Background: stroke is a highly common neurologic disease, with great mortality and morbidity rates. It is a cerebrovascular condition characterized by a deficiency in the blood supply that should reach the nervous tissue. It can be classified into two types, depending on its etiology: ischemic and hemorrhagic stroke, the first one being the most common. The correct diagnosis of this condition is a challenge, especially in cases of confusing conditions, such as stroke mimics (SM). A highly detailed epidemiologic description and previous knowledge of the disease can help to recognize it. In cases of stroke, a quick revascularization treatment is necessary for a good clinical outcome, however, the inadvertent administration of thrombolytics to the patient with SM can cause hemorrhage and death, as well as unnecessary costs. The present study consisted in evaluating the patients admitted in the stroke unit of the Clinical Hospital Complex of the Federal University of Paraná in Brazil, between October 2012 and September 2013, and describing the prevalence, clinical presentation, etiology, and treatment outcomes in the SM cases primarily diagnosed as a stroke. Results: 10 patients (7.1%) of the total number of patients with less than four hours of symptoms onset were considered SM and six were submitted to intravenous thrombolysis. The main clinical presentations were motor symptoms (90%) and dysarthria and sensitive symptoms (60%). Regarding the etiology of the patients with SM, six patients (60%) had functional disorders, one (10%) had Todd paresis, one (10%) exogenous intoxication, one (10%) diabetic ketoacidosis, and one (10%) presented with a clinically isolated syndrome. Conclusions: our results showed that an important percentage of patients admitted to a stroke unit are SM and that a significant part of these SM is subjected to unnecessary thrombolytic procedures. Thus, further studies are necessary and important to develop well-defined guidelines that stratify the risk of SM and evaluate, based on the stratification, the risk-benefit of soliciting imaging methods that can help to distinguish between stroke and SM.
Background: Headache is the most frequent neurological complaint in the population and the group of tension-type headaches (TTH) is the most prevalent subtype. Nevertheless, more information about the clinical features of headaches in patients attended at specialized centers are demanded. Methods: Cross-sectional, descriptive study. Data from patients referred to an outpatient specialized headache center from 2018 to 2019 were analyzed and clinical and epidemiological information was collected. This study was authorized by the research ethics committee of the HUUFJF (CAAE 03530818.9.0000.5133). Results: Data from 153 patients were assessed. The mean age of patients was 45,6 years and most cases were women (80,4%). The most frequent diagnosis were migraine (49,7%), TTH (22,8%) and temporomandibular disorders (8,5%). The prevalence of chronic headaches was 46,6%. Analgesic abuse was identified in 32% of participants, with a higher prevalence in women (Fischer’s exact test, P=0,05). Prophylactic treatment was used by 84,3% of the subjects. Pain was self-reported mild in 21,6% of cases, moderate in 30,1% and severe in 47,1%. The pain severity was inversely proportional to age (P=0,012). The most frequent associated symptoms were photophobia (57,5%), phonophobia (56,9%), nausea/ vomiting (47,1%). Conclusions: The findings show important differences in the prevalence of headache cases in specialized centers compared to the general population. Given the high prevalence of analgesic abuse reported, the development of effective educational programs for patients and healthcare providers at primary and secondary health services, might reduce the social burden of chronic headaches and decrease the demand for consultations on specialized headache clinics.
Background and Aims In patients on hemodialysis, sedentary lifestyle is highly prevalent and associated with elevated mortality. The sedentary lifestyle of these patients can be confirmed by assessing the physical activity level (PAL) evaluated by accelerometers and questionnaires. Considering that the PAL questionnaires are quick to perform and inexpensive, the aim of this study was to evaluate the association of three PAL questionnaires with daily step counts measured by an accelerometer in patients on hemodialysis. Method A cross-sectional study was conducted with patients aged ≥18 years who were undergoing hemodialysis treatment for at least three months. Patients were excluded if presented severe and unstable comorbidities, psychiatric or cognitive disorders, and hospitalization in the past three months. The daily step counts were recorded in the ActiGraph accelerometer (wGT3X-BT) during seven days, and analyzed by excluding the first and last day of recording and calculating the mean among the valid days (≥ 8 hours of wear time). Subsequently, the Human Activity Profile (HAP) questionnaire, the International Physical Activity Questionnaire (IPAQ) and the physical functioning domain of the 36-Item Short Form Survey (PF SF-36) were applied. The normality of the data was analyzed using the Shapiro‒Wilk test. The associations between each PAL questionnaire score and daily step counts were tested using Spearman´s correlation coefficients. Then, three multiple linear regression models were constructed with daily step counts as the dependent variable and PAL questionnaire score and potential confounders (age, gender, educational level, time on dialysis, hemoglobin, and body mass index) as independent variables. A p value <0.05 was considered as statistically significant. Results This study included 105 patients (59.2 ± 12.5 years, 60.0% male). Daily step counts correlated significantly with the questionnaires scores (HAP, ρ = 0.552, p < 0.001; IPAQ, ρ = 0.386, p < 0.001; PF SF-36, ρ = 0.337, p < 0.001). After adjusting for potential confounders, the multiple linear regression models showed an association between daily step counts with the HAP questionnaire score (R2 = 0.31; adjusted R2 = 0.26; p < 0.001) and PF SF-36 score (R2 = 0.23; adjusted R2 = 0.18; p = 0.001). Conclusion The PAL questionnaires were associated with daily step counts measured by an accelerometer in patients on hemodialysis. However, our results suggest that the HAP was the best questionnaire to evaluate PAL in these patients.
A síndrome dos ovários policísticos (SOP) é a doença endócrina mais comum entre mulheres em idade reprodutiva e corresponde à principal causa de anovulação. Além de suas principais manifestações clínicas, a doença tem grande relação com hiperinsulinismo e resistência à insulina. Assim, tal associação entre SOP e resistência insulínica desencadeou a realização de estudos sobre o uso de metformina no tratamento da síndrome, tendo em vista sua ação comprovada como sensibilizador de insulina. METODOLOGIA: O estudo trata-se de uma revisão narrativa da literatura com objetivo de esclarecer o impacto do uso de metformina na SOP. RESULTADOS: Como referencial ao artigo, foram selecionados dez estudos de revisões, quatro ensaios clínicos, duas diretrizes, um estudo prospectivo e um manuscrito. DISCUSSÃO: O uso de metformina no tratamento da SOP apresentou resultados de significativa relevância, principalmente em pacientes com obesidade e hiperinsulinemia: a droga diminui Índice de Massa Corporal (IMC) e os níveis de insulina em jejum. Todavia, foi evidenciado que a metformina em comparação a outros medicamentos apresenta resultados mais baixos em taxa de ovulação. CONCLUSÃO: A metformina se mostrou eficaz como terapia combinada com Clomifene e Letrozol no tratamento da SOP, porém não houve um consenso quanto ao uso em monoterapia.
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a neurovascular condition characterized by a severe sudden-onset headache that may be associated with focal neurological deficits. On imaging, the suggestive finding corresponds to multifocal vasoconstriction of the cerebral arteries, with a spontaneous resolution of approximately 12 weeks. The identification of precipitating factors and diagnosis must be carried out early, so that adequate management is established and the patient has a good prognosis, given the risk of secondary complications and residual neurological deficits. This study consists of a literature review based on the analysis of articles published between 2017 and 2022 in PubMed, SciELO, and ScienceDirect on RCVS, intending to understand the clinical and radiological characteristics, diagnosis, treatment, and prognosis of patients with RCVS. The pathophysiology, drug management, and prognosis still lack solid evidence; therefore, further studies on RCVS are needed to expand medical knowledge and avoid underdiagnosis and inadequate treatment of this important condition.
Background: Alzheimer’s disease (AD) represents one of the main causes of cognitive and functional decline in the world. Concomitant with pharmacological treatment, the practice of aerobic exercises (AE) can help in the symptomatic control of the disease. Objectives: To evaluate the effects of AE on activities of daily living and cognition in patients with AD. Methods: A systematic review was undertaken. EMBASE, Pubmed and BVS databases were searched using the terms “Alzheimer disease”, “Alzheimer syndrome” and “Alzheimer dementia”; “aerobic” and “exercise”. The inclusion criteria were: randomized controlled trials from 2016 to 2021, English language studies and human studies. Among 854 studies found, six were included in the review. Results: The potential benefits of AE training in AD patients are: improvement of functioning, quality of life and cognitive performance; better control of neuropsychiatric symptoms and possible reduction of systemic inflammation. Conclusions: AEs are associated with cognitive and functional performance gain in AD, probably related to synaptic plasticity optimization and improvement of the feeling of well-being. Although AEs may improve cognitive and neuropsychiatric symptoms, the response to treatment is individual. Future longitudinal studies with larger cohorts and functional neuroimaging studies are required for a better understanding of the real benefit of AE in AD.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.