.55-3.71; P<0.0001) and endostatin >4.7 (odds ratio, 2.02; 95% confidence interval, 1.19-3.45; P=0.010), together with age, sex, blood pressure, stroke severity, atrial fibrillation, and hypertension, were included in the model. Predictive accuracy was 80.6%. CONCLUSIONS: The studied biomarkers were not sufficient for an accurate differential diagnosis of stroke in the hyperacute setting. Additional discovery of new biomarkers and improvement on laboratory techniques seem necessary for achieving a molecular diagnosis of stroke.

Saúde e qualidade de vida: discursos de docentes no cotidiano de uma escola pública de Santa Catarina / Health and quality of life: teachers' speeches in daily life of a public school in Santa Catarina / Salud y calidad de vida: discursos de docentes en el cotidiano de una escuela pública de Santa Catarina

Resumo A pesquisa teve por objetivo conhecer as concepções sobre saúde, doença, qualidade de vida e temas afins de docentes de uma escola pública de Florianópolis, Santa Catarina, Brasil, 2013. Estudo qualitativo, descritivo, com dados coletados por meio de grupo focal e entrevistas semiestruturadas. A estratégia de grupo focal adotada foi orientada segundo a abordagem do ‘círculo de cultura’, no qual os participantes expressaram suas concepções sobre os temas estudados e refletiram sobre como contribuir com estratégias de promoção da saúde no contexto escolar por meio da educação em saúde. O universo da pesquisa foi formado por 16 docentes da rede estadual de ensino; oito docentes confirmaram a participação no grupo focal e, desses, apenas seis compareceram do primeiro ao último encontro. Ao final os dados revelaram que os docentes percebem uma estreita relação entre saúde e qualidade de vida e que uma vida saudável é possível na presença de enfermidade. Enfatizaram a necessidade de maior participação dos pais e profissionais da saúde no processo de educação em saúde e, também, de um preparo sistemático e permanente sobre as questões que envolvam saúde no contexto escolar. As concepções dos docentes reafirmam que a dimensão social sobressai à biológica e que o conhecimento e a valorização desses aspectos, na prática docente, podem ampliar as ações em saúde.

Abstract The research aimed to know the conceptions of health, disease, quality of life and other topics in teachers of a public school in Florianópolis, Santa Catarina, Brazil, 2013. A qualitative and descriptive study was carried out with data collected in focus group and semi-structured interviews. The focal group strategy was oriented on the approach of the ‘circle of culture’, in which the participants expressed their concepts on the studied themes and reflected on how to contribute to health promotion strategies in the school context through education on health. The research universe included 16 teachers from state schools; eight teachers confirmed their participation in the focus group and, of these, only six attended the first to the last meeting. At the end, the data revealed that teachers perceive a close relationship between health and quality of life and that a healthy life is possible in the presence of disease. They emphasized the need for greater participation of parents and health professionals in the health education process and also a systematic and continuing preparation on issues involving health in the school context. Conceptions of teachers reaffirm that the social dimension exceeds the biological one and that knowledge and appreciation of these aspects, in teaching practice, can broaden health actions.

Resumen La investigación tuvo por objetivo conocer las concepciones sobre salud, enfermedad, calidad de vida y temas afines de docentes de una escuela pública de Florianópolis, Santa Catarina, Brasil, 2013. Estudio cualitativo, de naturaleza descriptiva, con datos colectados por medio de grupo focal y entrevistas semiestructuradas. La estrategia de grupo focal adoptada fue orientada según el abordaje del ‘círculo de cultura’, en el cual los participantes expresaron sus concepciones sobre los temas estudiados y reflejan sobre como contribuir con estrategias de promoción de la salud en el contexto escolar por medio de educación en salud. El universo de la investigación fue formado por 16 docentes de la red estadual de enseño; ocho docentes confirmaron la participación en el grupo focal y, de esos, apenas seis comparecieron del primero al último encuentro. Al final los datos revelaron que los docentes perciben una estrecha relación entre salud y calidad de vida y que una vida saludable es posible en la presencia de enfermedad. Enfatizaron la necesidad de mayor participación de los padres y profesionales de la salud en el proceso de educación en salud y, también, de un preparo sistemático y permanente sobre las cuestiones que envuelven salud en el contexto escolar. Las concepciones de los docentes reafirman que la dimensión social sobresale a la biológica y que el conocimiento y la valorización de esos aspectos, en la práctica docente, pueden ampliar las acciones en salud.

O uso da aromaterapia no combate ao estresse / Use of aromatherapy in the fight against stress

O modelo biomédico tradicional, muitas vezes, realiza o atendimento fragmentado, não dá ênfase ao ser humano em sua totalidade. A correria do dia a dia faz com que o homem fique mais vulnerável aos agentes estressores, desestabilizando seu organismo. Por isso, há necessidade do atendimento acolhedor e humanitário por meio do cuidado integral, promovendo o bem-estar e qualidade de vida. As terapias complementares como a aromaterapia vem ganhando grande destaque nas áreas da estética e saúde. Essas terapias, segundo referenciais como os de Helman (2004), conseguem muitas vezes proporcionar para as pessoas que utilizam a sensação de equilíbrio corpóreo e bem-estar entre outros aspectos pessoais / individuais. Vários óleos essenciais são utilizados para o tratamento do estresse e devem ser manipulados por um profissional com conhecimento científico sobre os efeitos que proporciona. O objetivo do presente trabalho, consiste em uma levantamento bibliográfico da utilização dos óleos essenciais no tratamento do estresse, bem como em suas consequências a para a saúde. Conclui-se que a aromaterapia possui um papel significativo nos efeitos do estresse, pois proporciona momentos de satisfação e bem estar ao paciente.

The traditional biomedical model often provides a fragmented care, not emphasizing the human being in its entirety. The everyday rush makes humans become more vulnerable to stressors, destabilizing their body. Thus, there is the need for warm and humanitarian assistance through comprehensive care, promoting well-being and quality of life. Complementary therapies such as aromatherapy have gained great prominence in the s of aesthetics and health. These therapies, according to references such as Helman (2004), can often provide the sensation of balance and well-being, among other personal/individual aspects. Various essential oils are used for treating stress and should be handled by a professional with scientific knowledge on the effects they provide. The aim of this work consists in a literature review on the use of essential oils in the treatment of stress and its consequences in terms of health. It can be concluded that aromatherapy has a significant role in the effects of stress as it provides moments of satisfaction and well-being to the patient.

Antinociceptive effects of an extract, fraction and an isolated compound of the stem bark of Maytenus rigida

The antinociceptive activity of the Maytenus rigida Mart. (Celastraceae) ethanol extract and its ethyl acetate fraction as well as of (-)-4'-methylepigallocatechin (1), a previously isolated compound, was demonstrated in vivo. ED50 for 1 in the writhing test was 14.14 mg/kg. The acetic acid-induced writhing was inhibited by 98.4, 84.4, and 58.3%, respectively, when mice were treated with the ethanol extract, ethyl acetate fraction, and 1. In the hot plate test, mice pretreated with 1 showed significantly increased reaction times (60-89%). Oral administration of 1 significantly inhibited first and second phases of the formalin-induced pain (50 and 26.5%, respectively), whereas indomethacin inhibited only the second phase of the test (41.2%). Ethanol extract and its fraction showed effects on inflammatory pain, while neurogenic and inflammatory pain suppression by 1 is a strong indication of the presence of both central and peripheral effects and suggests its analgesic and anti-inflammatory potential.

Smoking cessation 1 year poststroke and damage to the insular cortex.

BACKGROUND AND PURPOSE: Hospitalization as a result of stroke provides an opportunity to stop smoking that is often not taken up. The present study analyzes sociodemographic, psychological, and lesion-related variables to identify associated factors for smoking cessation during the first year after stroke. METHODS: We conducted a prospective longitudinal study with a 1-year follow-up of a cohort of 110 patients with acute stroke who were smokers at the time of diagnosis and were admitted consecutively between January 2005 and July 2007. RESULTS: On hospital release, 69.1% had given up smoking but at 1 year, only 40% had stopped smoking. Of the 110 patients, 27 (24.5%) had an acute stroke lesion in the insular cortex, of which 19 (70.3%) were nonsmokers at 1 year. Strongly associated factors in giving up smoking were the location of the lesion in the insular cortex (OR, 5.42; 95% CI, 1.95-15.01; P=0.001) and having the intention of giving up before the stroke, comparing precontemplating patients (without intention of giving up in the near future) with contemplating and prepared patients (intention of stopping in the near future; OR, 7.29; 95% CI, 1.89-28.07; P=0.004). CONCLUSIONS: Of patients with stroke who were smokers, only 4 of 10 patients had stopped smoking 1 year after admission. Our results show that the variables best predicting smoking cessation in patients with a stroke diagnosis 1 year after hospital discharge are insular damage and the prestroke intention to stop.

Iron-related brain damage in patients with intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Iron plays a detrimental role after experimental intracerebral hemorrhage (ICH). This study investigates whether high-serum ferritin levels are associated with poor outcome in patients with ICH. METHODS: We studied 92 consecutive patients with primary hemispheric ICH within the first 12 hours from onset of symptoms (median, 3.3 hours). National Institute of Health Stroke Scale score, ICH, and peripheral edema volumes were measured at admission, 72 hours, and 7 days. Serum levels of ferritin and biomarkers of the inflammatory response were determined. The adjusted effect of ferritin on the full range of Rankin scale was analyzed by a general linear model. RESULTS: Fifty-one patients (55.4%) had poor outcome (Rankin score >2). Older age, higher stroke severity, larger hematoma volume, intraventricular extension, mass effect, and higher IL-6 and ferritin levels at baseline (270.6 [SD 81.4] vs 74.6 [SD 43.4] ng/mL; P<0.001) were associated with poor outcome. The higher the ferritin quartile, the worse the Rankin score. For every ferritin quartile, the Rankin score increased by a mean of 1.4 points (95% CI, 1.04-1.69) after adjusting for prognostic variables. Ferritin levels remained stable for 72 hours and did not correlate with acute phase reactants. CONCLUSIONS: High-serum ferritin levels at admission are independently associated with poor outcome in patients with ICH. These findings may suggest a neurotoxic effect of increased body iron stores in patients with hemorrhagic stroke.

Trabalho em saúde e a implantação do acolhimento na atenção primária à saúde: afeto, empatia ou alteridade? / Trabajo en salud y la implantación de la acogida en la atención primaria a la salud: ¿afecto, empatía o alteridad? / Health work and the implementation of user embracement in primary healthcare: affection, empathy or alterity?

Desenvolvemos uma reflexão teórica sobre o trabalho na Atenção Primária à Saúde (APS) na diretriz do acolhimento, buscando possibilidades de superar a alienação em seu processo produtivo, a partir de relatos de experiência da implantação do acolhimento em serviços de APS. Identificamos as seguintes perspectivas teóricas nas relações interpessoais nos serviços, com indicadores de avanços na humanização do trabalho em saúde e de uma aproximação com a subjetividade: afeto, empatia e alteridade. Ainda que todas sejam adequadas e mesmo complementares entre si, fazemos nossa opção pela alteridade como perspectiva teórica capaz de instrumentalizar o trabalhador da saúde para desenvolver o acolhimento, sem deixar de garantir sua própria humanização. Esta abre possibilidades de enfrentamento das situações do cotidiano dos serviços de saúde, oferecendo aos profissionais condições de construírem seu trabalho sem limitá-lo à perspectiva biomédica e preservando sua própria saúde.

We conducted a theoretical reflection on the work of primary healthcare professionals in the scope of user embracement, searching for possibilities to overcome alienation in their production process, based on experience reports regarding user embracement implementation in primary healthcare services. We identified the following theoretical perspectives which we consider useful in order to enhance humanization in the work in the health area and also to foster subjectivity in interpersonal relationships: affection, empathy and alterity. Although they are closely related to each other, we believe alterity is the theoretical perspective that is able to give the health worker conditions to develop user embracement while ensuring his/her own humanization. Alterity opens possibilities to cope with everyday situations in the healthcare services, providing health professionals with the conditions to work without restricting themselves to a biomedical point of view and, at the same time, preserving their own health.

Desarrollamos una reflexión teórica sabre el trabajo en la Atención Primaria a la Salud (APS) en la directriz de la acogida, buscando posibilidades de superar la alienación en su proceso productivo a partir de relatos de experiencia de la implantación de la acogida en servicios de APS. Identificamos las siguientes perspectivas teóricas en las relaciones interpersonales en los servicios, con indicadores de avances en la humanización del trabajo en salud y de una aproximación con la subjetividad: afecto, empatía y alteridad. Aunque todas sean adecuadas y basta complementarias entre sí, hacemos nuestra opción par la alteridad como perspectiva teórica capaz de instrumentalizar al trabajador de la salud para desarrollar la acogida sin dejar de garantizar su propia humanización. De este modo se abren posibilidades de afrontar las situaciones cotidianas de los servicios de salud, ofreciendo a los profesionales condiciones de construir su trabajo sin limitarlo a la perspectiva biomédica y de preservar su propia salud.

Antinociceptive activities of crude methanolic extract and phases, n-butanolic, chloroformic and ethyl acetate from Caulerpa racemosa (Caulerpaceae) / Atividade antinociceptiva do extrato metanólico bruto e das fases n-butanólica, clorofórmica e acetato de etila de Caulerpa recemosa (Caulerpaceae)

In this study, we attempted to identify the possible antinociceptive actions of n-butanolic phase, chloroformic phase, ethyl acetate phase and crude methanolic extract obtained from Caulerpa racemosa. This seaweed is cosmopolitan in world, mainly in tropical regions. The n-butanolic, chloroformic, ethyl acetate phases and crude methanolic extract, all administered orally in the concentration of 100 mg/kg, reduced the nociception produced by acetic acid by 47.39 percent, 70.51 percent, 76.11 percent and 72.24 percent, respectively. In the hotplate test the chloroformic and ethyl acetate phase were activite in this models. In the neurogenic phase on formalin test, were observed that crude methanolic extract (51.77 percent), n-butanolic phase (35.12 percent), chloroformic phase (32.70 percent) and indomethacin (32.06 percent) were effective in inhibit the nociceptive response. In the inflammatory phase, only the ethyl acetate phase (75.43 percent) and indomethacin (47.83 percent) inhibited significantly the nociceptive response. Based on these data, we can infer that the ethyl acetate phase shows a significant anti-inflammatory profile, whose power has not yet been determined. However, pharmacological and chemical studies are continuing in order to characterize the mechanism(s) responsible for the antinociceptive action and also to identify other active principles present in Caulerpa racemosa.

Neste estudo, tentamos identificar a atividade antinociceptiva do extrato metanólico bruto e das fases n-butanólica, clorofórmica e acetato de etila provenientes da alga Caulerpa racemosa. Esta alga é cosmopolita no mundo, principalmente em regiões tropicais. O extrato metanólico bruto e as fases n-butanólica, clorofórmica e acetato de etila foram administrados por via oral, na concentração de 100 mg/kg. Estes foram capazes de reduzir a nocicepção produzida pelo ácido acético, sendo 47,39 por cento, 70,51 por cento, 76,11 por cento e 72,24 por cento, respectivamente. No ensaio da placa quente as fases clorofórmica e acetato de etila foram ativas neste modelo. Na fase neurogênica do teste de formalina, foi observado que o extrato metanólico bruto (51,77 por cento), fase n-butanólica (35,12 por cento), fase clorofórmica (32,70 por cento) e indometacina (32,06 por cento) foram eficazes em inibir a resposta nociceptiva. Na fase inflamatória, apenas a fase acetato de etila (75,43 por cento) e indometacina (47,83 por cento) foram capazes de inibir significativamente a resposta nociceptiva. Com base nestes dados, podemos sugerir que o a fase acetato de etila apresenta um significativo efeito anti-inflamatório, cuja potência ainda não foi determinada. No entanto, estudos farmacológicos e químicos serão necessários, a fim de caracterizar o mecanismo responsável pela ação antinociceptiva e também para identificar outros princípios ativos presentes na alga Caulerpa racemosa.

Reverse smokers's and changes in oral mucosa. Department of Sucre, Colombia.

OBJECTIVES: This work is intended to establish the prevalence of reverse smokers at the villages of Hato Nuevo, San Francisco and Cayo de Palma, Department of Sucre, Colombia, characterizing their socio-culture conditions, clinical and histological changes in the oral mucosa. DESIGN OF STUDY: A descriptive study was done through a home to home inquiry to select the people with inclusion criteria for a posterior clinical test and a biopsy of the affected oral mucosa. RESULTS AND CONCLUSIONS: Reverse smokers's prevalence was from the 15%, mainly women (p<0.001) with an age average of 59.3 years. The lesions were classified clinically in mild, moderate and severe changes. Tongue moderate lesions presented the higher frequency (80%), followed by severe lesions on palate (74%). Oral cancer prevalence was 10.8% in the San Francisco village and 18.2% in Cayo de Palma village, no new cases were reported in Hato Nuevo village. This was the highest prevalence reported in comparison with other studies with similar population. The clinical and histological findings agree with the reported in literature, no relation was found between the degree of clinical severity and the dysplasia itself. Cases of oral submucous fibrosis-like lesions were found, which had never been reported in Latin America. Further studies are required in order to decrease the morbidity for this habit and to identify other related risk factors.

The prediction of malignant cerebral infarction by molecular brain barrier disruption markers.

BACKGROUND AND PURPOSE: Space-occupying brain edema is a life-threatening complication in patients with large hemispheric stroke. The aim of the study was to determine whether molecular markers of endothelial damage may help to predict secondary brain edema and, secondly, to identify patients who could benefit from aggressive therapies such as decompressive hemicraniectomy or hypothermia. METHODS: We studied 40 consecutive patients with malignant middle cerebral artery (MCA) infarction and 35 controls with massive MCA infarctions <70 years of age and matched by stroke severity on admission. Cranial computed tomography (CT) was performed at entry and repeated between days 4 and 7, or earlier if there was neurological worsening. Malignant MCA (m-MCA) infarction was diagnosed when follow-up CT detected a more than two-thirds space-occupying MCA infarction with midline shift, compression of the basal cisterns, and neurological deterioration. Plasma concentrations of glutamate, glycine, gamma-aminobutyric acid, interleukin-6 (IL-6), IL-10, tumor necrosis factor-alpha, matrix metalloproteinase-9 (MMP-9), and cellular-fibronectin (c-Fn) were determined in blood samples obtained at admission. RESULTS: Mean time from stroke onset to blood sampling was 6.3+/-4.8 in m-MCA and 7.7+/-6.0 hours in the control group (P=0.63). Baseline characteristics were comparable in both groups. c-Fn and MMP-9 levels were significantly higher in patients with m-MCA than in controls (all P<0.001). c-Fn >16.6 microg/mL had the highest sensitivity (90%), specificity (100%), and negative and positive predictive values (89% and 100%, respectively) for the prediction of m-MCA infarction. CONCLUSIONS: A plasma c-Fn concentration >16.6 microg/mL at admission is associated with the development of m-MCA infarction with high sensitivity and specificity, suggesting that c-Fn might be useful in therapeutic decision making.