Browsing by Author "Cunha, L"
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- Aphasia Rapid Test: Translation, Adaptation and Validation Studies for the Portuguese PopulationPublication . Tábuas-Pereira, M; Freitas, S; Beato-Coelho, J; Ribeiro, JA; Parra, J; Martins, C; Silva, M; Matos, MA; Nogueira, AR; Silva, F; Sargento-Freitas, J; Cordeiro, G; Cunha, L; Santana, IClassical aphasia evaluation scales are too long to use in the context of acute stroke or as a monitoring tool. The Aphasia Rapid Test is a 26-point scale developed as a bedside assessment to rate aphasia severity in acute stroke patients in less than 3 minutes. We aimed to adapt and validate this scale for European Portuguese.
- Blood Pressure Variability in Acute Ischemic Stroke: The Role of Early RecanalizationPublication . Martins, AI; Sargento-Freitas, J; Jesus-Ribeiro, J; Correia, I; Cardoso, L; Gomes, JP; Gonçalves, M; Costa, R; Silva, F; Galego, O; Nunes, C; Beato-Coelho, J; Varela, R; Machado, C; Rodrigues, B; Santo, GC; Cunha, LWe performed a retrospective study with the aim of investigating the association between blood pressure (BP) variability in the first 24 h after ischemic stroke and functional outcome, regarding arterial recanalization status. A total of 674 patients diagnosed with acute stroke and treated with revascularization therapies were enrolled. Systolic and diastolic BP values of the first 24 h after stroke were collected and their variation quantified through standard deviation. Recanalization state was evaluated at 6 h and clinical outcome at 3 months was assessed by modified Rankin Scale. In multivariate analyses systolic BP variability in the first 24 h post-stroke showed an association with 3 months clinical outcome in the whole population and non-recanalyzed patients. In recanalyzed patients, BP variability did not show a significant association with functional outcome.
- [Carotid atherosclerosis and white matter hypodensities: a controversial relationship]Publication . Félix-Morais, R; Sargento-Freitas, J; Silva, F; Cordeiro, G; Nunes, C; Ribeiro, J; Cordeiro, M; Moura, C; Cunha, LINTRODUCTION: White matter hypodensities of presumed vascular origin, are recognized as an important cause of morbidity with established clinical and cognitive consequences. Nonetheless, many doubts remain on its physiopathology. Our goal is to clarify the potential role of carotid atherosclerosis and other vascular risk factors in the development of white matter hypodensities of presumed vascular origin. MATERIAL AND METHODS: We included patients that underwent CT brain scan and neurosonologic evaluation within a one-month period. Full assessment of vascular risks factors was performed. We seek to find independent associations between white matter hypodensities of presumed vascular origin, carotid intima-media thickness and vascular risk factors. RESULTS: 472 patients were included, mean age was 67.32 (SD: 14.75), 274 (58.1%) were male. The independent predictors of white matter hypodensities of presumed vascular origin were age (OR: 1.067, 95% IC: 1.049 - 1.086, p < 0.001) and hypertension (OR: 1.726, 95% IC: 1.097 - 2.715, p = 0.018). No association was found between IMT (OR: 2.613, 95% IC: 0.886 - 7.708, p = 0.082) or carotid artery stenosis (OR: 1.021, 95% IC: 0.785 - 1.328, p = 0.877) and white matter hypodensities of presumed vascular origin. DISCUSSION: Only age and hypertension proved to have an independent association with white matter hypodensities of presumed vascular origin. Carotid atherosclerosis, evaluated by IMT and the degree of carotid artery stenosis, showed no association with white matter hypodensities of presumed vascular origin. Since atherosclerosis is a systemic pathology, these results suggest that alternative mechanisms are responsible for the development of white matter hypodensities of presumed vascular origin. CONCLUSION: Age and hypertension seem to be the main factors in the development of white matter hypodensities of presumed vascular origin. No association was found between carotid atherosclerosis and white matter hypodensities of presumed vascular origin.
- Collateral pial circulation relates to the degree of brain edema on CT 24 hours after ischemic strokePublication . Galego, O; Jesus-Ribeiro, J; Baptista, M; Sargento-Freitas, J; Martins, AI; Silva, F; Santos, GC; Cunha, L; Nunes, C; Machado, EBackground Cerebral edema is frequent in patients with acute ischemic stroke (AIS) who undergo reperfusion therapy and is associated with high mortality. The impact of collateral pial circulation (CPC) status on the development of edema has not yet been determined. Methods We studied consecutive patients with AIS and documented M1-middle cerebral artery (MCA) and/or distal internal carotid artery (ICA) occlusion who underwent reperfusion treatment. Edema was graded on the 24-hour non-contrast computed tomography (NCCT) scan. CPC was evaluated at the acute phase (≤6 hours) by transcranial color-coded Doppler, angiography and/or CT angiography. We performed an ordinal regression model for the effect of CPC on cerebral edema, adjusting for age, baseline National Institutes of Health Stroke Scale, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on admission, NCCT, parenchymal hemorrhagic transformation at 24 hours and complete recanalization at six hours. Results Among the 108 patients included, 49.1% were male and mean age was 74.2 ± 11.6 years. Multivariable analysis showed a significant association between cerebral edema and CPC status (OR 0.22, 95% CI 0.08-0.59, p = 0.003), initial ASPECTS (OR 0.72, 95% CI 0.57-0.92, p = 0.007) and parenchymal hemorrhagic transformation (OR 23.67, 95% CI 4.56-122.8, p < 0.001). Conclusions Poor CPC is independently associated with greater cerebral edema 24 hours after AIS in patients who undergo reperfusion treatment.
- Comportamentos dos Enfermeiros Perante os Alarmes Clínicos em Unidades de Cuidados Intensivos: uma Revisão IntegrativaPublication . Galo, AR; Diogo, C; Cipriano, D; Araújo, I; Martins, J; Cunha, LO presente estudo tem como propósito refletir sobre a prática de enfermagem no que concerne à temática da monitorização hemodinâmica. Pretendemos identificar a evidência empírica produzida sobre o comportamento dos enfermeiros perante os alarmes clínicos e, consequentemente, incentivar a adoção de estratégias que promovam um ambiente de cuidados intensivos menos ruidoso. Perspetivou-se um estudo de revisão sistemática da literatura. Selecionámos um conjunto de dezoito bases de dados eletrónicas, tendo recorrido a três idiomas. A colheita de informação decorreu entre dezembro de 2011 e janeiro de 2012 e, através de uma estratégia de cruzamento dos descritores selecionados, foram incluídos 5 artigos. Face a todo o corpo de discussão salientamos três categorias essenciais: opinião dos profissionais de saúde acerca dos alarmes clínicos; comportamento dos profissionais; estratégias promotoras de um ambiente menos ruidoso. Constatamos que os profissionais de saúde têm presente a bipolaridade dos alarmes clínicos e identificam limitações na sua gestão. Verificamos ainda que o comportamento dos profissionais nos estudos analisados não é linear, variando entre alterar os parâmetros no início de cada turno até ignorar uma grande maioria deles. Cientes desta realidade, os profissionais sugerem diversas estratégias passíveis de implementar, com vista a alarmes e comportamentos mais eficazes.
- Diagnostic value of CSF protein profile in a Portuguese population of sCJD patientsPublication . Baldeiras, IE; Ribeiro, MH; Pacheco, P; Machado, A; Santana, I; Cunha, L; Oliveira, CRThe clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) is difficult, and reliable markers are highly desired. In this work we assess the value of several cerebrospinal fluid (CSF) markers for sCJD diagnosis. Within the framework of the Portuguese Epidemiological Surveillance Program for Human Prion Diseases, CSF samples from 71 patients with clinically suspected sCJD, 30 definite sCJD and 41 non-CJD patients, were analysed for the presence of 14-3-3 protein. CSF levels of tau (t-tau), and phosphorylated tau (p-tau181), S-100b and beta amyloid (Abeta42) proteins were determined. The influence of clinical and genetic characteristics on CSF markers sensitivity was also evaluated. Protein 14-3-3 was detected in 29/30 sCJD patients and 9/41 non-CJD patients. Extremely elevated t-tau and S-100b protein levels were found in sCJD patients, while p-tau181 levels were only slightly elevated and Abeta42 showed no differences compared to controls. 14-3-3 was the most sensitive parameter (97%), but its specificity was low (78%); sensitivity/specificity for other proteins were: S-100b-93/93%, t-tau-93/95%, with maximum accuracy being obtained by a combination of tests (14-3-3 combined with either t-tau or S-100b, or combining S-100b with t-tau/Abeta42 or p-tau/t-tau ratios). The sensitivity of 14-3-3, as well as of p-tau181/t-tau ratio, was decreased in younger patients with long disease duration, with the PrP-2 isotype and MV genotype. Both 14-3-3, t-tau and S-100b are sensitive markers for sCJD, but 14-3-3 specificity seems to be lower in this special clinical setting of rapidly progressing dementias. We propose that in cases with a 14-3-3 weak positive result, or in young patients with long disease duration, a second CSF marker would be valuable for the diagnosis of sCJD.
- Downbeat nystagmus elicited by eyelid closurePublication . Lemos, J; Pereira, D; Amorim, M; Santiago, B; Paiva, A; Cunha, LWe describe a patient with downbeat nystagmus (DBN) evoked only by eye closure. Brain and spinal cord magnetic resonance imaging revealed a T2 paramedian lesion in the left lower basis pontis and other white matter lesions consistent with multiple sclerosis. One potential mechanism for DBN in this case involves transverse ephaptic spread of excitation from areas that subserve coordinated lid closure to the decussating ventral tegmental tract.
- Eficácia da plasmoferese e da imunoglobulina humana no síndrme de Guillain-BarréPublication . Negrão, L; Santos, JM; Camões, F; Barbosa, J; Cunha, L
- Endothelial Progenitor Cells influence acute and subacute stroke hemodynamicsPublication . Sargento-Freitas, J; Aday, S; Nunes, C; Cordeiro, M; Gouveia, A; Silva, F; Machado, C; Rodrigues, B; Santo, GC; Ferreira, C; Castelo-Branco, M; Ferreira, L; Cunha, LBACKGROUND: Endothelial Progenitor Cells (EPCs) are a circulating stem cell population with in vivo capacity of promoting angiogenesis after ischemic events. Despite the promising preclinical data, their potential integration with reperfusion therapies and hemodynamic evolution of stroke patients is still unknown. Our aim was to determine the association of EPCs with acute, subacute and chronic hemodynamic features. METHODS: In this prospective study, we included consecutive patients with ages between 18 and 80years and non-lacunar ischemic stroke within the territory of a middle cerebral artery. All patients were subject to hemodynamic evaluation by ultrasound at baseline, seven days and three months. We quantified cerebral blood flow (CBF) and assessed early recanalization and collateral flow. Hemorrhagic transformation was graded in Magnetic Resonance imaging performed at seven days. EPCs were isolated from peripheral venous blood collected in the first 24h and seven days, counted and submitted to functional in vitro tests. RESULTS: We included 45 patients with a median age of 70±10years. The angiogenic and migratory capacities of EPCs were associated with increased collateral flow in the acute stage and day seven CBF, without statistically significant associations with recanalization nor haemorrhagic transformation. The number of EPCs was not associated with any hemodynamic variable. CONCLUSIONS: The functional properties of EPCs are associated with acute and subacute stroke hemodynamics, with no effect on haemorrhagic transformation.
- Frontotemporal dementia and mitochondrial DNA transitionsPublication . Grazina, M; Silva, F; Santana, I; Santiago, B; Mendes, C; Simões, M; Oliveira, M; Cunha, L; Oliveira, CRFrontotemporal dementia (FTD) is the second most common type of primary degenerative dementia. Some patients present an overlap between Alzheimer's disease (AD) and FTD both in neuropathological and clinical aspects. This may suggest a similar overlap in physiopathology, namely an involvement of mitochondrial DNA (mtDNA) in FTD, as it has been associated to AD. To determine if mtDNA is involved in FTD, we performed a Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) analysis, specific to mtDNA NADH Dehydrogenase subunit 1 (ND1) nucleotides 3337-3340, searching for mutations previously described in Parkinson's and AD patients. We could identify one FTD patient with two mtDNA transitions: one already known (3316 G-to-A) and another unreported (3337 G-to-A). Additionally, mitochondrial respiratory chain complex I activity was reduced in leukocytes of this patient (36% of the control mean activity). To our knowledge, this is the first report of mtDNA variants in FTD patients.