Background: Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT. Methods: Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function. Results: Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery. Conclusion: VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.
Objective: To analyse the diagnostic capacity of barium enema (BE) in the diagnostic investigation for Hirschsprung's disease (HD) was analyzed for transition zone (TZ) identification and rectosigmoid index (RSI) ≤1.0 determination. Patients and Methods: BE images were analyzed retrospectively by 2 examiners and the results were compared with the histopathology of rectal biopsies. Results: TZ identification and RSI ≤1.0 were assessed separately and combined in 43 patients. Twelve (27.9%) patients had the diagnosis of HD based on rectal biopsies. TZ identification presented better diagnostic capacity for the 2 examiners than RSI ≤1.0. However, interexaminer agreement was higher for RSI ≤1.0 than for TZ identification. The combination of TZ identification and RSI ≤1.0 increased the sensitivity (83.3%–92.3%) and the negative predictive value (90.4%–92.3%). Conclusion: Therefore, the high diagnostic sensitivity of TZ identification combined to RSI ≤1.0 reinforces the usefulness of these BE parameters in the screening for Hirschsprung's disease.
Objectives: To evaluate the efficacy of blood transfusion compared to no intervention in obstetric patients. Material and methods:A systematic review was performed with Cochrane Database of Clinical Trials, PubMed, EMBASE and LILACS databases searched as of September, 2016. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data, using the GRADE approach.Results: Five studies within a total of 6,297 met the inclusion criteria, with women generally aged 20-40 years. Three included studies allocated women to receive blood transfusion or no intervention. Two other studies allocated women with either restricted or full blood supplies. The major issue regarding risk of bias was the extent of concealment of randomization and blinding. There was no statistically significant difference between blood transfusion versus no transfusion or restricted blood supply on mortality (relative risk 0.82 [95% confidential interval 0.32 to 2.09], p = 0.68; two studies; I 2 = not applicable). Conclusions:Very low-quality evidence suggests no significant difference between blood transfusion and no intervention in obstetric patients, underlining the need for more robust clinical trials evaluating this area.
Introduction: The higher prevalence of stroke in the elderly population is increasingly recognized, but safety and efficacy of thrombolysis in this population are still debatable in clinical practice. Methods: This is a retrospective cohort study of stroke patients admitted in a health center in Brazil. We investigated the effectiveness of thrombolysis in stroke patients aged above 80y. The primary outcome was Rankin at discharge and the secondary outcome was lethality. Results: We studied a cohort of 185 stroke patients aged above 80. Mean age was 84.9 (standard deviation [SD] 4.1). The majority was female (121–65.4%). Mean initial National Institute of Health Stroke Scale (NIHSS) was 12.2 (SD 6.7). Most patients had arterial hypertension (83.2%) with equal proportion between sexes. Thrombolysis was performed in 20.8%. The proportion of risk factors was the same for those who received or not thrombolytic therapy. Age, Aspects score, and comorbidity index were similar for the groups, as was the proportion of female/male. The rate of in-hospital infection was insignificantly higher in the non-thrombolytic group (34.9% for non-thrombolytic group and 25% for the thrombolytic one; P = 0.285). NIHSS was significantly higher for the thrombolytic group (14.6 versus 10.9 points – P = 0.0007). The rate of case-fatality was 30.1% for the non-thrombolytic group and 19.3% for those treated with thrombolysis. A multivariate logistic regression analysis disclosed in-hospital infection as the main predictor of lethality (odds ratio [OR] 3.1; CI 1.33–7.15; P < 0.0001) for both groups. Predictors of a good outcome at discharge (Rankin score ≤ 2) included a lower initial NIHSS score and the treatment with thrombolysis (adjusted OR 5.3; CI 1.79–15.80). Conclusion: Thrombolysis in stroke patients aged 80 years was safe and effective, disclosing the strongest predictor of good short-term outcome.
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