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[PMID]: 23530151 [Au] Autor: Katan M; Moon YP; Paik MC; Sacco RL; Wright CB; Elkind MS [Ad] Endereço: Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA. mk3270@columbia.edu [Ti] Título: Infectious burden and cognitive function: the Northern Manhattan Study. [So] Source: Neurology;80(13):1209-15, 2013 Mar 26. [Is] ISSN: 1526-632X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: We hypothesized that infectious burden (IB), a composite serologic measure of exposure to common pathogens (i.e., Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpes simplex virus 1 and 2) associated with vascular risk in the prospective Northern Manhattan Study (NOMAS), would also be associated with cognition. METHODS: Cognition was assessed using the Mini-Mental State Examination (MMSE) at enrollment and the modified Telephone Interview for Cognitive Status (TICS-m) at annual follow-up visits. Adjusted linear and logistic regressions were used to measure the association between IB index and MMSE. Generalized estimating equation models were used to evaluate associations with TICS-m and its change over time. RESULTS: Serologies and cognitive assessments were available in 1,625 participants of the NOMAS cohort. In unadjusted analyses, higher IB index was associated with worse cognition (change per standard deviation [SD] of IB for MMSE was -0.77, p < 0.0001, and for first measurements of TICS-m was -1.89, p < 0.0001). These effects were attenuated after adjusting for risk factors (for MMSE adjusted change per SD of IB = -0.17, p = 0.06, for TICS-m adjusted change per SD IB = -0.68, p < 0.0001). IB was associated with MMSE ≤24 (compared to MMSE >24, adjusted odds ratio 1.26 per SD of IB, 95% confidence interval 1.06-1.51). IB was not associated with cognitive decline over time. The results were similar when IB was limited to viral serologies only. CONCLUSION: A measure of IB associated with stroke risk and atherosclerosis was independently associated with cognitive performance in this multiethnic cohort. Past infections may contribute to cognitive impairment. [Mh] Termos MeSH primário: Transtornos Cognitivos/etiologia Cognição/fisiologia Infecção/complicações Entrevistas como Assunto Entrevista Psiquiátrica Padronizada [Mh] Termos MeSH secundário: Idoso Transtornos Cognitivos/diagnóstico Estudos de Coortes Feminino Humanos Masculino Meia-Idade Testes Neuropsicológicos Estudos Prospectivos Fatores de Risco Acidente Vascular Cerebral/complicações Acidente Vascular Cerebral/diagnóstico [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 130326 [St] Status: MEDLINE [do] DOI: 10.1212/WNL.0b013e3182896e79

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[PMID]: 23486872 [Au] Autor: Matosevic B; Knoflach M; Werner P; Pechlaner R; Zangerle A; Ruecker M; Kirchmayr M; Willeit J; Kiechl S [Ad] Endereço: Department of Neurology, Innsbruck Medical University, Innsbruck, Austria. [Ti] Título: Fibrinogen degradation coagulopathy and bleeding complications after stroke thrombolysis. [So] Source: Neurology;80(13):1216-24, 2013 Mar 26. [Is] ISSN: 1526-632X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: Prominent fibrinogen cleavage by recombinant tissue plasminogen activator and formation of fibrinogen degradation products with anticoagulant properties was proposed to amplify the risk of thrombolysis-related bleeding complications, but supportive evidence mainly derived from studies on myocardial infarction. METHODS: This study included 547 consecutive stroke patients treated with recombinant tissue plasminogen activator, who underwent repeated assessment of fibrinogen levels before and 6 hours after thrombolysis. Symptomatic intracranial hemorrhages were ascertained using National Institute of Neurological Disorders and Stroke criteria. RESULTS: Intracranial hemorrhage or systemic bleeding events manifested in 47 patients (8.6%). A decrease ≥200 mg/dL in the fibrinogen level 6 hours after thrombolysis emerged as a significant and independent predictor for bleeding risk (multivariable odds ratio [95% confidence interval] 4.53 [2.39-8.60], p < 0.001). The population-attributable risk was 39.9% (95% confidence interval, 19.0-60.2) for any major bleeding, causality assumed, and surpassed 50% in patients with less severe strokes (NIH Stroke Scale score ≤16). Quantification of fibrinogen depletion after stroke thrombolysis significantly improved routine risk prediction of bleeding complications as indicated by an increase in the C-statistics from 0.712 to 0.798 (p = 0.015) and a net reclassification index of 0.341 (p < 0.001). A prospective bicenter validation sample (n = 148) corroborates the key findings of this study and suggests positive and negative predictive values of fibrinogen depletion for any major bleeding of 29.2% and 93.5%. CONCLUSION: This study lends strong support to the concept that prominent fibrinogen turnover after IV stroke thrombolysis-a condition termed "early fibrinogen degradation coagulopathy"-is a relevant cause of major bleeding complications. Rigorous testing of more fibrin-specific thrombolytic agents in the setting of acute stroke is warranted. [Mh] Termos MeSH primário: Fibrinogênio/metabolismo Fibrinolíticos/efeitos adversos Hemorragia/induzido quimicamente Acidente Vascular Cerebral/quimioterapia Terapia Trombolítica/efeitos adversos Ativador de Plasminogênio Tecidual/efeitos adversos [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Idoso de 80 Anos ou mais Transtornos da Coagulação Sanguínea/quimioterapia Feminino Fibrinolíticos/uso terapêutico Hemorragia/complicações Humanos Masculino Meia-Idade Estudos Prospectivos Risco Acidente Vascular Cerebral/complicações Ativador de Plasminogênio Tecidual/uso terapêutico Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Fibrinolytic Agents); 9001-32-5 (Fibrinogen); EC 3.4.21.68 (Tissue Plasminogen Activator) [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 130326 [St] Status: MEDLINE [do] DOI: 10.1212/WNL.0b013e3182897015

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[PMID]: 23468545 [Au] Autor: Brush LN; Monagle PT; Mackay MT; Gordon AL [Ad] Endereço: School of Medicine, University of Melbourne, Australia. [Ti] Título: Hypertension at time of diagnosis and long-term outcome after childhood ischemic stroke. [So] Source: Neurology;80(13):1225-30, 2013 Mar 26. [Is] ISSN: 1526-632X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To determine the prevalence of hypertension (HPT) in the acute phase after ischemic stroke (IS) and explore its relationship to outcome. METHODS: We performed a retrospective review of children aged 1 month to 18 years with first IS admitted to a tertiary hospital between 2003 and 2008. Blood pressure readings recorded over the first 72 hours after diagnosis and morbidity or mortality at 12 months were documented. HPT was defined as 2 consecutive readings of systolic blood pressure ≥95th percentile for age. RESULTS: Ninety children were identified (median age 3.8 years). Fifty-three of 84 patients (63%) who had blood pressure readings available had at least 1 episode of HPT and 19 (22%) had HPT on 3 consecutive days. HPT was more prevalent at both ends of the age spectrum. The relative risk of 12-month mortality was 4.5 times higher (95% confidence interval = 0.6-34.5, p = 0.096) and relative risk of death in the hospital was 1.7 times higher (95% confidence interval = 1.4-2.0, p = 0.05) if the patient experienced HPT. There was no association between HPT and vascular territory, etiology, or neurologic disability. CONCLUSIONS: HPT is prevalent in children with IS in the first 3 days after diagnosis and is associated with increased risk of death. Larger prospective studies involving systematic recording of blood pressure are required to delineate the impact of HPT on risk of death or disability. [Mh] Termos MeSH primário: Isquemia Encefálica/epidemiologia Hipertensão/diagnóstico Acidente Vascular Cerebral/epidemiologia [Mh] Termos MeSH secundário: Adolescente Fatores Etários Pressão Sanguínea Isquemia Encefálica/mortalidade Criança Pré-Escolar Feminino Humanos Hipertensão/epidemiologia Hipertensão/mortalidade Lactente Masculino Prevalência Estudos Retrospectivos Risco Acidente Vascular Cerebral/complicações Acidente Vascular Cerebral/diagnóstico Acidente Vascular Cerebral/mortalidade Fatores de Tempo Resultado de Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 130326 [St] Status: MEDLINE [do] DOI: 10.1212/WNL.0b013e3182896ffb

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[PMID]: 23509051 [Au] Autor: Walters MR; Williamson C; Lunn K; Munteanu A [Ti] Título: Chocolate consumption and risk of stroke: A prospective cohort of men and meta-analysis. [So] Source: Neurology;80(12):1173-4, 2013 Mar 19. [Is] ISSN: 1526-632X [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Cacau Acidente Vascular Cerebral/epidemiologia [Mh] Termos MeSH secundário: Humanos Masculino [Pt] Tipo de publicação: COMMENT; EDITORIAL [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 130319 [St] Status: MEDLINE [do] DOI: 10.1212/01.wnl.0000428365.81656.e0

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[PMID]: 23446683 [Au] Autor: Woitzik J; Hecht N; Pinczolits A; Sandow N; Major S; Winkler MK; Weber-Carstens S; Dohmen C; Graf R; Strong AJ; Dreier JP; Vajkoczy P; COSBID study group [Ad] Endereço: Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany. johannes.woitzik@charite.de [Ti] Título: Propagation of cortical spreading depolarization in the human cortex after malignant stroke. [So] Source: Neurology;80(12):1095-102, 2013 Mar 19. [Is] ISSN: 1526-632X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To investigate hemodynamic response pattern and spatiotemporal propagation of cortical spreading depolarization in the peri-infarct region of malignant hemispheric stroke. METHODS: In this prospective observational case study we used intraoperative laser speckle technology to measure cerebral blood flow in patients with malignant hemispheric stroke. Additionally, postoperative occurrence of cortical spreading depolarization was monitored using a subdural recording strip for electrocorticography and infarct progression was assessed by serial MRI. RESULTS: In 7 of 20 patients, 19 blood flow changes typical of cortical spreading depolarizations occurred during a 20-minute period. Thirteen events were characterized by increase, 2 by biphasic response, and 4 by decrease of blood flow. Propagation velocity ranged from 1.7 to 9.2 mm/min and propagation area from 0.1 to 4.8 cm(2). Intrinsic optical signal alterations preceded and low-frequency vascular fluctuations were suppressed during the hemodynamic responses. A mean number of 56 ± 82 cortical spreading depolarizations per patient was recorded and a mean infarct progression of 30 ± 13 cm(3) was detected in 5 of 7 patients. CONCLUSIONS: We visualize the spatiotemporal propagation of spreading depolarizations in the human cerebral cortex intraoperatively. In patients with focal ischemia, multiple cortical spreading depolarizations with either hyperemic or hypoemic flow responses occurred. Our data suggest that, in patients with focal ischemia, cortical spreading depolarizations are associated with both unfavorable and protective hemodynamic responses. [Mh] Termos MeSH primário: Córtex Cerebral/fisiologia Infarto Cerebral/fisiopatologia Depressão Alastrante da Atividade Elétrica Cortical/fisiologia Hemodinâmica/fisiologia Acidente Vascular Cerebral/fisiopatologia [Mh] Termos MeSH secundário: Infarto Cerebral/epidemiologia Infarto Cerebral/cirurgia Humanos Monitorização Intraoperatória/métodos Estudos Prospectivos Acidente Vascular Cerebral/epidemiologia Acidente Vascular Cerebral/cirurgia [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 130319 [St] Status: MEDLINE [do] DOI: 10.1212/WNL.0b013e3182886932

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[PMID]: 23390923 [Au] Autor: Broderick JP; Palesch YY; Demchuk AM; Yeatts SD; Khatri P; Hill MD; Jauch EC; Jovin TG; Yan B; Silver FL; von Kummer R; Molina CA; Demaerschalk BM; Budzik R; Clark WM; Zaidat OO; Malisch TW; Goyal M; Schonewille WJ; Mazighi M; Engelter ST; Anderson C; Spilker J; Carrozzella J; Ryckborst KJ; Janis LS; Martin RH; Foster LD; Tomsick TA; Interventional Management of Stroke (IMS) III Investigators [Ad] Endereço: Department of Neurology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH 45267-0525, USA. joseph.broderick@uc.edu. [Ti] Título: Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. [So] Source: N Engl J Med;368(10):893-903, 2013 Mar 7. [Is] ISSN: 1533-4406 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Endovascular therapy is increasingly used after the administration of intravenous tissue plasminogen activator (t-PA) for patients with moderate-to-severe acute ischemic stroke, but whether a combined approach is more effective than intravenous t-PA alone is uncertain. METHODS: We randomly assigned eligible patients who had received intravenous t-PA within 3 hours after symptom onset to receive additional endovascular therapy or intravenous t-PA alone, in a 2:1 ratio. The primary outcome measure was a modified Rankin scale score of 2 or less (indicating functional independence) at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). RESULTS: The study was stopped early because of futility after 656 participants had undergone randomization (434 patients to endovascular therapy and 222 to intravenous t-PA alone). The proportion of participants with a modified Rankin score of 2 or less at 90 days did not differ significantly according to treatment (40.8% with endovascular therapy and 38.7% with intravenous t-PA; absolute adjusted difference, 1.5 percentage points; 95% confidence interval [CI], -6.1 to 9.1, with adjustment for the National Institutes of Health Stroke Scale [NIHSS] score [8-19, indicating moderately severe stroke, or ≥20, indicating severe stroke]), nor were there significant differences for the predefined subgroups of patients with an NIHSS score of 20 or higher (6.8 percentage points; 95% CI, -4.4 to 18.1) and those with a score of 19 or lower (-1.0 percentage point; 95% CI, -10.8 to 8.8). Findings in the endovascular-therapy and intravenous t-PA groups were similar for mortality at 90 days (19.1% and 21.6%, respectively; P=0.52) and the proportion of patients with symptomatic intracerebral hemorrhage within 30 hours after initiation of t-PA (6.2% and 5.9%, respectively; P=0.83). CONCLUSIONS: The trial showed similar safety outcomes and no significant difference in functional independence with endovascular therapy after intravenous t-PA, as compared with intravenous t-PA alone. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00359424.). [Mh] Termos MeSH primário: Procedimentos Endovasculares/métodos Fibrinolíticos/uso terapêutico Acidente Vascular Cerebral/quimioterapia Trombectomia Ativador de Plasminogênio Tecidual/uso terapêutico [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Angiografia Cerebral Hemorragia Cerebral/etiologia Terapia Combinada Avaliação da Deficiência Procedimentos Endovasculares/efeitos adversos Feminino Fibrinolíticos/efeitos adversos Humanos Infusões Intravenosas Masculino Meia-Idade Acidente Vascular Cerebral/mortalidade Acidente Vascular Cerebral/cirurgia Trombectomia/instrumentação Ativador de Plasminogênio Tecidual/efeitos adversos Tomografia Computadorizada por Raios X Resultado de Tratamento Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Fibrinolytic Agents); EC 3.4.21.68 (Tissue Plasminogen Activator) [Em] Mês de entrada: 1303 [Cu] Atualização por classe: 130513 [Lr] Data última revisão: 130513 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 130307 [Cl] Clinical Trial: ClinicalTrial [St] Status: MEDLINE [do] DOI: 10.1056/NEJMoa1214300

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[PMID]: 23429336 [Au] Autor: Tényi T [Ad] Endereço: Pecsi Tudomanyegyetem Pszichiatriai es Pszichoterapias Klinika, Pecs, Hungary, E-mail: tamas.tenyi@aok.pte.hu. [Ti] Título: The madness of Dionysus -- six hypotheses on the illness of Nietzsche. [So] Source: Psychiatr Hung;27(6):420-5, 2012. [Is] ISSN: 0237-7896 [Cp] País de publicação: Hungary [La] Idioma: eng [Ab] Resumo: BACKGROUND: Friedrich Nietzsche (1844-1900) is considered as one of the most influential modern thinkers of the last two centuries. The great philosopher and poet developed a mental illness at the age of 44 and died at the age of 56. Pathological examination was not undertaken. At that time Nietzsche was diagnosed as having atypical paralysis progressiva, however recently five other probable diagnoses appeared in literature. METHOD: Literature search in MEDLINE and Web of Science on the illness of Nietzsche. RESULTS: Six hypotheses were identified: 1. Paralysis progressiva (General paralysis of the insane) 2. Bipolar affective disorder followed by vascular dementia 3. Hereditary form of frontotemporal dementia 4. Brain tumor 5. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) 6. Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome. CONCLUSION: Developments in neurology and molecular genetics give new perspectives to the secret of Nietzsche's illness and also there is a consensus on the questioning of the original paralysis progressiva concept. As there was no postmortem, the clinical speculations on the medical problems of the great philosopher remain a challenge. [Mh] Termos MeSH primário: Transtorno Bipolar/história Neoplasias Encefálicas/história CADASIL/história Demência Vascular/história Pessoas Famosas Demência Frontotemporal/história Síndrome MELAS/história Neurossífilis/história [Mh] Termos MeSH secundário: Acidose Láctica/história Transtorno Bipolar/diagnóstico Neoplasias Encefálicas/diagnóstico CADASIL/diagnóstico Demência Vascular/diagnóstico Demência Frontotemporal/diagnóstico História do Século XIX Humanos Síndrome MELAS/diagnóstico Neurossífilis/diagnóstico Filosofia Acidente Vascular Cerebral/história [Pt] Tipo de publicação: BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE [Ps] Nome de pessoa como assunto: Nietzsche F [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 130222 [St] Status: MEDLINE

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[PMID]: 23265344 [Au] Autor: Macchia A; Grancelli H; Varini S; Nul D; Laffaye N; Mariani J; Ferrante D; Badra R; Figal J; Ramos S; Tognoni G; Doval HC; GESICA Investigators [Ad] Endereço: Fundación GESICA (Grupo de Estudio de Investigación Clínica en Argentina), Buenos Aires, Argentina. macchia@negrisud.it [Ti] Título: Omega-3 fatty acids for the prevention of recurrent symptomatic atrial fibrillation: results of the FORWARD (Randomized Trial to Assess Efficacy of PUFA for the Maintenance of Sinus Rhythm in Persistent Atrial Fibrillation) trial. [So] Source: J Am Coll Cardiol;61(4):463-8, 2013 Jan 29. [Is] ISSN: 1558-3597 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVES: The aim of this study was to evaluate the efficacy of polyunsaturated fatty acids (n-3 PUFA) for the prevention of recurrent atrial fibrillation (AF) in patients with normal sinus rhythm. BACKGROUND: Current pharmacological treatments to limit recurrent AF in patients with previous AF have limited efficacy and high rates of adverse events. Results of trials that tested the efficacy of n-3 PUFA provided heterogeneous results. METHODS: This was a prospective, randomized, double-blind, placebo-controlled, multicenter trial involving 586 outpatient participants with confirmed symptomatic paroxysmal AF that required cardioversion (n = 428), at least 2 episodes of AF in the 6 months before randomization (n = 55), or both (103). Patients were randomly allocated to n-3 PUFA (1 g/day) or placebo for 12 months. The primary endpoint was symptomatic recurrence of AF. RESULTS: There were no significant differences between patients allocated to placebo and those who received n-3 PUFA for the main outcome. At 12 months, 56 of 297 participants (18.9%) in the placebo group and 69 of 289 participants (24.0%) in the n-3 PUFA group had a recurrent symptomatic AF (hazard ratio: 1.28, 95% confidence interval: 0.90 to 1.83, p = 0.17). There was no difference between treatment with placebo and n-3 PUFA for any of the other pre-specified endpoints, including the composite of all-cause mortality, nonfatal stroke, nonfatal acute myocardial infarction, systemic embolism, heart failure development, or severe bleeding that occurred in 20 (6.7%) and 16 (5.5%) of patients randomized to placebo or n-3 PUFA, respectively (hazard ratio: 0.86, 95% confidence interval: 0.44 to 1.66, p = 0.65). CONCLUSIONS: Pharmacological supplementation with 1 g of n-3 PUFA for 1 year did not reduce recurrent AF. (Randomized Trial to Assess Efficacy of PUFA for the Maintenance of Sinus Rhythm in Persistent Atrial Fibrillation [FORWARD]; NCT00597220). [Mh] Termos MeSH primário: Antiarrítmicos/administração & dosagem Fibrilação Atrial Cardioversão Elétrica/métodos Ácidos Graxos Ômega-3/administração & dosagem Testes de Função Cardíaca/métodos Acidente Vascular Cerebral/etiologia [Mh] Termos MeSH secundário: Idoso Fibrilação Atrial/diagnóstico Fibrilação Atrial/mortalidade Fibrilação Atrial/fisiopatologia Fibrilação Atrial/terapia Suplementos Dietéticos Método Duplo-Cego Eletrocardiografia Determinação de Ponto Final/estatística & dados numéricos Feminino Hospitalização/estatística & dados numéricos Humanos Masculino Meia-Idade Recidiva/prevenção & controle Acidente Vascular Cerebral/epidemiologia Taxa de Sobrevida Resultado de Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Anti-Arrhythmia Agents); 0 (Fatty Acids, Omega-3) [Em] Mês de entrada: 1304 [Cu] Atualização por classe: 130514 [Lr] Data última revisão: 130514 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 130125 [Cl] Clinical Trial: ClinicalTrial [St] Status: MEDLINE

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[PMID]: 23159474 [Au] Autor: Gupta PK; Ramanan B; Mactaggart JN; Sundaram A; Fang X; Gupta H; Johanning JM; Pipinos II [Ad] Endereço: Department of Surgery, University of Wisconsin Hospital & Clinics, Madison, WI, USA. [Ti] Título: Risk index for predicting perioperative stroke, myocardial infarction, or death risk in asymptomatic patients undergoing carotid endarterectomy. [So] Source: J Vasc Surg;57(2):318-26, 2013 Feb. [Is] ISSN: 1097-6809 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: The latest guidelines recommend performance of carotid endarterectomy (CEA) on asymptomatic patients with high-grade carotid stenosis, only if the combined perioperative stroke, myocardial infarction (MI), or death risk is ≤3%. Our objective was to develop and validate a risk index to estimate the combined risk of perioperative stroke, MI, or death in asymptomatic patients undergoing elective CEA. METHODS: Asymptomatic patients who underwent an elective CEA (n = 17,692) were identified from the 2005-2010 National Surgical Quality Improvement Program, a multicenter, prospective database. Multivariable logistic regression analysis was performed with primary outcome of interest being the composite of any stroke, MI, or death during the 30-day periprocedural period. Bootstrapping was used for internal validation. A risk index was created by assigning weighted points to each predictor using the ß-coefficients from the regression analysis. RESULTS: Fifty-eight percent of the patients were men with a median age of 72 years. Thirty-day incidences of stroke, MI, and death were 0.9% (n = 167), 0.6% (n = 108), and 0.4% (n = 72), respectively. The combined 30-day stroke, MI, or death incidence was 1.8% (n = 324). On multivariable analysis, six independent predictors were identified and a risk index created by assigning weighted points to each predictor using the ß-coefficients from the regression analysis. The predictors included age in years (<60: 0 point; 60-69: -1 point; 70-79: -1 point; ≥80: 2 points), dyspnea (2 points), chronic obstructive pulmonary disease (3 points), previous peripheral revascularization or amputation (3 points), recent angina within 1 month (4 points), and dependent functional status (5 points). Patients were classified as low (<3%), intermediate (3%-6%), or high (>6%) risk for combined 30-day stroke, MI, or death, based on a total point score of <4, 4-7, and >7, respectively. There were 15,249 patients (86.2%) in the low-risk category, 2233 (12.6%) in the intermediate-risk category, and 210 (1.2%) in the high-risk category. CONCLUSIONS: The validated risk index can help identify asymptomatic patients who are at greatest risk for 30-day stroke, MI, and death after CEA, thereby aiding patient selection. [Mh] Termos MeSH primário: Estenose das Carótidas/cirurgia Técnicas de Apoio para a Decisão Endarterectomia das Carótidas/efeitos adversos Endarterectomia das Carótidas/mortalidade Infarto do Miocárdio/mortalidade Acidente Vascular Cerebral/mortalidade [Mh] Termos MeSH secundário: Idoso Doenças Assintomáticas Estenose das Carótidas/complicações Estenose das Carótidas/diagnóstico Estenose das Carótidas/mortalidade Feminino Mortalidade Hospitalar Humanos Incidência Modelos Logísticos Masculino Meia-Idade Análise Multivariada Razão de Chances Seleção de Pacientes Período Perioperatório Valor Preditivo dos Testes Sistema de Registros Reprodutibilidade dos Testes Estudos Retrospectivos Medição de Risco Fatores de Risco Índice de Gravidade de Doença Fatores de Tempo Resultado de Tratamento Estados Unidos/epidemiologia [Pt] Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; VALIDATION STUDIES [Em] Mês de entrada: 1303 [Cu] Atualização por classe: 130513 [Lr] Data última revisão: 130513 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 130122 [St] Status: MEDLINE

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[PMID]: 23020940 [Au] Autor: Eguchi K; Hoshide S; Ishikawa S; Shimada K; Kario K [Ad] Endereço: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan. ke112@jichi.ac.jp [Ti] Título: Short sleep duration and type 2 diabetes enhance the risk of cardiovascular events in hypertensive patients. [So] Source: Diabetes Res Clin Pract;98(3):518-23, 2012 Dec. [Is] ISSN: 1872-8227 [Cp] País de publicação: Ireland [La] Idioma: eng [Ab] Resumo: AIMS: We tested the hypothesis that short sleep duration is not only a risk factor for diabetes, but that the two conditions in combination would be associated with the risk of incident cardiovascular disease (CVD). METHODS: We analyzed 1255 hypertensive patients (mean age: 70.4±9.9 years) with (N=299) and without diabetes (N=956). Short sleep duration was defined as a sleep time <7.5 h. A Hard CVD event was defined as either myocardial infarction, stroke, or sudden cardiac death; and All CVD events as Hard CVD events plus angina, heart failure and end-stage renal disease. RESULTS: When the patients were divided into 4 categories by diabetes (present or absent) and sleep duration (short or long), the diabetes+short sleep group had a significantly higher incidence of both Hard CVD events (HR=2.27, 95% CI=1.17-4.42, P=0.015) and All CVD events (HR=2.47, 95% CI=1.37-4.43, P=0.003) compared with the non-diabetes+long sleep group, independent of significant covariates. There were significant interactions between sleep duration and glycemic control on CVD events. CONCLUSIONS: The combination of both diabetes and short duration of sleep was associated with higher risk of incident CVD compared with those with only one or neither condition. Altered glycemic control and short sleep duration could act synergistically to pose a risk for future CVD. [Mh] Termos MeSH primário: Doenças Cardiovasculares/etiologia Diabetes Mellitus Tipo 2/complicações Hipertensão/complicações Hipertensão/fisiopatologia Pré-Hipertensão/complicações Pré-Hipertensão/fisiopatologia Transtornos do Sono/complicações [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Doenças Cardiovasculares/epidemiologia Estudos de Coortes Morte Súbita Cardíaca/epidemiologia Morte Súbita Cardíaca/etiologia Feminino Seguimentos Humanos Incidência Japão/epidemiologia Masculino Meia-Idade Infarto do Miocárdio/epidemiologia Infarto do Miocárdio/etiologia Modelos de Riscos Proporcionais Estudos Prospectivos Fatores de Risco Índice de Gravidade de Doença Transtornos do Sono/fisiopatologia Acidente Vascular Cerebral/epidemiologia Acidente Vascular Cerebral/etiologia [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 121210 [St] Status: MEDLINE

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