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BACKGROUND: Large vessel occlusion acute ischemic stroke prognosis improved following the 2015 endovascular therapy (EVT) trials. Blood-based biomarkers may improve outcome prediction. We aimed to assess plasma brain-derived tau (BD-Tau) performance in predicting post-EVT large vessel occlusion acute ischemic stroke outcomes. METHODS: We included 2 temporally independent prospective cohorts of anterior circulation in patients with large vessel occlusion acute ischemic stroke who successfully recanalized post-EVT. We measured plasma BD-Tau, GFAP (glial-fibrillary-acidic-protein), NfL (neurofilament-light-chain), and total-Tau upon admission, immediately, 24 hours, and 72 hours post-EVT. Twenty-four-hour neuroimaging and 90-day functional outcomes were independently assessed using the Alberta Stroke Program Early Computed Tomography Score (good outcome: >7 or unchanged) and the modified Rankin Scale (favorable outcome <3 or unchanged), respectively. Based on the first cohort (derivation), we built a multivariable logistic regression model to predict a 90-day functional outcome. Model results were evaluated using the second cohort (evaluation). RESULTS: In the derivation cohort (n=78, mean age=72.9 years, 50% women), 62% of patients had a good 24-hour neuroimaging outcome, and 45% had a favorable 90-day functional outcome. GFAP admission-to-EVT rate-of-change was the best predictor for early neuroimaging outcome but not for 90-day functional outcome. At admission, BD-Tau levels presented the highest discriminative performance for 90-day functional outcomes (area under the curve, 0.76 [95% CI, 0.65-0.87]; P<0.001). The model incorporating age, admission BD-Tau, and 24-hour Alberta Stroke Program Early Computed Tomography Score achieved excellent discrimination of 90-day functional outcome (area under the curve, 0.89 [95% CI, 0.82-0.97]; P<0.001). The score's predictive performance was maintained in the evaluation cohort (n=66; area under the curve, 0.82 [95% CI, 0.71-0.92]; P<0.001). CONCLUSIONS: Admission plasma BD-Tau accurately predicted 90-day functional outcomes in patients with large vessel occlusion acute ischemic stroke after successful EVT. The proposed model may predict functional outcomes using objective measures, minimizing human-related biases and serving as a simplified prognostic tool for AIS.
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BACKGROUND: Accurate prediction of functional outcomes is crucial in stroke management, but this remains challenging. OBJECTIVE: To evaluate the performance of the generative language model ChatGPT in predicting the functional outcome of patients with acute ischemic stroke (AIS) 3 months after mechanical thrombectomy (MT) in order to assess whether ChatGPT can used to be accurately predict the modified Rankin Scale (mRS) score at 3 months post-thrombectomy. METHODS: We conducted a retrospective analysis of clinical, neuroimaging, and procedure-related data from 163 patients with AIS undergoing MT. The agreement between ChatGPT's exact and dichotomized predictions and actual mRS scores was assessed using Cohen's κ. The added value of ChatGPT was measured by evaluating the agreement of predicted dichotomized outcomes using an existing validated score, the MT-DRAGON. RESULTS: ChatGPT demonstrated fair (κ=0.354, 95% CI 0.260 to 0.448) and good (κ=0.727, 95% CI 0.620 to 0.833) agreement with the true exact and dichotomized mRS scores at 3 months, respectively, outperforming MT-DRAGON in overall and subgroup predictions. ChatGPT agreement was higher for patients with shorter last-time-seen-well-to-door delay, distal occlusions, and better modified Thrombolysis in Cerebral Infarction scores. CONCLUSIONS: ChatGPT adequately predicted short-term functional outcomes in post-thrombectomy patients with AIS and was better than the existing risk score. Integrating AI models into clinical practice holds promise for patient care, yet refining these models is crucial for enhanced accuracy in stroke management.
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Introdução: A transmissão vertical representou, em 2012, dentre os expostos ao HIV com menos de treze anos de idade, 99,6% dos casos identificados. Para enfrentar este crescimento, programas voltados a enfrentar o aumento da transmissão vertical vêm sendo desenvolvidos no âmbito do Sistema Único de Saúde. Este artigo objetiva investigar o fluxo do programa de distribuição de fórmula infantil para crianças de zero a seis meses de vida, nascidas de mães HIV positivas, na cidade de Porto Alegre/RS, para a identificação dos fluxos de acesso ao programa e sua eficácia. Métodos: O presente estudo é de natureza qualitativa e de caráter exploratório acerca do tema. Resultados: Três das cinco maternidades que fazem parte do Projeto Nascer têm seus dados de dispensação da fórmula infantil contabilizados pela Secretaria Municipal. Constatou-se que o processo está bem implementado e não faltam insumos e fórmula para este grupo da população. Na Atenção Básica, pode-se verificar que, em geral, a retirada se dá de forma sistemática, não há dificuldades por parte dos profissionais em atender a essa demanda no serviço. Conclusão: Necessita-se de mais estudos em relação ao tema, principalmente nas demais regiões do país, bem como nos municípios do interior, para que se possa traçar um perfil da implementação da distribuição em todo o Brasil. Tornam-se indispensáveis, por outro lado, estudos que possam evidenciar os demais aspectos que impactam na vida das crianças e suas famílias.
Introduction: In 2012, vertical transmission accounted, among those exposed to HIV under thirteen years of age, for 99.6% of the identified cases. To meet this growth, programs aimed at facing the increase of vertical transmission have been developed within the National Health System. This paper aims to investigate the flow of the infant formula distribution program for children from birth to 6 months of life, born to HIV-positive mothers in the city of Porto Alegre, RS, to identify access flows to the program and its effectiveness. Methods: This is a qualitative study of exploratory nature. Results: Three of the fi ve hospitals that are part of Project Nascer have their data of infant formula dispensation accounted for by the municipal department. The process was found to be well implemented and inputs and formula abound for this population group. In Primary Care, it can be seen that, in general, delivery takes place systematically, there is no difficulty for professionals to meet this demand in the service. Conclusion: Further studies on the subject should be conducted, especially in other regions of Brazil, as well as in countryside municipalities, so that a profi le of the distribution implementation across the country can be traced. However, studies highlighting other aspects that impact the lives of children and their families are crucial.
Subject(s)
Humans , Female , Infant , HIV , Breast-Milk Substitutes , Infectious Disease Transmission, VerticalABSTRACT
Na criança, a nutrição adequada é fundamental para o crescimento e desenvolvimento normais. Este estudo objetivou avaliar a oferta de alimentos industrializados em pré-escolares pelos pais e pela escola, assim como o estado nutricional. Métodos: Estudo transversal com amostra de 54 pré-escolares. Realizou-se avaliação do estado nutricional, por meio das variáveis: índice de massa corpórea, sexo, idade, peso, estatura. Avaliou-se consumo de alimentos industrializados na escola, por meio de observação do cardápio escolar e, no domicílio, através de questionário de frequência alimentar. A análise dos dados foi realizada pelo SPSS 15.0. Resultados: Dos pré-escolares avaliados 59,3% eram do sexo masculino. A média de idade foi 42,87 (±13,29) meses. Alto índice de risco de sobrepeso, 27,8% para IMC, 25,9% para P/A. Índices de sobrepeso e obesidade apresentaram, ambos, 11,1% no indicador IMC. Nos domicílios há elevada oferta de alimentos industrializados (21 qualidades diferentes), e destes, todos são consumidos com frequência maior que uma vez por semana. Já os cardápios escolares oferecem (13 diferentes), e destes, sete são consumidos mais de uma vez na semana. Conclusão: Observou-se consumo significativo de alimentos industrializados tanto nas escolas infantis quanto nos domicílios, por crianças com e sem excesso de peso. Foi relevante o número de pré-escolares de ambos os sexos, com excesso de peso.
In children, adequate nutrition is essential for normal growth and development. This study aimed to evaluate the availability of processed foods to preschool children by their parents and school as well as their nutritional status. Methods: Cross-sectional study of a sample of 54 preschoolers. We carried out an assessment of nutritional status through the following variables: body mass index, sex, age, weight, and height. We evaluated the consumption of foods at school, through observation of the school menu, and at home using a food frequency questionnaire. Data analysis was performed using SPSS 15.0. Results: 59.3% of the young children evaluated were males. The mean age was 42.87 (± 13.29) months. There was a high degree of risk of overweight: 27.8% for BMI and 25.9% for W/H. Rates of overweight and obesity were both 11.1% according to BMI. In the households there was a high supply of processed foods (21 different qualities), and of these, all are consumed more frequently than once a week. On the other hand the school menus offer 13 different items, and of these, seven are consumed more than once a week. Conclusion: There was a significant consumption of processed foods at school and at home by children with and without overweight. The number of preschool children of both sexes who were overweight was significant.