Could an increased risk of obstructive sleep apnoea be one of the determinants associated with disability in individuals with cardiovascular and cerebrovascular diseases?

PURPOSE: To investigate a possible association between the risk of obstructive sleep apnoea (OSA) and disability in individuals with cardiovascular or cerebrovascular diseases. METHODS: Cross-sectional study was conducted with 373 individuals (313 with cardiovascular or cerebrovascular diseases and 60 healthy). Disability was assessed by the 12-item World Health Organization Disability Assessment Schedule (WHODAS), and the risk of OSA was assessed by STOP-BANG. Anxiety and depression symptoms, daytime sleepiness, and cognition were assessed by the Hospital Anxiety and Depression Scale (HADS), Epworth Sleepiness Scale (ESS), and Mini Mental State Examination (MMSE). RESULTS: Greater disability was found in individuals with intermediate or high risk of OSA, considering healthy individuals (p=0.03), or individuals diagnosed with arrhythmia (p<0.01) or coronary artery disease (p=0.04). A high risk of OSA and higher WHODAS scores was significant among women as well as between OSA risk categories (p<0.01). Cognitive deficit and level of education also showed differences between OSA risk categories. Age, depression, and sleepiness were also associated with the subjects' disability (p<0.01). Gamma regression model showed higher WHODAS scores in female, in those with intermediate and high risk of OSA, and in those with depressive symptoms and cognitive deficit. Age also showed a correlation with higher WHODAS scores. The presence of all investigated cardio and cerebrovascular diseases showed an increase in the WHODAS score, implying a greater disability compared to healthy individuals. CONCLUSION: Moderate and high risk of OSA is associated with disability, as well as gender, age, depressive symptoms, cognitive deficit, and cardiovascular diseases.

The effect of air temperature on mortality from cerebrovascular diseases in Brazil between 1996 and 2017. / O efeito da temperatura do ar na mortalidade por doenças cerebrovasculares no Brasil entre 1996-2017.

Cerebrovascular diseases (CVD) are one of the leading causes of mortality globally. Air temperature is one of the risk factors for CVD; however, few studies have investigated the relationship between air temperature and mortality from these diseases in Brazil. This time series study investigated the relationship between air temperature and CVD mortality in 10 microregions located across Brazil's five regions during the period 1996 to 2017 using mortality data from the national health information system, DATASUS and daily mean temperature data. The association between mean air temperature and mortality from CVD was measured using generalized additive models with Poisson distribution and relative and attributable risks were estimated together with 95% confidence intervals using distributed lag non-linear models and a 14-day lag. There were 531,733 deaths from CVD during the study period, 21,220 of which (11,138-30,546) were attributable to air temperature. Minimum mortality temperatures ranged from 20.1ºC in Curitiba to 29.6ºC in Belém. Associations between suboptimal air temperatures and increased risk of death from CVD were observed in all of Brazil's five regions. Relative risk from the cold was highest in Manaus (RR 1.53; 1.22-1.91) and Campo Grande (RR 1.52; 1.18-1.94), while relative risk from heat was highest in Manaus (RR 1.75; 1.35-2.26) and Brasília (RR 1.36; 1.15-1.60).

As doenças cerebrovasculares (DCV) estão entre as principais causas de mortalidade no mundo e a temperatura do ar é um dos seus fatores de risco, embora sua relação seja pouco estudada no Brasil. Este artigo objetiva investigar a relação entre temperatura do ar e mortalidade por DCV em 10 microrregiões nas cinco grandes regiões brasileiras. Foi realizado estudo de séries temporais com os óbitos diários por DCV e a média diária de temperatura do ar no período de 1996 a 2017. Foram utilizando dados do Departamento de Informática do SUS (DATASUS) e modelos aditivos generalizados com distribuição de Poisson e os riscos relativos e atribuíveis foram estimados (com intervalo de confiança de 95%) até uma defasagem de 14 dias com modelos DLNM (distributed lag non-linear models). No período ocorreram 531.733 óbitos por DCV nestas microrregiões, dos quais 21.220 (11.138-30.546) atribuíveis à temperatura do ar. As temperaturas de mortalidade mínima variaram entre 20,1°C em Curitiba a 29,6°C em Belém. Foram observadas associações entre temperaturas não ótimas do ar e aumento no risco de óbito em todas as cinco regiões brasileiras, destacando Manaus com risco relativo (RR) 1,53 (1,22-1,91) e Campo Grande com RR 1,52 (1,18-1,94) no frio, e Manaus com RR 1,75 (1,35-2,26) e Brasília com RR 1,36 (1,15-1,60) no calor.

Serum ferritin and incident cardiometabolic diseases in Scottish adults.

BACKGROUND: Iron stores, estimated as ferritin levels, and type 2 diabetes (T2D) have been associated previously, while findings regarding coronary heart disease (CHD) and cerebrovascular disease (CEVD) are still inconclusive. No study has focused on simultaneous evaluation of associations between iron stores and the above cardiometabolic diseases (CMD) in the same population. We aim to evaluate the association between serum ferritin and risk of T2D, CHD and CEVD in Scottish population over a wide range of ferritin levels. METHODS: Longitudinal study in 6,497 participants of the 1995 and 1998 Scottish health surveys, who were followed-up until 2011. Cox regression models were conducted adjusting for age, sex/menopausal status, fibrinogen, GGT levels, smoking, alcohol consumption, total cholesterol, HDL-cholesterol, blood pressure, and BMI. Ferritin was used as continuous (sex/menopausal status-specific Z score) and categorical variable (sex/menopausal status-specific quartiles, quintiles and sextiles). RESULTS: During follow-up, 4.9% of the participants developed T2D, 5.3% CHD, and 2.3% CEVD. By using ferritin quartiles, serum ferritin was positively associated with T2D, CHD and CEVD but only the association with T2D remained after adjustment for covariates [Quartile 4 v. 1: adjusted HR 95% CI 1.59 (1.10-2.34); P = 0.006]. When ferritin sextiles were used (6 v. 1), the ferritin-CEVD association became slightly stronger and significant [adjusted HR 95% CI 2.08 (1.09-3.94); P = 0.024]. CONCLUSIONS: Iron stores relate differently to each CMD. Serum ferritin levels were positively and independently associated with incident T2D, and with incident CEVD if higher cut-off points for high ferritin levels were considered.

Elderly Mortality from Cerebrovascular Disease in Alagoas, 2000-2016: Spatial-Temporal Analysis

Abstract Background Cerebrovascular diseases (CVDs) are the second leading cause of death in Brazil. Objective This study aimed to describe the epidemiological profile and to analyze the spatiotemporal dynamics of mortality from cerebrovascular disease in the elderly in Alagoas from 2000-2016. Methods This is a multilevel ecological study of all deaths from CVD in individuals aged 60 years or older. Data were collected from the Mortality Information System. The variables were submitted to descriptive analysis, trend analysis by Joinpoint Regression method and spatial analysis with Global Moran's and local statistics; 95% confidence interval and significance of 5% were considered in the analysis. Results There were 21,440 deaths in the study period, 50.4% (n=10,797) male, 40.5% (n=8,670) aged ≥ 80 years, 44.5% (n=9,465) of "brown" race, 30.1% (n=6,448) married and 36.5% (n=7,828) with less than four years of schooling. Female and male mortality rates were 460.24/100,000 and 602.23 / 100,000, respectively. An annual decreasing trend of -1.4% (p<0.001) in overall and male mortality was observed from 2007 on. The highest mortality rates were concentrated in the eastern region of Alagoas (Moran's I =0.766288; p=0.01). Twenty-two municipalities were in quadrant Q1 of Moran's scattering diagram and considered priorities. Conclusion Death from CVD in Alagoas occurred equally in men and women in the study period, mostly in individuals of mixed race, married, and with low education attainment. The highest rates were observed in the eastern region of the state . The results highlight the need for public policies aimed at healthy aging in the state. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Manifestaciones neuroftalmológicas en pacientes con enfermedad cerebrovascular isquémica / Neuro-ophthalmological manifestations in patients with ischemic cerebrovascular disease

La enfermedad cerebrovascular isquémica tiene una elevada incidencia y prevalencia en Cuba, y constituye la tercera causa de muerte en el país. Existen diferencias anatómicas y clínicas entre el infarto de la circulación anterior y la posterior. En ocasiones, los elementos distintivos que ayudan al diagnóstico topográfico de la enfermedad cerebrovascular isquémica son las manifestaciones neuroftalmológicas. Con el objetivo de profundizar en el conocimiento actual sobre las alteraciones neuroftalmológicas que se asocian a la enfermedad cerebrovascular isquémica, se realizó una revisión bibliográfica, donde se consultaron un total de 69 fuentes de información digital de los últimos 5 años. La circulación cerebral se divide de manera general en anterior y posterior. Los síntomas y signos principales del ictus que afecta la circulación anterior son la desviación conjugada de la mirada, la afectación de las sácadas, la hemianopsia homónima, la heminegligencia y la apraxia de la apertura ocular; mientras que las alteraciones asociadas a la afectación de la circulación posterior son el nistagmo, las anormalidades en la alineación y los movimientos oculares, así como la hemianopsia homónima con conservación macular. Se concluye que en la enfermedad cerebrovascular isquémica aparecen síntomas y signos como consecuencia de la afectación, tanto de la vía visual aferente, como de la eferente. La hemianopsia homónima es el signo más frecuente reportado(AU)

Ischemic cerebrovascular disease has a high incidence and prevalence in Cuba, and it is the third cause of death in the country. A number of anatomical and clinical differences distinguish anterior from posterior circulation infarction. On certain occasions the distinguishing elements that aid in the topographic diagnosis of ischemic cerebrovascular disease are its neuro-ophthalmological manifestations. With the purpose of gaining insight into the current knowledge about the neuro-ophthalmological alterations associated to ischemic cerebrovascular disease, a bibliographic review was conducted based on the analysis of 69 digital information sources from the last five years. Cerebral circulation is generally divided into anterior and posterior. The main symptoms and signs of the stroke that affects anterior circulation are conjugate gaze deviation, altered saccades, homonymous hemianopsia, heminegligence and eyelid opening apraxia, whereas the alterations associated to posterior circulation involvement are nystagmus, eye movement and alignment abnormalities, and homonymous hemianopsia with macular preservation. It is concluded that ischemic cerebrovascular disease presents symptoms and signs related to both the afferent and the efferent visual pathways. Homonymous hemianopsia is the most common sign reported(AU)

Relationship between the history of cerebrovascular disease and mortality in COVID-19 patients: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Past history of stroke has been associated with an increased risk of a new ischemic stroke. Several studies have indicated increased prevalence of strokes among coronavirus patients. However, the role of past history of stroke in COVID19 patients is still unclear. The purpose of this systematic review is to evaluate and summarize the level of evidence on past history of stroke in COVID19 patients. METHODS: A systematic review was performed according to the PRISMA guidelines was performed in PubMed, Embase, EBSCO Host, Scopus, Science Direct, Medline, and LILACS. Eligibility criteria: We evaluated studies including patients with diagnosis of COVID 19 and a past history of stroke. Risk of bias: was evaluated with the Newcastle- Ottawa Scale (NOS) and experimental studies were evaluated using the ROBINS-I scale. RESULTS: Seven articles out of the total 213 articles were evaluated and included, involving 3244 patients with SARS VOC 2 Disease (COVID19) of which 198 had a history of cerebrovascular disease. Meta-analysis of the data was performed, observing an increase in mortality in patients with a history of cerebrovascular disease compared to those with different comorbidities or those without underlying pathology (OR 2.78 95 % CI [1.42-5.46] p = 0.007; I2 = 49 %) showing adequate heterogeneity. The presence of publication bias was evaluated using the Egger test in a funnel plot, showing adequate. Asymmetry, indicating that there is no publication bias; however, due to the low number of included studies, we could not rule out or confirm the presence of bias. CONCLUSIONS: The history of cerebrovascular disease was associated with a 2.78-fold increased risk of mortality compared to patients with other comorbidities or without underlying pathologies.

ACE2 Expression Is Increased in the Lungs of Patients With Comorbidities Associated With Severe COVID-19.

Patients who died from COVID-19 often had comorbidities, such as hypertension, diabetes, and chronic obstructive lung disease. Although angiotensin-converting enzyme 2 (ACE2) is crucial for SARS-CoV-2 to bind and enter host cells, no study has systematically assessed the ACE2 expression in the lungs of patients with these diseases. Here, we analyzed over 700 lung transcriptome samples from patients with comorbidities associated with severe COVID-19 and found that ACE2 was highly expressed in these patients compared to control individuals. This finding suggests that patients with such comorbidities may have higher chances of developing severe COVID-19. Correlation and network analyses revealed many potential regulators of ACE2 in the human lung, including genes related to histone modifications, such as HAT1, HDAC2, and KDM5B. Our systems biology approach offers a possible explanation for increased COVID-19 severity in patients with certain comorbidities.

Analyses of Mortality and Prevalence of Cerebrovascular Disease in Colombia, South America (2014-2016): A Cross-Sectional and Ecological Study.

BACKGROUND: Stroke is the second cause of death and the first cause of disability worldwide. However, although numerous reports regarding stroke epidemiology in Latin America have been published, they differ widely in terms of employed methods and end points. This is the first of a series of articles that describes the epidemiology of stroke and other cerebrovascular diseases (CVD) in the nation, as well as their correlation with recognized risk factors and social variables. METHODS: Descriptive analyses were performed using the Colombian vital registration system and social security information system as primary data sources. Rates and ratios were calculated, corrected for under-registration, and standardized. Secondary analyses were made using data from national surveys and government organizations on hypertension, diabetes mellitus, sedentarism, obesity, tobacco and alcohol consumption, and unsatisfied basic needs. Factorial multivariate multiple regression analyses were performed to evaluate correlations. Concentration curves and indices were calculated to evaluate for inequities in the distribution of events. RESULTS: Global CVD had a national mortality rate and a prevalence ratio of 28 and 142 per 100,000 persons, respectively. Nontraumatic intracranial hemorrhage had the highest mortality rate (ie, 15 per 100,000), while cerebral infarction and transitory cerebral ischemia had the highest prevalence ratios (ie, 28 and 29 per 100,000, respectively). Hypertension and tobacco use were the most relevant risk factors for most of the simple and multiple models, and cerebral amyloid angiopathy and nonpyogenous intracranial venous thrombosis were the disease categories with the most socially unequal distribution of deaths and cases (ie, concentration indices of .34 and .29, respectively). CONCLUSIONS: CVDs are a cause for concern in Colombia and a marker of healthcare inequality and social vulnerability. Nationwide control of risk factors such as hypertension and tobacco use, as well as the design and conduct of public policy focused on the vulnerable and medically underserved regions and on standardizing mandatory CVD registries might ease its burden.

Cerebrovascular Correlates of Dementia in Community-Dwelling Older Adults Living in Rural Communities - The Three Villages Study. Rationale and Protocol of a Population-Based Prospective Cohort Study.

BACKGROUND: Despite the assumption that dementia is increasing in rural areas of Latin America, there is no information on the burden and risk factors leading to dementia in these settings. AIMS: To assess prevalence and incidence of dementia, and its cerebrovascular correlates in an established cohort of community-dwelling older adults living in rural Ecuador, and to explore the impact of dementia on functional disability and the role of the social determinants of health in the above-mentioned relationships. DESIGN: Population-based, cohort study with cross-sectional and longitudinal components. Baseline clinical interviews will focus on the assessment of cognitive performance and dementia by means of the clinical dementia rating scale (CDRS). Functional disability and social determinants of health will be correlated with CDRS scores. In addition, participants will undergo interviews and procedures to assess cardiovascular risk factors and signatures of brain damage, cerebral small vessel disease, and other stroke subtypes. The CDRS and the Functional Activities Questionnaire will be administered every year to assess the rate of incident dementia and the severity of functional disability. Neuroimaging studies will be repeated at the end of the study (5 years) to assess the impact of newly appeared cerebral and vascular lesions on cognitive decline. COMMENT: This study will allow determine whether cerebrovascular diseases are in the path of dementia development in these rural settings. This may prove cost-effective for the development of preventive strategies aimed to control modifiable factors and reduce disability in patients with dementia living in underserved populations.

Risk Factors for Acute Ischemic Stroke Caused by Anterior Large Vessel Occlusion.

Background and Purpose- Accurate prediction of acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) that is amendable to mechanical thrombectomy remains a challenge. We developed and validated a prediction model for anterior circulation LVO stroke using past medical history elements present on admission and neurological examination. Methods- We retrospectively reviewed AIS patients admitted between 2009 and 2017 to 3 hospitals within a large healthcare system in the United States. Patients with occlusions of the internal carotid artery or M1 or M2 segments of the middle cerebral artery were randomly split into 2/3 derivation and 1/3 validation cohorts for development of an anterior circulation LVO prediction model and score that was further curtailed for potential use in the prehospital setting. Results- A total of 1654 AIS were reviewed, including 248 (15%) with proximal anterior circulation LVO AIS. In the derivation cohort, National Institutes of Health Stroke Scale score at the time of cerebrovascular imaging, current smoking status, type 2 diabetes mellitus, extracranial carotid, and intracranial atherosclerotic stenosis was significantly associated with anterior circulation LVO stroke. The prehospital score was curtailed to National Institutes of Health Stroke Scale score, current smoking status, and type 2 diabetes mellitus. The areas under the curve for the prediction model, prehospital score, and National Institutes of Health Stroke Scale score alone were 0.796, 0.757, and 0.725 for the derivation cohort and 0.770, 0.689, and 0.665 for the validation cohort, respectively. The Youden index J was 0.46 for a score of >6 with 84.7% sensitivity and 62.0% specificity for the prediction model. Conclusions- Previously reported LVO stroke prediction scores focus solely on elements of the neurological examination. In addition to stroke severity, smoking, diabetes mellitus, extracranial carotid, and intracranial atherosclerotic stenosis were associated with anterior circulation LVO AIS. Although atherosclerotic stenosis may not be known until imaging is obtained, smoking and diabetes mellitus history can be readily obtained in the field and represent important elements of the prehospital score supplementing National Institutes of Health Stroke Scale score.

Trends of hospitalizations for ambulatory care-sensitive cardiovascular conditions in the municipality of Senador Canedo, Goiás, Brazil, 2001-2016. / Tendências das internações por condições cardiovasculares sensíveis à atenção primária à saúde no município de Senador Canedo, Goiás, 2001-2016.

OBJECTIVE: to analyze trends of hospitalization for ambulatory care-sensitive cardiovascular conditions (ACSCC). METHODS: this was an ecological study of time series of rates of hospitalization for ACSCC in the municipality of Senador Canedo, GO, Brazil, 2001-2016; we used data from the Hospital Information System and population estimates provided by the Inter-Agency Health Information Network (RIPSA) and the Brazilian Institute of Geography and Statistics (IBGE); the Prais-Winsten method was used to analyze trends. RESULTS: we used data on 3,244 hospitalizations for ACSCC; there was decreasing trend in the rate of hospitalizations for ACSCC (annual increase rate [AIR] = -8.14 - 95%CI -11.78;-4.35) and in the heart failure rate (AIR = -12.07 - 95%CI -14.75;-9.30); hospitalization rate time trends for hypertension, angina and cerebrovascular diseases were stationary. CONCLUSION: rates of hospitalization for ACSCC and heart failure decreased, however rates for hypertension, angina and cerebrovascular diseases remained constant.

Tendências das internações por condições cardiovasculares sensíveis à atenção primária à saúde no município de Senador Canedo, Goiás, 2001-2016 / Tendencias de las internaciones por condiciones cardiovasculares sensibles a la atención primaria de salud en el municipio de Senador Canedo, Goiás, Brasil, 2001-2016 / Trends of hospitalizations for ambulatory care-sensitive cardiovascular conditions in the municipality of Senador Canedo, Goiás, Brazil, 2001-2016

Objetivo: analisar a tendência das taxas de internação por condições cardiovasculares sensíveis à atenção primária à saúde (CCSAP). Métodos: estudo ecológico das séries temporais das taxas de internação por CCSAP pelo Sistema Único de Saúde (SUS) no município de Senador Canedo, GO, em 2001-2016; utilizaram-se dados do Sistema de Informações Hospitalares e estimativas populacionais da Rede Interagencial de Informações para a Saúde (RIPSA) e da Fundação IBGE; utilizou-se o método de Prais-Winsten para análise de tendência. Resultados: utilizaram-se dados de 3.244 internações por CCSAP; verificou-se tendência temporal decrescente para a taxa de internações por CCSAP (taxa de incremento anual [TIA] = -8,14 - IC95% -11,78;-4,35) e a taxa de insuficiência cardíaca (TIA = -12,07 - IC95% -14,75;-9,30); as tendências temporais das taxas de internações por hipertensão, angina e doenças cerebrovasculares foram estacionárias. Conclusão: as taxas de internação por CCSAP e insuficiência cardíaca diminuíram; entretanto as taxas por hipertensão, angina e doenças cerebrovasculares permaneceram constantes.

Objetivo: analizar la tendencia de las tasas de internación por condiciones cardiovasculares sensibles a la atención primaria de salud (CCSAP). Métodos: estudio ecológico de las series temporales de tasas de internación por CCSAP en el Sistema Único de Salud (SUS) en el municipio de Senador Canedo, GO, Brasil, en 2001-2016; se utilizaron datos del Sistema de Informaciones Hospitalarias y estimativas de población de la Red Interagencial de Informaciones para Salud (RIPSA) y de la Fundación IBGE; se utilizó el método de Prais-Winsten para el análisis de tendencia. Resultados: se utilizaron datos de 3.244 internaciones por CCSAP; hubo una tendencia temporal decreciente para la tasa de internaciones por CCSAP (tasa de incremento anual [TIA] = -8,14 - IC95% -11,78;-4,35) y de insuficiencia cardíaca (TIA = -12,07 - IC95% -14,75;-9,30); las tendencias temporales de las tasas de internaciones para hipertensión, angina y enfermedades cerebrovasculares (EC) fueron estacionarias. Conclusión: las tasas de internación por CCSAP e insuficiencia cardíaca disminuyeron; sin embargo, las tasas por hipertensión, angina y enfermedades cerebrovasculares permanecieron constantes.

Objective: to analyze trends of hospitalization for ambulatory care-sensitive cardiovascular conditions (ACSCC). Methods: this was an ecological study of time series of rates of hospitalization for ACSCC in the municipality of Senador Canedo, GO, Brazil, 2001-2016; we used data from the Hospital Information System and population estimates provided by the Inter-Agency Health Information Network (RIPSA) and the Brazilian Institute of Geography and Statistics (IBGE); the Prais-Winsten method was used to analyze trends. Results: we used data on 3,244 hospitalizations for ACSCC; there was decreasing trend in the rate of hospitalizations for ACSCC (annual increase rate [AIR] = -8.14 - 95%CI -11.78;-4.35) and in the heart failure rate (AIR = -12.07 - 95%CI -14.75;-9.30); hospitalization rate time trends for hypertension, angina and cerebrovascular diseases were stationary. Conclusion: rates of hospitalization for ACSCC and heart failure decreased, however rates for hypertension, angina and cerebrovascular diseases remained constant.

Capacidade funcional de pacientes com indicação de cuidados paliativos na atenção primária / Functional capacity of patients indicated for palliative care in primary care

INTRODUÇÃO: Pacientes com indicação de cuidados paliativos podem ter perda da capacidade funcional e da qualidade de vida, mas há pouca informação sobre essas condições na atenção primária à saúde. OBJETIVO: Caracterizar os aspectos funcionais e sintomáticos dos indivíduos com indicação de cuidados paliativos na atenção primária. MÉTODOS: Estudo transversal e descritivo com seis equipes de saúde da família de três unidades básicas de saúde de Londrina, Paraná, que indicaram pacientes com necessidade de cuidados paliativos. Os pacientes foram avaliados pela Escala de Performance de Karnofsky (EPK), pela Escala de Avaliação de Sintomas de Edmonton (ESAS) e por questionário sociodemográfico e clínico. RESULTADOS: 73 pacientes (30 homens e 43 mulheres) foram incluídos, com idade média de 77,2 ± 12,1 anos. Demências e doenças cerebrovasculares foram as condições mais frequentes com 20 (27%) e 19 (26%) pacientes, respectivamente. A média na EPK foi de 47,9 ± 13,9 pontos, sendo 44 ± 11,3 pontos para homens e 51 ± 11,3 para mulheres, com diferença significativa entre os sexos (p = 0,023). Pacientes com câncer tiveram um melhor grau de funcionalidade em comparação àqueles com doenças neurológicas. A ESAS indicou que os sintomas mais frequentes foram o comprometimento do bem-estar, dor, cansaço e sonolência, todos com escore médio abaixo de 3 pontos (intensidade leve). Pacientes sem cuidadores tiveram melhor status funcional, mas apresentaram maior intensidade para dor e cansaço. CONCLUSÃO: Todos os pacientes tinham alguma limitação da funcionalidade, sendo aqueles com doença neurológica os mais acometidos. Os sintomas tiveram, no geral, uma intensidade leve. A presença de cuidadores pode ter influência num melhor controle dos sintomas.

INTRODUCTION: Patients indicated for palliative care may have losses in functional capacity and quality of life, but there is little information about these conditions in primary health care. OBJECTIVE: To characterize the functional and symptomatic aspects of individuals indicated for palliative care in primary care. METHODS: This cross-sectional descriptive study involved six family health teams from three basic health units in Londrina, Paraná, Brazil that indicated patients with palliative care needs. The patients were assessed with the Karnofsky Performance Scale (KPS), the Edmonton Symptom Assessment Scale (ESAS) and a sociodemographic and clinical questionnaire. RESULTS: 73 patients (30 men and 43 women) whose mean age was 77.2 ± 12.1 years were included. Dementia and cerebrovascular diseases were the most frequent conditions, with 20 (27%) and 19 (26%) patients, respectively. The mean KPS score was 47.9 ± 13.9 points (44 ± 11.3 points for men and 51 ± 11.3 for women), with a significant difference between the sexes (p = 0.023). Cancer patients had better functionality than those with neurological diseases. The ESAS, whose mean score was below 3 points (mild intensity), indicated that the most frequent symptoms were impaired well-being, pain, fatigue and drowsiness. Patients without caregivers had better functional status, but greater pain and fatigue intensity. CONCLUSION: All patients had some functional limitations, and those with neurological diseases were the most affected. The symptoms were generally mild. The presence of caregivers may positively influence symptom control.

[Morbidity of Chronic Obstructive Pulmonary Disease in Colombia. Results of the study SANEPOC-2] / Morbilidad de la Enfermedad Pulmonar Obstructiva Crónica en Colombia. Resultados del Estudio SANEPOC-2.

Objective: to relate the morbidities of patients belonging to the COPD program of a health institution in Anserma, Caldas (Colombia). Material and Methods: a descriptive study was presented with a sample of 51 patients who underwent exploratory spirometry, the findings were contrasted with the main commodities reported by the patients or the Medical Record through descriptive and inferential statistics. Results: 50% of the evaluated population had at least one recorded comorbidity; the main morbidity found was Arterial Hypertension followed by Chronic Kidney Disease; an associated behavior was found between the GOLD classification and the presence of symptoms with non-statistically significant values; no statistically significant association was found between comorbidities and spirometric values. Conclusions: new research is needed that clearly values causality in the Colombian population.

OBJETIVO: relacionar las morbilidades de los pacientes pertenecientes al programa de EPOC de una institución de salud del municipio de Anserma, Caldas (Colombia). MATERIAL Y MÉTODOS: estudio descriptivo de 51 pacientes a quienes les fueron tomadas espirometrías exploratorias, los hallazgos fueron contrastados con las principales comorbilidades registradas en la Historia Clínica a través de estadística descriptiva e inferencial. RESULTADOS: 50% presentaron al menos una comorbilidad registrada, principalmente la Hipertensión Arterial seguida de la Enfermedad Renal Crónica, se encontró un comportamiento asociado entre la clasificación GOLD y la presencia de síntomas con valores no estadísticamente significativos; no se encontró asociación estadísticamente significativa entre las comorbilidades y los valores espirométricos. CONCLUSIONES: se hacen necesarias nuevas investigaciones que valoren de forma clara la causalidad en la población colombiana.

Platelet count is associated with outcome in cancer patients with stroke.

INTRODUCTION: Cerebrovascular disease (CVD) and cancer are among the most common causes of mortality worldwide, preceded only by ischemic heart disease (IHD). Thrombocytopenia was shown to be associated with poor outcomes in IHD and CVD in the general population. This study aimed to assess the relationship of thrombocytopenia with poor outcomes in cancer patients with CVD. MATERIALS AND METHODS: Data on patients with concomitant CVD and cancer who were initially treated at a cancer referral center between January 2010 and December 2017 were included. Thrombocytopenia was defined as a platelet count < 150,000/mm3 during the first 24 h of CVD symptom onset. The IRB (CI/837/17) approved the review of clinical records. RESULTS: Among 268 cancer patients with CVD included in the study, 210 met the inclusion criteria. Median overall survival of the entire cohort was 7.2 months, which was significantly shorter in males (p = 0.029) and patients with hematologic tumors (p = 0.009), hemorrhagic CVD (p < 0.001), altered mental status (p < 0.001), and thrombocytopenia (p < 0.001). Multiple regression logistic analysis revealed that thrombocytopenia (risk ratio [RR] 1.6, 95% confidence interval [CI] 1.1-2.4) and altered mental status (RR 2.7, 95% CI 1.9-4.0) remained statistically significant risk factors for mortality. CONCLUSION: In cancer patients with CVD, thrombocytopenia at the time of CVD diagnosis and altered mental status during initial clinical evaluation were associated with higher mortality, which should be confirmed in future studies.

Migraine and cerebrovascular diseases: Epidemiology, pathophysiological, and clinical considerations.

Migraine and cerebrovascular diseases are disabling disorders, which are possibly closely interrelated. Heterogeneous and scattered evidence in literature remains a challenge. We searched for systematic reviews including diverse cerebrovascular events in migraineurs and reported relevant original studies to update the evidence when necessary. The studies show that migraine is associated with increased risk of transient ischemic attacks, any stroke, and possibly hemorrhagic stroke. In addition, migraine with aura increases the risk of ischemic stroke and white matter abnormalities. Migraine without aura increases the risk of cervical artery dissection as a cause of ischemic stroke. Groups with specific risk profiles are women, young people, smokers, and oral contraceptive users. The pathophysiology of the association remains uncertain. However, genetic and environmental factors may be involved in intricate mechanisms responsible for oxidative stress, vascular dysfunction and, ultimately, vascular events. In conclusion, migraine is a potential risk factor for cerebrovascular diseases. Migraineurs should be carefully evaluated considering their vascular risk assessment based on current evidence, so that healthcare professionals can provide appropriate and individualized management of other cardiovascular risk factors, notably quitting smoking and restricting use of oral contraceptives.

The burden of cardiovascular diseases in Santa Catarina State, Brazil, in 2009. / A carga das doenças cardiovasculares no estado de Santa Catarina no ano de 2009.

OBJECTIVE: to estimate the burden of cardiovascular diseases in Santa Catarina State, Brazil. METHODS: this is an ecological study with the nine health macroregions of the state as units of analysis; the number of years of life lost, the number of years lived with disability and the number disability-adjusted life years (DALYs) for 2009 were estimated. RESULTS: a total of 358,777 DALYs were estimated, with a rate of 5,852 DALYs/100,000 inhabitants, 51.1% in males; age groups with the highest rates were 45-59, 60-69, and 70-79 years; diseases that most contributed to the DALYs were ischemic heart diseases and cerebrovascular diseases; health regions with the highest DALYs rates were Planalto Norte, Sul and Serra Catarinense. CONCLUSION: the high burden of cardiovascular diseases in Santa Catarina shows the need to intensify actions of health promotion and prevention in all regions of the state.

Vascular Cerebral Damage in Frail Older Adults: The AMImage Study.

BACKGROUND: Frailty has been associated with increased risk of adverse-health related outcomes including cognitive impairment. However, little is know about the pathogenesis relating frailty to cognitive decline. Therefore, the main objective of this study was to investigate the association between vascular cerebral damage and frailty. METHODS: Cross-sectional study involving 176 community-dwelling participants aged 67-86 years, participating in the AMImage Study, an ancillary neuro-imaging project of the AMI cohort, a French prospective cohort including older farmers living in rural areas. Frailty was defined as proposed by Fried. 3T magnetic resonance imaging (MRI) examination was performed with anatomical, diffusion, and fluid-attenuated inversion recovery sequences. The evaluation included the assessment of white matter hyperintensities (WMH) volumes and of microstructural white matter integrity through exploration of diffusion tensor imaging (DTI) parameters. RESULTS: The analyses showed that WMH volumes were higher in frail persons compared with nonfrail subgroup. Frail participants presented DTI modifications in extensive areas of white matter. In comparison with nonfrail subgroup, frail participants showed a strong association between WMH volumes and DTI changes. CONCLUSION: These results show that subclinical cerebrovascular damage is present in the frail older person, which could support the hypothesis that frailty is a prodromal state of central nervous system vascular injury.