Browsing by Author "Mouzinho, Maria"
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- Fine particulate air pollution and occurrence of spontaneous intracerebral hemorrhage in an area of low air pollutionPublication . Nzwalo, Hipólito; Guilherme, Patricia; Nogueira, Jerina; Felix, Catarina; S. André, Ana; Teles, Joana; Mouzinho, Maria; Ferreira, Fatima; Marreiros, Ana; Logallo, Nicola; Bentes, CarlaObjectives:The association between short-term ambient particulate matter ≤ 2.5 μm diameter (PM2.5) andspontaneous intracerebral hemorrhage (SICH) occurrence is unclear. We aimed to study the association ofambient PM2.5 with occurrence of SICH in an area of low air pollution in southern Portugal.Patientsandmethods:PM2.5 levels from the 3 days before the SICH event (Lag 1, 2, 3) was compared with onecontrol period (Lag 15–17) using a case-crossover analysis. Conditional logistic regression was used to estimatethe odds ratio (OR) with 95% confidence interval (CI). Analysis was stratified by gender, age, functional neu-rological status, type of SICH, environmental factors (temperature, humidity, time of day and season).Results:Three-hundred and eight patients were included (2010–2015); mean age 70.8 years, 62.8% were males.The mean values (μg/l) of PM2.5 were higher on the case days (Lag1 = 7.76, Lag2 = 7.64, Lag3 = 7.74)compared to control period (Lag14-17 = 6.77). For each 10 μg/l increase, the likelihood of SICH increased 5.7%(95% CI = 1.020-1.095. P = .002). The strength of the association was higher in patients younger than 70 years(OR = 1.064, 95% CI = 1.009–1.122); without prior to SICH neurological disability (OR = 1.061, 95% CI1.022–1.101); with non-lobar type (OR = 1.054, 95% CI = 1.012–1.099). A circadian and circannual patternwas present with increased strength of the association when SICH occurred in the morning time (OR = 1,067,95% CI = 1.012–1.125), in the fall (OR = 1.118, 95% CI = 1.031–1.213) and the in the winter (OR = 1.064,95% CI = 1.002–1.129). The association was also potentiated at lower temperature values.Conclusion:Short-term increases of PM2.5 are associated with occurrence of SICH in Algarve, a region of lowambient pollution. Patient and ambient level factors can influence the strength of this association.
- Poor intensive stroke care is associated with short-term death after spontaneous intracerebral hemorrhagePublication . Martinez, Joana; Mouzinho, Maria; Teles, Joana; Guilherme, Patricia; Nogueira, Jerina; Felix, Catarina; Ferreira, Fatima; Marreiros, Ana; Nzwalo, HipólitoObjectives: The case fatality from spontaneous ICH (SICH) remains high. The quality and intensity of early treatment is one of the determinants of the outcome. We aimed to study the association of early intensive care, using the Intracerebral Hemorrhage-Specific Intensity of Care Quality Metrics (IHSICQM) with the 30-day in-hospital mortality in Algarve, Portugal. Patients and Methods: analysis of prospective collected data of 157 consecutive SICH patients (2014-2016). Logistic regression was performed to assess the role of IHSICQM on the 30-day in-hospital mortality controlling for the most common clinical and radiological predictors of death. Receiver operating characteristic (ROC) curve was developed to evaluate the prediction accuracy of the IHSICQM score (C-statistics). Results: forty-five (29 %) patients died. The group of deceased patients had lower intensity of care (lower IHSICQM score) and higher proportion of poor prognosis associated factors (pre-ICH functional dependency, intraventricular dissection/glycaemia). On the multivariate analysis, higher IHSICQM was associated with reduction of the odds of death, 0.27 (0.14-0.50) per each increasing point. The ROC curve showed a high discriminating ability of isolated IHSICQM in predicting the 30-day mortality (AUC = 0,95; 95 % CI = [0,86; 0,95]). Conclusion: the early intensity of quality of care independently predicts the 30-day in-hospital mortality. Quantification of the intensity of SICH is a valid tool to persuade improvement of SICH care, as well to help comparison of performances within and between hospitals.
- Stroke-associated cortical deafness: a systematic review of clinical and radiological characteristicsPublication . Silva, Gracinda; Gonçalves, Rita; Taveira, Isabel; Mouzinho, Maria; Osório, Rui; Nzwalo, HipólitoBackground: Stroke is the leading cause of cortical deafness (CD), the most severe form of central hearing impairment. CD remains poorly characterized and perhaps underdiagnosed. We perform a systematic review to describe the clinical and radiological features of stroke-associated CD. Methods: PubMed and the Web of Science databases were used to identify relevant publications up to 30 June 2021 using the MeSH terms: “deafness” and “stroke”, or “hearing loss” and “stroke” or “auditory agnosia” and “stroke”. Results: We found 46 cases, caused by bilateral lesions within the central auditory pathway, mostly located within or surrounding the superior temporal lobe gyri and/or the Heschl’s gyri (30/81%). In five (13.51%) patients, CD was caused by the subcortical hemispheric and in two (0.05%) in brainstem lesions. Sensorineural hearing loss was universal. Occasionally, a misdiagnosis by peripheral or psychiatric disorders occurred. A few (20%) had clinical improvement, with a regained oral conversation or evolution to pure word deafness (36.6%). A persistent inability of oral communication occurred in 43.3%. A full recovery of conversation was restricted to patients with subcortical lesions. Conclusions: Stroke-associated CD is rare, severe and results from combinations of cortical and subcortical lesions within the central auditory pathway. The recovery of functional hearing occurs, essentially, when caused by subcortical lesions.