Desfechos clínicos de pacientes com acidente vascular cerebral isquêmico após terapia trombolítica / Clinical outcomes of ischemic stroke patients after thrombolytic therapy

Resumo Objetivo Analisar desfechos e fatores associados em pacientes com acidente vascular cerebral isquêmico após terapia trombolítica. Métodos Estudo do tipo coorte retrospectivo de pacientes com acidente vascular cerebral isquêmico submetidos à terapia trombolítica. Foram descritas as comorbidades; os défices neurológicos e os tempos de atendimento. Utilizou-se o teste qui quadrado para associação entre comorbidades, tempos de atendimento e ocorrência de transformação hemorrágica. Resultados Houve elevada frequência de comorbidades. Défices neurológicos pontuaram média de 15 pontos. A janela de tempo obteve média de 98 minutos e o tempo porta-agulha, 89,8 minutos. Observou-se transformação hemorrágica em 20 pacientes. Na análise bivariada, a ocorrência de transformação hemorrágica esteve associada com maior défice neurológico, fibrilação atrial e cardiopatia. Houve redução dos défices neurológicos de 51% para 12,5 entre a admissão e alta. Conclusão A terapia trombolítica apresentou resultados positivos, apesar de tempos de atendimento elevados e pacientes com défices neurológicos com elevada pontuação.

Abstract Objective To analyze outcomes and associated factors in ischemic stroke patients submitted to thrombolytic therapy. Methods This was a retrospective cohort study of ischemic stroke patients submitted to thrombolytic therapy. Comorbidities, neurologic deficits and time of thrombolysis were described. The chi-squared test was used to assess association among comorbidities, time of thrombolysis, and occurrence of hemorrhagic transformation. Results There was a high frequency of comorbidities. Mean neurological deficit score was 15 points. Mean time window was 98 minutes and needle-to-door time, 89.9 minutes. Hemorrhagic transformation was observed in 20 patients. Bivariate analysis revealed that hemorrhagic transformation was associated with greater neurologic deficit score, atrial fibrillation and heart disease. Neurologic deficit fell from 51% to 12.5% between admission and discharge. Conclusion Thrombolytic therapy presented positive outcomes, regardless of long thrombolysis time and high neurologic deficit scores.

Postpartum Treatment With Immunoglobulin Does Not Prevent Relapses of Multiple Sclerosis in the Mother.

Multiple sclerosis (MS) is a chronic, neurological, immune-mediated disease that can worsen in the postpartum period. There is no consensus on the use of immunoglobulin for prevention of disease relapses after delivery. We have shown that the controversial beneficial effect of immunoglobulin given immediately after birth could not be observed in patients with MS.

Multiple sclerosis starting before the age of 18 years: the Brazilian experience.

Multiple sclerosis (MS) starting in childhood and adolescence poses a challenge for diagnosis and management of the disease. The aim of the present study was to assess the characteristics of early onset MS in Brazilian patients. Methods Retrospective data collection from specialized MS units. Results From 20 MS units in 11 Brazilian states, 117 cases of MS starting before the age of 18 years were collected. These patients had an average of 10 years of disease duration, still typically with low disability and one relapse every 2.5 years. The mean age for disease onset was 13.7 years. Conclusion The present study introduces a large series of Brazilian cases of pediatric MS. Although some patients presented a very severe form of MS, on the whole the group of patients with MS starting in childhood or adolescence presented a relatively mild form of this disease in Brazil.

Pain measurement as part of primary healthcare of adult patients with sickle cell disease.

OBJECTIVE: The aim of this exploratory, cross-sectional study was to evaluate pain in sickle cell disease patients and aspects related to primary healthcare. METHODS: Data were obtained through home interviews. The assessment instruments (body diagram, Numerical Pain Scale, McGill Pain Questionnaire) collected information on the underlying disease and on pain. Data were analyzed using the Statistical Package for Social Sciences program for Windows. Associations between the subgroups of sickle cell disease patients (hemoglobin SS, hemoglobin SC, sickle ß-thalassemia and others) and pain were analyzed using contingency tables and non-parametric tests of association (classic chi-square, Fisher's and Kruskal-Wallis) with a level of 5% (p-value < 0.05) being set for the rejection of the null hypothesis. RESULTS: Forty-seven over 18-year-old patients with sickle cell disease were evaluated. Most were black (78.7%) and female (59.6%) and the mean age was 30.1 years. The average number of bouts of pain annually was 7.02; pain was predominantly reported by individuals with sickle cell anemia (hemoglobin SS). The intensity of pain (Numeric Pain Scale) was 5.5 and the quantitative index (McGill) was 35.9. This study also shows that patients presented a high frequency of moderately painful crises in their own homes. CONCLUSION: According to these facts, it is essential that pain related to sickle cell disease is properly identified, quantified, characterized and treated at the three levels of healthcare. In primary healthcare, accurate measurement of pain combined with better care may decrease acute painful episodes and consequently minimize tissue damage, thus improving the patient's overall health.

Multiple sclerosis in South America: month of birth in different latitudes does not seem to interfere with the prevalence or progression of the disease.

OBJECTIVE: To assess whether the month of birth in different latitudes of South America might influence the presence or severity of multiple sclerosis (MS) later in life. METHODS: Neurologists in four South American countries working at MS units collected data on their patients' month of birth, gender, age, and disease progression. RESULTS: Analysis of data from 1207 MS patients and 1207 control subjects did not show any significant variation in the month of birth regarding the prevalence of MS in four latitude bands (0-10; 11-20; 21-30; and 31-40 degrees). There was no relationship between the month of birth and the severity of disease in each latitude band. CONCLUSION: The results from this study show that MS patients born to mothers who were pregnant at different Southern latitudes do not follow the seasonal pattern observed at high Northern latitudes.

Multiple sclerosis starting before the age of 18 years: the Brazilian experience / Esclerose multipla com inicio antes dos 18 anos de idade: a experiencia brasileira

Multiple sclerosis (MS) starting in childhood and adolescence poses a challenge for diagnosis and management of the disease. The aim of the present study was to assess the characteristics of early onset MS in Brazilian patients. Methods Retrospective data collection from specialized MS units. Results From 20 MS units in 11 Brazilian states, 117 cases of MS starting before the age of 18 years were collected. These patients had an average of 10 years of disease duration, still typically with low disability and one relapse every 2.5 years. The mean age for disease onset was 13.7 years. Conclusion The present study introduces a large series of Brazilian cases of pediatric MS. Although some patients presented a very severe form of MS, on the whole the group of patients with MS starting in childhood or adolescence presented a relatively mild form of this disease in Brazil. .

Esclerose múltipla (EM) com início na infância e adolescência constitui um desafio para o diagnóstico e manejo da doença. A proposta do presente estudo foi avaliar as características da EM de início precoce em pacientes brasileiros. Métodos Coleta de dados retrospectiva de arquivos de unidades especializadas em atendimento da EM. Resultados A partir de 20 unidades de EM de nove estados brasileiros, foram coletados 117 casos de EM com início antes dos 18 anos de idade. Estes pacientes tinham uma média de 10 anos de duração da doença, de maneira geral apresentavam pouca incapacidade , com um surto a cada dois anos e meio. A média de idade no início da doença era 13,7 anos. Conclusão O presente estudo apresenta uma grande série de casos brasileiros de EM pediátrica. Embora alguns pacientes tenham apresentado forma grave de EM, de maneira geral o grupo de pacientes cuja EM iniciou-se na infância ou adolescência apresentou uma forma relativamente leve da doença no Brasil. .

Multiple sclerosis in South America: month of birth in different latitudes does not seem to interfere with the prevalence or progression of the disease / Esclerose multipla na America do Sul: mes de nascimento em diferentes latitudes nao parece interferir com a prevalencia ou progressao da doenca

Objective To assess whether the month of birth in different latitudes of South America might influence the presence or severity of multiple sclerosis (MS) later in life. Methods Neurologists in four South American countries working at MS units collected data on their patients' month of birth, gender, age, and disease progression. Results Analysis of data from 1207 MS patients and 1207 control subjects did not show any significant variation in the month of birth regarding the prevalence of MS in four latitude bands (0–10; 11–20; 21–30; and 31–40 degrees). There was no relationship between the month of birth and the severity of disease in each latitude band. Conclusion The results from this study show that MS patients born to mothers who were pregnant at different Southern latitudes do not follow the seasonal pattern observed at high Northern latitudes. .

Objetivo Avaliar se o mês de nascimento em diferentes latitudes da América do Sul pode influenciar a presença ou gravidade da esclerose múltipla (EM) na vida. Método Neurologistas de quatro países da América do Sul trabalhando em unidades de EM coletaram os dados de seus pacientes com referência ao mês de nascimento, gênero, idade e progressão da doença. Resultados A análise dos dados mostrou que, para 1207 pacientes com EM e 1207 controles, não havia diferença significativa no mês de nascimento com relação à prevalência de EM em quatro zonas de latitude (0–10; 11–20; 21–30; e 31–40 graus). Não houve relação entre o mês de nascimento e a gravidade da doença em nenhuma destas zonas. Conclusão Os resultados deste estudo mostram que pacientes com EM nascidos de mães grávidas em diferentes latitudes sul não seguem o padrão dos resultados sazonais encontrados nas latitudes norte. .

Força de pinça trípode e destreza manual em pacientes portadores de esclerose múltipla forma remitente-recorrente / Tripod pinch strength and manual dexterity of patientswith multiple sclerosis form relapsing-remitting

Esclerose múltipla é uma doença desmielinizante do sistemanervoso central, podendo provocar alterações de força e destrezamanual. A força do movimento de pinça trípode pode ser quantificadapor dinamômetro. A destreza manual pode ser quantificadaatravés do teste de Caixa e Blocos que consiste em uma caixa demadeira com 150 blocos. Este estudo objetivou descrever e analisara força muscular e destreza manual e verificar se há correlação entreelas, Expanded Disability Status Scale (EDSS) e idade. Realizamoso teste de caixa e blocos e a análise de força de pinça trípode em 18indivíduos da forma remitente-recorrente. Para o teste de caixa eblocos os resultados foram 35,38 blocos/min para a mão direita e36,66 blocos/min para a mão esquerda. A força de pinça foi de 6,86kgf para a mão direita e 6,54 kgf para a mão esquerda. Média deEDSS de 2,86 e idade 46,39 anos. Os pacientes analisados apresentaramalterações na destreza manual, mas não apresentaram alteraçãoda força de pinça. A idade não se correlaciona com as variáveis doestudo, e o EDSS somente com a destreza manual.

Multiple Sclerosis is a demyelinating disease of the centralnervous system and may cause changes in strength and manualdexterity. The strength of movement of the tripod pinch can bemeasured by dynamometer. Manual dexterity can be quantifiedthrough the Box and Blocks test that consists of a wooden boxwith 150 blocks. This study aimed to describe and analyze muscularstrength and manual dexterity and verifying correlation amongthem, Expanded Disability Status Scale (EDSS) and age. We carriedout the box and block test and analysis of tripod pinch strength in18 patients. The Box and Blocks test showed for the right hand anaverage of 35.38 packs / min and for the left hand 36.66 packs/min. The pinch strength was 6.86 kgf for the right hand and 6.54kgf for the left hand. EDSS average 2.86 and 46.39 years old. Thepatients studied showed changes in manual dexterity, but showed nochange in pinch strength. The age is not correlated with the studyvariables, and EDSS only with manual dexterity.

Neuromyelitis optica and pregnancy.

Less than a hundred cases of pregnancies in women with neuromyelitis optica (NMO) have been published in the world. The aim of the present study was to add the Brazilian experience to this subject. Cases of women with NMO who became pregnant, or who developed NMO soon after pregnancy, were included. Retrospective analysis of medical data from these patients was carried out by the neurologist responsible for the case. Seventeen cases of pregnancies (16 full-term pregnancies, one miscarriage) were identified. The relapse rate of demyelinating events in the first trimester after pregnancy was significantly higher than at any other time. Disability progression was significantly worse 1 year after delivery. Pregnancy negatively influenced the disease course of NMO in these women. These results are similar to those of other authors, although the total number of cases so far described is still small. Obstetricians must be aware of the potential complications of a pregnancy in a woman who has NMO.

The effects of long-term exposure to disease-modifying drugs during pregnancy in multiple sclerosis.

BACKGROUND AND OBJECTIVE: Women with multiple sclerosis (MS) who intend to get pregnant are often advised to discontinue disease modifying therapy (DMT) prior to conception. This recommendation is not based on medical evidence and may interfere with disease control by immunomodulatory drugs. The present study was designed to help discuss the effect of DMT for MS on pregnancy and on disease course. PATIENTS AND METHODS: Retrospective data from 152 pregnancies of 132 women with MS were collected by the physician in charge of the case. All data were entered into a specific file for qualitative and quantitative statistical analysis. RESULTS: From the total group of patients, 89 pregnancies occurred without any exposure to MS drugs, while 61 pregnancies occurred with at least eight weeks of exposure to MS immunomodulatory drugs. The rate of obstetric and neonatal complications was similar in both groups, except for the newborn weight and height which was smaller for mothers receiving medications. Mothers' post-delivery relapse rate and EDSS scores in the follow-up period were significantly higher in the absence of treatment. CONCLUSION: It is possible that, with further such supportive data, international guidelines on MS treatment in young women who intend to get pregnant may need to be revised.

Pain measurement as part of primary healthcare of adult patients with sickle cell disease

OBJECTIVE: The aim of this exploratory, cross-sectional study was to evaluate pain in sickle cell disease patients and aspects related to primary healthcare. METHODS: Data were obtained through home interviews. The assessment instruments (body diagram, Numerical Pain Scale, McGill Pain Questionnaire) collected information on the underlying disease and on pain. Data were analyzed using the Statistical Package for Social Sciences program for Windows. Associations between the subgroups of sickle cell disease patients (hemoglobin SS, hemoglobin SC, sickle β-thalassemia and others) and pain were analyzed using contingency tables and non-parametric tests of association (classic chi-square, Fisher's and Kruskal-Wallis) with a level of 5% (p-value < 0.05) being set for the rejection of the null hypothesis. RESULTS: Forty-seven over 18-year-old patients with sickle cell disease were evaluated. Most were black (78.7%) and female (59.6%) and the mean age was 30.1 years. The average number of bouts of pain annually was 7.02; pain was predominantly reported by individuals with sickle cell anemia (hemoglobin SS). The intensity of pain (Numeric Pain Scale) was 5.5 and the quantitative index (McGill) was 35.9. This study also shows that patients presented a high frequency of moderately painful crises in their own homes. CONCLUSION: According to these facts, it is essential that pain related to sickle cell disease is properly identified, quantified, characterized ...

Avaliação de dor e do perfil epidemiológico, de pacientes atendidos no pronto-socorro de um hospital universitário / Pain and epidemiologic evaluation of patients seen by the first aid unit of a teaching hospital

JUSTIFICATIVA E OBJETIVOS: Dor é um dos principais motivos de procura por pronto-atendimento. No entanto, nem sempre é bem avaliada, documentada e tratada. O objetivo deste estudo foi descrever o perfil epidemiológico, caracterização da dor, tratamento analgésico instituído e satisfação de pacientes atendidos no pronto-socorro (PS) de um Hospital Universitário (HC). MÉTODO: Estudo prospectivo, transversal, realizado com 309 pacientes atendidos no PS/HC da Universidade Federal do Triângulo Mineiro (UFTM). As informações foram coletadas a partir de instrumento contendo identificação, dados sócio-demográficos, avaliação de dor pela escala numérica de dor (END), prescrição de analgésicos, satisfação com a analgesia. RESULTADOS: Houve predomínio do sexo masculino, cor branca e com ensino fundamental. Média de idade 46,7 anos. Desempregados: 10% e 15% aposentados. Prevalência de dor 45,6%. Principais causas: traumatismos, dor abdominal, cefaleia, picada por animais peçonhentos, vasculopatias. Cerca de 5% dos pacientes foram atendidos com menos de 1h de dor e 40% com mais de 72h. A localização mais comum foi abdômen (25,2%) e membros inferiores (MMII) (23,4%). A dor foi intensa em dois terços dos pacientes, com intensidade média na admissão de 7,8 ± 2,1 pela END. Tempo de melhora após analgesia: menor que 30 minutos para 25% dos pacientes. Em 17,7% dos casos de dor, não houve prescrição analgésica. O analgésico mais prescrito foi a dipirona, com ou sem associação. Apenas 30% tiveram resolução da dor. Apesar destes dados, metade dos pacientes, disseram-se satisfeitos com a analgesia. CONCLUSÃO: A dor foi altamente prevalente no pronto-atendimento, pouco valorizada, mal avaliada e subtratada, com baixa resolutividade e prescrição inadequada de analgésicos.

BACKGROUND AND OBJECTIVES: Pain is s major reason for seeking emergency care. However it is not always accurately evaluated, documented and managed. This study aimed at describing the epidemiologic profile, the characterization of pain, the analgesic treatment instituted and the satisfaction of patients seen by the first aid unit (FA) of a Teaching Hospital (TH). METHOD: This is a prospective transversal study carried out with 309 patients seen by the FA/TH of the Federal University, Triângulo Mineiro (UFTM). Information was collected as from a tool with identification, socio-demographic data, pain evaluation by the pain numerical scale (PNS), analgesics prescription and satisfaction with analgesia. RESULTS: There has been predominance of Caucasian males with basic education. Mean age was 46.7 years. Unemployed were 10% and retired 15%. Pain prevalence was 45.6%. Major causes: traumas, abdominal pain, headache, bites by venomous animals and vasculopathies. Approximately 5% of patients were seen with less than 1 hour of pain and 40% with more than 72 hours. Most common sites were abdomen (25.2%) and lower limbs (MMII) (23.4%). Pain was severe in two thirds of patients, with mean intensity at admission of 7.8 ± 2.1 by PNS. Improvement time after analgesia: less than 30 minutes for 25% of patients. There has been no analgesic prescription for 17.7% of cases. Most prescribed analgesic was dipirone, with or without association. Only 30% had pain resolution. In spite of these data, half the patients reported being happy with analgesia. CONCLUSION: Pain was highly prevalent during first aid visits, was poorly valued and undertreated, with low resolution rate and inadequate analgesics prescription.

Qualidade de vida de portadores de dor crônica atendidos em clínica multiprofissional / Calidad de vida y dolor crónico: una evaluación de pacientes tratados en una clínica de dolor multiprofesional / Quality of life in chronic pain sufferers: an evaluation of patients attended within a multi-professional pain clinic

Estudo descritivo, exploratório, com abordagem quantitativa, com objetivo de analisar a qualidade de vida dos portadores de dor crônica de uma clínica multiprofissional de dor de um hospital público de ensino de Minas Gerais. Para coleta dos dados utilizou-se o questionário Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), com a obtenção das médias dos escores de cada domínio. Para a análise foi realizada estatística descritiva. Foram entrevistados 31 pacientes. A maioria (61,3%) referiu dor em coluna e membros. O maior escore encontrado foi no domínio capacidade funcional (47,09), seguido de saúde mental (40,00). Os menores escores foram nos domínios limitações por aspectos físicos (27,41) e dor (28,06). Observaram-se escores menores entre os pacientes cadastrados há mais de dois anos na clínica multiprofissional de dor. Esses achados apontam para a necessidade de inserção de novas modalidades de tratamento considerando a complexidade da dor crônica.

This descriptive, exploratory study was performed using a quantitative approach, with the objective to analyze the quality of life of individuals with chronic pain undergoing treatment at a multidisciplinary pain clinic at a public teaching hospital in Minas Gerais. Data collection was performed using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) to obtain the mean score in each domain. Descriptive statistics were used for analysis. A total of 31 patients were interviewed. Most (61.3%) reported experiencing pain in the back and limbs. The highest identified score referred to the functional capacity domain (47.09), followed by mental health (40.00). The lowest scores referred to the domains of limitations due to physical aspects (27.41) and pain (28.06). Lower scores were observed among patients who had been attending the multidisciplinary pain clinic for over two years. These findings suggest a need to include new treatment modalities that consider the complexity of chronic pain.

Estudio descriptivo, exploratorio, de abordaje cuantitativo, objetivando analizar la calidad de vida de pacientes con dolor crónico atendidos por equipo multiprofesional del dolor de un hospital público de enseñanza de Minas Gerais. Datos recolectados mediante cuestionario Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), obteniéndose los puntajes promedio para cada dominio, analizados posteriormente utilizando estadística descriptiva. Fueron entrevistados 31 pacientes. La mayoría (61,3%) refería dolor en columna y miembros. El mayor puntaje encontrado correspondió al dominio capacidad funcional (47,09), seguido de salud mental (40,00). Los menores puntajes se observaron en los dominios limitaciones por aspectos físicos (27,41) y dolor (28,06). Se observaron puntajes menores entre pacientes atendidos durante más de dos años por el equipo multiprofesional de dolor. Estos hallazgos determinan la necesidad de inserción de nuevas modalidades de tratamiento, considerando la complejidad del dolor crónico.

Clinical and epidemiological profile of patients with multiple sclerosis in Uberaba, Minas Gerais, Brazil.

UNLABELLED: Multiple sclerosis (MS) is an immune-mediated disease that affects the central nervous system. Clinical presentation and prevalence vary widely around the world. OBJECTIVE: To describe the clinical and epidemiological aspects of patients with MS in Uberaba (MG). METHOD: We conducted a transversal descriptive study, with data analysis of 35 patients with MS. RESULTS: Prevalence of MS was 12.5 cases/100,000 inhabitants, with a predominance in females (71.4%) and Caucasoid (85.7%). The current average age was (43.8 ys). The most common initial symptom was sensory (40%), followed by optical neuritis (25.7%). Expanded Disability Status Scale average score was 2.4. The relapsing-remitting form was predominant (88.6%), most (74.3%) were on immunomodulatory treatment and (40%) had college education. CONCLUSION: Prevalence of MS in Uberaba (MG) is considered average in accordance to Kurtzke and Page and clinical features are consistent with most Brazilian studies.

Clinical and epidemiological profile of patients with multiple sclerosis in Uberaba, Minas Gerais, Brazil / Perfil clínico e epidemiológico dos pacientes com esclerose múltipla na cidade de Uberaba (MG), Brasil

Multiple sclerosis (MS) is an immune-mediated disease that affects the central nervous system. Clinical presentation and prevalence vary widely around the world. OBJECTIVE: To describe the clinical and epidemiological aspects of patients with MS in Uberaba (MG). METHOD: We conducted a transversal descriptive study, with data analysis of 35 patients with MS. RESULTS: Prevalence of MS was 12.5 cases/100,000 inhabitants, with a predominance in females (71.4 percent) and Caucasoid (85.7 percent). The current average age was (43.8 ys). The most common initial symptom was sensory (40 percent), followed by optical neuritis (25.7 percent). Expanded Disability Status Scale average score was 2.4. The relapsing-remitting form was predominant (88.6 percent), most (74.3 percent) were on immunomodulatory treatment and (40 percent) had college education. CONCLUSION: Prevalence of MS in Uberaba (MG) is considered average in accordance to Kurtzke and Page and clinical features are consistent with most Brazilian studies.

A esclerose múltipla (EM) é uma doença imunomediada que acomete o sistema nervoso central. Seus aspectos clínicos e prevalência variam consideravelmente em todo o mundo. OBJETIVO: Descrever a prevalência, os aspectos clínicos e epidemiológicos dos pacientes com EM na cidade de Uberaba (MG). MÉTODO: Realizado estudo descritivo transversal, com análise dos dados de 35 pacientes com EM. RESULTADOS: A prevalência de EM foi de 12,5 casos/100.000 habitantes, com predomínio no sexo feminino (71,4 por cento) e etnia caucasóide (85,7 por cento), idade média atual de 43,8 anos. Do total, 40 possuem curso superior. O sintoma inicial mais frequente foi o sensitivo (40 por cento), seguido de neurite óptica (25,7 por cento). A média dos escores da Escala de Status de Incapacidade Expandida foi de 2,4. A forma evolutiva recorrente-remitente foi predominante (88,6 por cento), com (74,3 por cento) dos pacientes em uso de imunomodulador. CONCLUSÃO: A prevalência de EM no município de Uberaba (MG) é considerada média, de acordo com Kurtzke e Page. Os aspectos clínico-epidemiológicos estão em consonância com a maioria dos estudos brasileiros.

Estudo de 127 amostra de líquido cefalorraquidiano (LCA) em pacientes com SIDA / Study of 127 samples of cerebrospinal fluid (CSF) in AIDS patients

Foram estudadas 127 amostras de LCR de pacientes adultos com diagnóstico de síndrome de imunodeficiência adquirida (SIDA. Encontramos anormalidades em 105 (82,6 por cento) amostras, caracterizadas pelo aumentos das proteínas totais 56 (44 por cento), hipercitose 49 (38,6 por cento) e hipoglicorraquia em 23 (18 por cento). As reaçöes imunológicas mostraram-se positivas para toxoplasmose em 38 (29,9 por cento) amostras, sífilis 9 (7 por cento) e cisticercose em 3 (2,3 por cento). O diagnóstico de neurocriptococose foi constatado em 25 (19,8 por cento) do total, meningite bacteriana 2 (1,6 por cento), neurotuberculose 2 (1,6 por cento) e meningite asséptica em 20 (15,7 por cento). Associaçäo das diversas patologias infecciosas ocorreu em 16 (12,6 por cento)

Estudo de 127 amostras de liquido cefalorraquidiano (LCR) em pacientes com SIDA

Foram estudadas 127 amostras de LCR de pacientes adultos com diagnostico de sindrome de imunodeficiencia adquirida (SIDA). Encontramos anormalidades em 105 (82,6 por cento) amostras, caracterizadas por aumento das proteinas totais 56 (44 por cento), hipercitose 49 (38,6 por cento) e hipoglicorraquia em 23 (18 por cento). As reacoes imunologicas mostraram-se positivas para toxoplasmose em 38 (29,9 por cento) amostras, sifilis 9 (7 por cento) e cisticercose em 3(2,3 por cento). O diagnostico de neurocriptococose foi constatado em 25 (19,8 por cento) do total, meningite bacteriana 2(1,6 por cento), neurotuberculose 2(1,6 por cento) e meningite asseptica em 20 (15,7 por cento). Associacao das diversas patologias infecciosas ocorreu em 16 (12,6 por cento).

Proteínas totais do LCR no prognóstico do paciente com acidente vascular encefálico hemorrágico / Total proteins of the CSF in the prognosis of patients with subarachnoid hemorrhage

O prognóstico dos pacientes com acidente vascular encefálico hemorrágico (AVEH) é reservado, apresentando altas taxas de morbidade e mortalidade. Estudos experimentais sugerem que existe alteraçöes da barreira hematoencefálica nos AVEH experimentais e que estas alteraçöes estäo relacionadas ao desenvolvimento do vasoespasmo e pior prognóstico. Distúrbios da barreira hematoencefálica podem ser avaliados pelo estudo da taxa das proteínas totais do LCR. O propósito deste estudo é avaliar o valor da taxa de proteínas totais no prognóstico, em relaçäo à sobrevida, de pacientes com derrame de sangue no espaço subracnóideo. Para tanto foram estudadas 254 fichas de pacientes do Departamento de Neurologia e Neurocirurgia da Escola Paulista de Medicina, com diagnóstico de AVEH, 144 do sexo masculino e 110 do sexo feminino, com idade variando de 8 a 84 anos. Foi verificado que a taxa de proteínas totais está diretamente correlacionada ao prognóstico, em relaçäo à sobrevida, nos pacientes com AVEH. Quanto mais elevada a taxa de proteínas, pior o prognóstico; no material deste estudo todos os pacientes, em número de 15, que tiveram taxa de proteínas totais no LCR acima de 3000mg/10ml faleceram. Este achado indica que a taxa de proteínas totais no LCR de paciente com AVEH é um preditor de óbito. A análise comparativa entre os sexos näo mostrou diferença estatística. Porém quando foram correlacionados o sexo, a idade e a taxa de proteínas, verificou-se que homens acima de 50 anos tiveram taxa de proteínas mais elevadas que mulheres na mesma faixa etária, demonstando que homens idosos têm pior prognóstico que as mulheres nessa mesma faixa etária