Investigating predictors of community integration in individuals after stroke in a residential setting: A longitutinal study.

AIM: To identify potential predictors of community integration in individuals after stroke using a residential setting-based strategy. METHOD: A prospective cohort of post-stroke individuals was recruited from the Stroke Unit of the Roberto Santos General Hospital (UAVC-HGRS). All included individuals were aged over 18 years, received a diagnosis of ischemic stroke confirmed by neuroimaging and resided in the city of Salvador (Bahia, Brazil). Following discharge from the stroke unit, the individuals themselves, or their responsible parties, were contacted by telephone to schedule a home visit no less than three months after discharge. All subjects were examined in their homes, at which time the Community Integration Questionnaire (CIQ) was also applied. A robust linear regression model was used to assess community reintegration using CIQ score as the outcome variable. RESULTS: A total of 124 individuals effectively fulfilled the eligibility criteria: 51.6% were females, the median (IQR) age was 63(53-69) years, 82.3% were non-white, 53.2% were married, the median (IQR) of years of schooling was 6 (4-12) and family income averaged two minimum monthly wages. Investigated individuals presented a median (IQR) NIH Stroke Scale (NIHSS) score of 7 (4-12). Multivariate linear regression identified the following independent predictors of community integration: age (ß = -0.095; 95% CI = -0.165 to -0.025; p = 0.008), diabetes mellitus (ß = -2.348; 95% CI = -4.125 to -0.571; p = 0.010), smoking habit (ß = -2.951; 95% CI = -5.081 to -0.821; p = 0.007), functional capacity upon hospital discharge (ß = 0.168; 95% CI = 0.093 to 0.242; p = <0.001) and stroke severity (ß = -0.163; CI = -0.318 to -0.009); p = 0.038). CONCLUSIONS: Regardless of length of time since stroke, individuals present restrictions that compromise their reintegration into their respective communities. The demographic, clinical and functional factors identified herein as potential predictors should be considered when conducting regular follow-up, as well as in the rehabilitation of individuals after stroke with the purpose to identify the interventions necessary to optimize their reintegration into the community.

Opsoclonus-myoclonus-ataxia syndrome associated with chikungunya and dengue virus co-infection.

Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare neurological disorder characterized by irregular multidirectional eye movements, myoclonus, cerebellar ataxia, sleep disturbances, and cognitive dysfunction. Although most commonly related to paraneoplastic syndrome, this condition has occasionally been described following infectious illnesses. This article reports the first case of OMAS in association with chikungunya and dengue virus co-infection. The genetic analysis identified chikungunya virus of East/Central/South African genotype and dengue serotype 4 virus of genotype II. This report represents an unusual clinical syndrome associated with viral co-infection and reinforces the need for clinical vigilance with regard to neurological syndromes in the context of emergent arboviruses.