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- Clinicoepidemiological profile of cerebral venous thrombosis in Algarve, Portugal: a retrospective observational studyPublication . Nzwalo, Hipólito; Rodrigues, Fatima; Carneiro, Patricia; Macedo, Ana; Ferreira, Fatima; Basilio, CarlosBackground: Cerebral venous thrombosis (CVT) is a very uncommon disorder with a wide variety of clinical manifestations. There are few studies describing the clinical and epidemiological profile of CVT in peripheral or rural areas. Over the last decades, the frequency in which this disease is diagnosed has increased due to greater awareness and availability of noninvasive diagnostic techniques. Materials and Methods: A hospital-based retrospective case review of adult (>= 15 years) patients with CVT between 2001 and 2012 is described. 31 patients with confirmed imagiological diagnosis of CVT were included. Statistical Analysis Used: Statistical analysis was performed using R version 2.15.2. Incidence rate was computed as number of new cases by time. Confidence interval (CI) was set at 95% and P < 0.05 was considered significant. Results: The average annual incidence was 0.84 (CI: 0.58-1.18) to 0.73 (CI: 0.5-1.02) per 100 000 cases for adult population. There were 23 (74%) women and 8 (26%) men. Predominant initial manifestations were headache, followed by altered mental status and seizures. Median diagnostic delay from onset of illness was 8 days. All patients were treated with unfractionated heparin or low-molecular heparin followed by warfarin. Complete recovery occurred in the majority of cases 22 (78.6%) but two patients died during hospitalization. Conclusions: Albeit with some particularities, the epidemiology and clinical manifestations we found are comparable to what has been reported in western studies.
- Acute stroke with concomitant acute myocardial infarction: will you thrombolyse?Publication . Maciel, Rita; Palma, Raquel; Sousa, Pedro; Ferreira, Fatima; Nzwalo, HipólitoConcomitant occurrence of acute myocardial infarction (MI) and stroke is infrequently encountered in emergent patients. Acute MI within the previous 3 months is considered a relative contraindication for therapy with alteplase or intravenous tissue plasminogen activator (IV rtPA).1 The use of IV rtPA for stroke in patients with a recent MI is associated with an increased risk of cardiac rupture, secondary to breakdown of the existing fibrin clot within the necrotic myocardium and/or degradation of collagen2 . Whether it is appropriate to perform thrombolysis in an emergent patient with concomitant ischemic stroke and MI remains a matter for debate.
- Incidence and case-fatality from spontaneous intracerebral hemorrhage in a southern region of PortugalPublication . Nzwalo, Hipólito; Nogueira, Jerina; Félix, Catarina; Guilherme, Patrícia; Baptista, Alexandre; Figueiredo, Teresa; Ferreira, Fatima; Marreiros, Ana; Thomassen, Lars; Logallo, NicolaBackground: There is scarce information on incidence and case fatality of spontaneous intracerebral hemorrhage (SICH) in certain regions of the world, including in Europe. There is no community-based data on SICH in Southern Portugal. Aim: To determine the incidence and early case-fatality from SICH in Algarve, the southernmost region of Portugal. Methods: The recommended criteria for stroke incidence studies was used to identify cases of incident first-ever SICH from January 1st to December 31st 2015 in a subregion with 280,081 inhabitants. Crude incidence rates per age group and gender; standardized rates to the European population; and age adjusted case fatality rates were calculated. Results: Eighty-two first-ever cases of SICH (64.6% men) occurred. The mean age was 72.3 years (SD +/- 12.1); women were 3 years older than men on average and had more frequently lobar SICH. The crude annual incidence rate was 29.2/100,000 (95% CI 23.4- 38.6; p < 0.001); higher in men (39.7/100,000) than women (19.8/100,000). The standardized to the European population incidence was 15.1/100,000 (95% CI 3.6-18.9; p < 0.05); 26.9 and 10.9/100,000 for men and women respectively. The 30-day case-fatality was 40 % (95% CI 29-51) and increased steeply with age Conclusion: The incidence of SICH in Southern Portugal was high, but within the figures found in some parts of Europe. However, a marked predominance of males was found and the case-fatality rate was amongst the highest reported in western countries. (C) 2017 Elsevier B.V. All rights reserved.
- 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.
- 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.