Treatment of ischemic stroke with r-tPA: implementation challenges in a tertiary hospital in Brazil.

PURPOSE: This paper presents the initial experience with thrombolysis for acute ischaemic stroke at Hospital de Base do Distrito Federal (HBDF), Brazil, and the difficulties associated with the implementation of this treatment. METHOD: A retrospective study was performed using the medical records of all patients with acute stroke who were treated with intravenous alteplase in our department, between May 2011 and April 2012. RESULTS: The thrombolytic therapy was administered to 32 patients. The mean time between the ictus and the start of stroke therapy start was 195 (60-270) minutes. Sixteen patients demonstrated a significant clinical improvement (decrease in National Institute Health Stroke Scale [NIHSS] score≥4 points in 24 hours); 6 patients were discharged with an NIHSS score of 0 and 2 demonstrated haemorrhagic transformation. CONCLUSIONS: The results of our study are similar to those reported in the literature, although we have been dealing with difficulties, such as the lack of a stroke unit.

Treatment of ischemic stroke with r-tPA: implementation challenges in a tertiary hospital in Brazil / Tratamento do acidente vascular cerebral isquêmico com r-tPA: o desafio da implantação em um hospital terciário no Brasil

Purpose: This paper presents the initial experience with thrombolysis for acute ischaemic stroke at Hospital de Base do Distrito Federal (HBDF), Brazil, and the difficulties associated with the implementation of this treatment. Method: A retrospective study was performed using the medical records of all patients with acute stroke who were treated with intravenous alteplase in our department, between May 2011 and April 2012. Results: The thrombolytic therapy was administered to 32 patients. The mean time between the ictus and the start of stroke therapy start was 195 (60-270) minutes. Sixteen patients demonstrated a significant clinical improvement (decrease in National Institute Health Stroke Scale [NIHSS] score≥4 points in 24 hours); 6 patients were discharged with an NIHSS score of 0 and 2 demonstrated haemorrhagic transformation. Conclusions: The results of our study are similar to those reported in the literature, although we have been dealing with difficulties, such as the lack of a stroke unit. .

Introdução: O objetivo deste trabalho é apresentar a experiência inicial em trombólise para o acidente vascular encefálico isquêmico (AVC) no Hospital de Base do Distrito Federal (HBDF) e as dificuldades encontradas na implementação do serviço. Método: Foi realizado estudo retrospectivo através da análise de prontuário de todos os pacientes submetidos à terapia trombolítica no período de maio de 2011 a abril de 2012. Resultados: A terapia trombolítica foi administrada a 32 pacientes. O tempo médio do ictus até o início da terapia foi de 195 (60-270) minutos. Dezesseis pacientes apresentaram uma melhora clínica significativa (queda do National Institute Health Stroke Scale [NIHSS] maior ou igual a 4 pontos em 24 horas). Seis pacientes receberam alta com NIHSS 0. Dois pacientes apresentaram transformação hemorrágica. Conclusão: Apesar das dificuldades encontradas, como a ausência de uma Unidade de AVC, o desfecho da nossa série é semelhante aos resultados descritos na literatura. .

Estatinas e neuropatias periféricas: uma revisão da literatura / Statins and peripheral neuropathy: a review of the literature

Vários estudos com delineamentos diferentes postulam que as estatinas podem estar relacionadas ao desenvolvimento de neuropatia periférica. Outras análises, no entanto, mostraram potencial efeito protetor dessas drogas em pacientes com neuropatia diabética. O presente trabalho tem como objetivo avaliar essa relação na literatura vigente. A revisão de vários relatos de caso, estudos populacionais e experimentos em animais não permitem afirmar se existe relação direta causal entre o uso de inibidores da hidroximetilglutaril-coenzima A e neuropatia periférica. Os benefícios das estatinas no tratamento de doenças graves tais como a aterosclerose cardiovascular e cerebral, com certeza, suplantam esse pequeno risco de acometimento de nervos periféricos.

Several studies of different designs indicate that statins could be associated with the development of peripheral neuropathy. However, other analyses have shown a potential benefit of these drugs in patients with diabetic neuropathy. Our study aims to evaluate this possible relationship comparing data from the current literature. After review of several case reports, populational studies and animal experiments, it is not possible to conclude that there is a cause-effect relationship between the use of HMG-CoA inhibitors and peripheral neuropathy. The well-established benefits of statins in the treatment of potentially severe diseases such as cerebral and cardiovascular atherosclerosis outweigh the relatively small risk of peripheral nerve involvement.

Transcriptome analysis of the Amazonian viper Bothrops atrox venom gland using expressed sequence tags (ESTs).

Bothrops atrox is a highly dangerous pit viper in the Brazilian Amazon region. We produced a global catalogue of gene transcripts to identify the main toxin and other protein families present in the B. atrox venom gland. We prepared a directional cDNA library, from which a set of 610 high quality expressed sequence tags (ESTs) were generated by bioinformatics processing. Our data indicated a predominance of transcripts encoding mainly metalloproteinases (59% of the toxins). The expression pattern of the B. atrox venom was similar to Bothrops insularis, Bothrops jararaca and Bothrops jararacussu in terms of toxin type, although some differences were observed. B. atrox showed a higher amount of the PIII class of metalloproteinases which correlates well with the observed intense hemorrhagic action of its toxin. Also, the PLA2 content was the second highest in this sample compared to the other three Bothrops transcriptomes. To our knowledge, this work is the first transcriptome analysis of an Amazonian rain forest pit viper and it will contribute to the body of knowledge regarding the gene diversity of the venom gland of members of the Bothrops genus. Moreover, our results can be used for future studies with other snake species from the Amazon region to investigate differences in gene patterns or phylogenetic relationships.

Transcriptome analysis of the Amazonian viper Bothrops atrox venomgland using expressed sequence tags (ESTs)

Bothrops atrox is a highly dangerous pit viper in the Brazilian Amazon region.We produced a global catalogue of gene transcripts to identify the main toxin and other protein families present in the B. atrox venom gland. We prepared a directional cDNA library, from which a set of 610 high quality expressed sequence tags (ESTs) were generated by bioinformatics processing. Our data indicated a predominance of transcripts encoding mainly metalloproteinases(59% of the toxins). The expression pattern of the B. atrox venom was similar to Bothrops insularis, Bothrops jararaca and Bothrops jararacussu in terms of toxin type, although some differences were observed. B. atrox showed a higher amount of the PIII classof metalloproteinases which correlates well with the observed intense hemorrhagic action of its toxin. Also, the PLA2 content was the second highest in this sample compared to theother three Bothrops transcriptomes. To our knowledge, this work is the first transcriptome analysis of an Amazonian rain forest pit viper and it will contribute to the body of knowledge regarding the gene diversity of the venom gland of members of the Bothropsgenus. Moreover, our results can be used for future studies with other snake species from the Amazon region to investigate differences in gene patterns or phylogenetic relationships.