Jefferson Gomes Fernandes

Confiabilidade de escalas de comprometimento neurológico em pacientes com acidente vascular cerebral

Scales for the assessment of neurological impairment are employed in clinical trials, outcome evaluation and in therapeutic decisions. We evaluated the reliability of the Portuguese version of the Rankin Scale (RS), Barthel Index (BI) and the NIHSS (National Institute of Health Stroke Scale) in 51 stroke patients, estimating the agreement of the results for examiners. The interrater reliability was measured using the Kappa Coefficient and Intraclass Correlation Coefficient. The RS showed moderate, substantial and excellent coefficients of agreement. The BI showed from substantial to excellent coefficients of agreement as a whole and also for its constituents. This scale was stratified in prognostic and functional groups, both presenting coefficients of agreement from substantial to excellent. The NIHSS presented excellent agreement on its total and substantial agreements on its individual items. The NIHSS was also stratified in groups of points, which presented moderate or excellent coefficient, and in groups of congruous items, wich showed a moderate to excellent agreement. These results suggest that the Portuguese version of the RS, BI and the NIHSS present adequate reliability.

Antibodies to the atherosclerotic plaque components beta2-glycoprotein I and heat-shock proteins as risk factors for acute cerebral ischemia

One third of cases of cerebral ischemia have no clear etiology. A humoral response to the atherosclerotic plaques components beta2-glycoprotein l (beta2-gpl) and heat-shock proteins (Hsp) might be involved in the pathogenesis of stroke. This case-control study includes a complete profile of anti-beta2-gpl antibodies and testing of IgG antibodies to the 60/65 kilodaltons (kDa) Hsp in stroke patients. Ninety-three patients with acute ischemic stroke and 93 controls were evaluated for age, sex, race, hypertension, smoking, previous cardiopathy, diabetes mellitus, hypercholesterolemia and previous history of cerebral ischemia. lgG/lgM/lgA anticardiolipin (aCL) and anti-beta2-gpl antibodies, as well as lgG antibodies to human 60 kDa Hsp and to Mycobacterium bovis 65 kDa Hsp, were detected by immunoassay. Adjusted odds ratios (OR) were calculated by logistic regression. The adjusted OR for IgA anti-beta2-gpl antibodies was 4.6 (90%Cl 1.5 to 14.3; p = 0.025). The non-adjusted OR for IgG antibodies to Hsp 60 was 26.1. The adjusted OR for IgG antibodies to Hsp 65 was 3.2 (90%Cl 1.2 to 8.3; p = 0.044). The adjusted OR for lgG to any Hsp (60 or 65) was 4.8 (90%Cl 1.9 to 12.1; p = 0.006). This study demonstrates that elevated IgA anti-beta2-gpl and lgG anti-Hsp 60/65 antibodies are associated with increased risk of ischemic stroke. The association occurred independently of other risk factors. This humoral response might link autoimmunity, thrombophilia and atherosclerosis in stroke patients.

Guidelines for acute ischemic stroke treatment - Part I

Executive Committee: Charles André, Aroldo Luiz Bacellar, Daniel da Cruz Bezerra, Roberto Campos, João José Freitas de Carvalho, Gabriel Rodrigues de Freitas, Roberto de Magalhães Carneiro de Oliveira, Sebastião Eurico Melo de Souza, Soraia Ramos Cabette Fábio, Eli Faria Evaristo, Jefferson Gomes Fernandes, Maurício Friedrich, Marcia Maiumi Fukujima, Rubens José Gagliardi, Sérgio Roberto Haussen, Maria Clinete Sampaio Lacativa, Bernardo Liberato, Alexandre L. Longo, Sheila Cristina Ouriques Martins, Ayrton Roberto Massaro, Cesar Minelli, Carla Heloísa Cabral Moro, Jorge El-Kadum Noujaim, Edison Matos Nóvak, Jamary Oliveira-Filho, Octávio Marques Pontes-Neto, César Noronha Raffin, Bruno Castelo Branco Rodrigues, José Ibiapina Siqueira-Neto, Elza Dias Tosta, Raul Valiente, Leonardo Vedolim, Marcelo Gabriel Veja, Leonardo Vedolin, Fábio Iuji Yamamoto, Viviane Flumignan Zétola. Correspondence: Jamary Oliveira-Filho; Rua Reitor Miguel Calmon s/n; Instituto de Ciências da Saúde / sala 455; 40110-100 Salvador BA Brasil; E-mail: jamaryof@ufba.br Conflict of interest: There is no conflict of interest to declare. Received 18 February 2012; Received in final form 22 February 2012; Accepted 29 February 2012 Guidelines for acute ischemic stroke treatment – Part I

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br).

Prevalence and risk factors for stroke in a population of Southern Brazil

UNLABELLED Stroke is the leading cause of death in many countries of Latin America. Population studies are necessary in this region. OBJECTIVES To evaluate the prevalence of stroke and its risk factors in a population of vulnerable communities of southern Brazil. METHODS Population-based crosssectional study with systematic sampling. Individuals aged 20 and over were included (n=3,391). Individuals with previous diagnosis of stroke or identified by a validate stroke questionnaire were compared with those without stroke in many variables. RESULTS 285 individuals (8.4%) had previous stroke. The group without stroke showed greater average of years of study than the group with stroke (p<0.001). Multivariable analysis identified as risk factors for stroke (p<0.05): age from 40 to 59, age from 60 to 79, widowhood, present smoking, previous smoking, hypertension and ischemic heart disease. CONCLUSION The findings in this population indicate the need of preventive cost-effective public health policies in Brazil.

Is there evidence for recommending specific intravenous immunoglobulin formulations? A systematic review of head-to-head randomized controlled trials

Intravenous immunoglobulins (IVIG) have been used for several licensed and off-label indications. Each IVIG product is a unique formulation of IgG and excipients, making them distinct products. How these differences impact on individual IVIG product efficacy and safety are not well established but can be investigated by head-to-head randomized controlled trials (RCT). A systematic review of head-to-head RCT comparing different formulations of IVIG, regardless of the target condition and outcomes investigated. Two reviewers screened 4084 citations retrieved from MEDLINE, Embase, Cochrane and LILACS, and 23 citations were fully-text evaluated. Eight trials were included. The clinical conditions, outcomes and risk of bias were assessed. Of the eight trials included only two investigated products that are currently on the market. One evaluated two Grifols brands used in patients with primary immunodeficiency and another evaluated two Baxter brands used in patients with chronic inflammatory demyelinating polyradiculoneuropathy. There were no differences between the formulations for the outcomes evaluated. In the other trials, either the manufacturers were acquired by other companies or the formulation was withdrawn from the market. As consequence, evidence concerning these products could not be considered. The quality of the studies was low, showing high risk of bias. Direct evidence about the different IVIGs is scarce and, at present, there is no scientific evidence that can be applied for a specific brand or formulation. Further comparative effectiveness studies are highly desirable for a better understanding of the differences in safety and efficacy of IVIGs.

Endovascular thrombectomy for the treatment of acute ischemic stroke

UNLABELLED Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments. OBJECTIVE To systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs). METHOD Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015). RESULTS From the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020. CONCLUSION Evidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.

Revascularização clínica e intervencionista no acidente vascular cerebral isquêmico agudo: opinião nacional

Arq Neuropsiquiatr 2006;64(2-A):342-348* P a rticipantes: Ana Claudia Ferraz, Alexandre L. Longo, Aroldo Luiz Bacellar, Ay rton Roberto Massaro, Carla Heloisa Cabral Moro ,Cesar N. Raffin, Charles Andre, Edson Matos Novak, Eli Faria Evaristo, Elza Dias Tosta, Fabio Iuji Yamamoto, Gabriel Rodriguez deF reitas, Ibsen Thadeo Damiani, Jamary Oliveira Filho, Jayme Antunes Maciel Junior, Jefferson Gomes Fernandes, Jorge El KadumNoujaim, Jose Ibiapina Siqueira Neto, Marcia Maiumi Fukujima, Maria Lucia Pimentel, Mauricio Friedrich, Paulo Puglia, Roberto deMagalhaes Carn e i ro Oliveira, Rogerio Darwich, Rubens Jose Gagliardi, Sebastiao Eurico Mello-Souza, Sergio Roberto Haussen,Soraia Ramos Cabete Fabio, Viviane Flumignan Zetola, Waldir Antonio Tognola. O forum de “Opiniao Nacional” foi realizado emSao Paulo-SP, no dia 1o de julho de 2004. Os temas de trabalho foram divididos para analise inicial por grupos de 5 a 6 neuro l o g i s t a s .Os coordenadores do presente tema foram os Drs. Cesar N. Raffin e Jefferson Gomes Fernandes. Um esboco de texto foi propostopara analise em plenario em leitura publica. Comentarios, criticas e sugestoes de mudancas foram amplamente debatidos por esteplenario e incorporados ao texto final, redigido pelo grupo responsavel pelo tema. Recebido 8 Novembro 2005. Aceito 24 Janeiro 2006.

Does treatment with N-butyl cyanoacrylate embolization protect against hemorrhage in cerebral arteriovenous malformations?

OBJECTIVE To assess the role of this procedure to prevent hemorrhage in cerebral arteriovenous malformations (cAVM). METHOD Between 1992 and 2000, we studied 104 patients submitted to embolization as the main treatment. Patients were followed until hemorrhage or death. RESULTS Follow-up ranged from 1.6 months to 8 years. The most frequent presentations were hemorrhage (50%) and seizures (38%). In addition, 40% were small (<30 mm); 56% were medium (30-60 mm). Obliteration was < or =1/3 in 11% of the cases; from 1/3 to < or = 2/3 in 49%; >2/3 in 36%; complete in 5%. The risk of death was 1%/year, and of bleeding, 5.4%/year. Presentation with hemorrhage and low obliteration rate were the main factors associated with hemorrhage. CONCLUSION cAVM embolization provides limited protection against hemorrhage with obliteration rates below 2/3. Presentation with hemorrhage is the main factor for predicting hemorrhage.

Aspectos clínicos e neuropatológicos da síndrome de Wernicke-Korsakoff

O abuso de alcool e um dos mais serios problemas de saude publica e a sindrome de Wernicke-Korsakoff e uma das mais graves consequencias do alcoolismo. Esta patologia e infrequentemente diagnosticada nas suas apresentacoes menos evidentes, razao pela qual uma abordagem diagnostica apropriada e importante passo para seu tratamento. Entre as novas propostas farmacologicas, esta a reposicao dos niveis de tiamina, embora isto seja insuficiente para prevenir o declinio psicologico de um grande numero de pacientes. O impacto cognitivo da patologia e derivado da interacao entre neurotoxicidade alcoolica, deficiencia de tiamina e suscetibilidade pessoal. Sao descritos, a historia, a epidemiologia e os achados clinicos e neuropatologicos, bem como alguns aspectos de tratamento e prognostico da sindrome de Wernicke-Korsakoff.Alcohol abuse is one of most serious problems in public health and the Wernicke-Korsakoff syndrome one of the gravest consequences of alcoholism. The pathology is often undiagnosed in its less evident presentations, therefore an accurate diagnostic approach is a critical step in planning treatment. Besides new pharmacological proposals, treatment is based on the restoration of thiamine, although this is insufficient to prevent the psychological decline of a great number of patients. The cognitive impact of the pathology is derived from the interaction of alcoholic neurotoxicity, thiamine deficiency and personal susceptibility. In this article the history, epidemiology, clinical and neuropathological features of the Wernicke-Korsakoff syndrome, as well as some aspects of its treatment and prognosis, are described. Wernicke’s encephalopathy. Alcohol amnestic disorder. Alcoholism, complications.