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Background: Hemorrhagic transformation (HT) is a complication in ischemic strokes, regardless of use of reperfusion therapy (RT). There are many predictive scores for estimating the risk of HT. However, most of them include patients also treated with RT. Therefore, this may lead to a misinterpretation of the risk of HT in patients who did not undergo RT. Objective: We aimed to review published predictive scores and analyze their accuracy in our dataset. Methods: We analyzed the accuracy of seven scales. Our dataset was derived from a cohort of 1,565 consecutive patients from 2015 to 2017 who were admitted to a comprehensive stroke center. All patients were evaluated with follow-up neuroimaging within seven days. Comparison of area under the curve (AUC) was performed on each scale, to analyze differences between patients treated with recombinant tissue plasminogen activator (tPA) and those without this treatment. Results: Our dataset provided enough data to assess seven scales, among which six were used among patients with and without tPA treatment. HAT (AUC 0.76), HTI (0.73) and SEDAN (0.70) were the most accurate scores for patients not treated with tPA. SPAN-100 (0.55) had the worst accuracy in both groups. Three of these scores had different cutoffs between study groups. Conclusions: The predictive scores had moderate to fair accuracy for predicting HT in patients treated with tPA. Three scales were more accurate for predicting HT in patients not treated with tPA. Through standardizing these characteristics and including more patients not treated with RT in a large multicenter series, accurate predictive scores may be created.

Objetivo: Avaliar a situação epidemiológica do lúpus eritematoso sistêmico no estado do Ceará no ano de 2015. Método: Trata-se de um estudo retrospectivo quantitativo no qual foram analisados todos os registros das consultas médicas realizadas no Centro de Referência em Dermatologia Dona Libânia (CDERM), Fortaleza, Ceará, em 2015, por meio das variáveis: nome, sexo, idade, data da consulta, número do prontuário, diagnóstico presuntivo ou confirmado, outras afecções associadas e frequência do paciente no CDERM (se primeira vez ou retorno ao atendimento médico da instituição). Resultados: Dos 19.576 pacientes analisados, 320 foram diagnosticados com lúpus, representando prevalência de 1,63% no serviço, e desse número 185 foram diagnosticados com lúpus discoide. Conclusão: O lúpus cutâneo é uma doença de extrema importância e prevalência significativa em nosso meio, porém ainda carece de consistência de dados epidemiológicos, sendo necessários estudos multicêntricos e epidemiológicos maiores tanto no Ceará quanto no Brasil, para a adequada avaliação da prevalência dessa enfermidade.

Introdução: A esclerodermia abrange amplo espectro de manifestações clínicas, sendo subdividida em forma localizada e sistêmica. A forma localizada, com acometimento exclusivamente cutâneo e de tecidos circunvizinhos, apresenta fisiopatologia e epidemiologia parcialmente conhecidas pela comunidade científica, com a maioria dos estudos epidemiológicos se concentrando na forma generalizada e extrapolando seus resultados para a outra forma. Este estudo tem o intuito de esclarecer a epidemiologia da esclerodermia localizada no estado do Ceará, visando compreender seus fatores de risco na população brasileira. Trata-se do primeiro estudo epidemiológico brasileiro acerca da esclerodermia localizada. Metodologia: Delineou-se um estudo retrospectivo quantitativo, no qual foram analisados todos os registros das consultas médicas realizadas no Centro de Referência em Dermatologia Dona Libânia (CDERM), Fortaleza, Ceará, em 2015, através das variáveis: nome, sexo, idade, data da consulta, número do prontuário, diagnóstico presuntivo ou confirmado e a frequência do paciente no CDERM. Resultados: Dos 19.576 pacientes analisados, 124 pacientes foram diagnosticados com esclerodermia localizada, representando uma incidência aproximada de 0,62% no serviço. Dentre estes pacientes, 96 (77,42%) eram do sexo feminino e 28 (22,58%) do sexo masculino. A idade média dos pacientes foi de 29,7 anos. Discussão: A prevalência e distribuição por sexo obedeceram às tendências mundiais relatadas em outros trabalhos. Entretanto, constatou-se elevada prevalência de diagnóstico no sexo feminino na faixa etária pediátrica, o que contrasta com dados na literatura que afirmam que as diferenças na distribuição de gênero começam a existir no início da adolescência. Esta diferença pode dever-se a fatores culturais, subdiagnóstico na população masculina ou uma tendência regional na epidemiologia da esclerodermia localizada. Conclusão: Este estudo corresponde ao primeiro estudo epidemiológico brasileiro acerca da esclerodermia localizada, sendo necessários estudos mais amplos e multicêntricos que permitam entender melhor a doença na nossa população e, assim, possam servir de base para futuras ações assistenciais.

Hemorrhagic transformation (HT) is a dreaded complication in stroke patients who were treated or not with recombinant tissue plasminogen activator (tPA). There are many predictive scores of HT, but all of them included patients treated with tPA. Molecular effects of tPA and clinical aspects of eligible patients for tPA therapy may imply specific HT's risk factors. We aimed to describe HT's characteristics and risk factors in patients treated or not with tPA.We included 1565 consecutive stroke patients admitted to a Comprehensive Stroke Center, from 2015 to 2017. All included patients underwent a follow-up neuroimaging within seven days after admission. From a logistic regression model, we derived a score based on the beta-coefficients. The accuracy of the models was attested by Receiver Operating Characteristic analysis.Low ASPECTS, blood glucose ≥ 180 mg/dL, tPA treatment, and cardio-aortic embolism were predictors of HT. Male sex, leukoaraiosis, and hyperdense MCA sign were associated with HT in non-treated patients. Diastolic blood pressure ≥ 105 mmHg was a risk factor only in non-treated patients. The cutoff of our predictive score of HT was higher in patients not treated with tPA (5 vs 2 points).High arterial blood pressure was associated with HT only in patients treated with tPA. Different cutoffs and accuracy measurements suggest that scoring systems derived from patients treated with tPA may not be efficient to predict HT in non-treated patients. Further directions indicate considering the use of reperfusion therapies to select the most accurate predictive variables of HT.

Background: Lupus Nephritis (LN) progression to Chronic Kidney Disease (CKD) and End-Stage-Renal-Disease (ESRD) represents one of the most dreaded complications of Systemic Lupus Erythematosus (SLE), directly impacting quality of life and overall survival in affected patients. Identifying LN patients at high risk for poor renal outcome could lead to individualized management and treatment strategies regarding this population. We hypothesized that 24-hour urine proteinuria (PTU) after 12 months of treatment could act as a predictor of poor renal outcome in LN patients Methods: two hundred and fourteen patients who were diagnosed with LN and were followed up for more than 10 years in our center were enrolled retrospectively. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of PTU who predict bad long-term renal outcome. Results: the statistical difference was observed from 12 months when the outcome was ESRD, with a tendency from 6 months (p=0.06). Proteinuria > 0.9g/day at 12 months was the best predictor of ESRD, with the highest AUC (0.72). The sensitivity, specificity, positive predictive value and negative predictive value were 0.83, 0.65, 0.40, and 0.93, respectively. In the first year of LN treatment the serum creatinine was statistically different in any time for CKD (chronic kidney disease), but only at baseline for ESRD. Conclusions: In a population with more severe LN followed for a long time (>10 years), the cut-off point of PTU > 0.9/day is the best that predict progression to ESRD. The high negative predictive value emphasizes the need for a 1-year PTU-based LN treat to target treatment as a predictor of long-term renal outcome.

The coronavirus SARS-CoV-2 pandemia is infecting millions of people and some studies relate conditions that might increase the risk of developing a fatal course for the disease, such as diabetes, cardiovascular diseases and obesity. In COVID-19 physiopathology, one of the main inflammation mechanisms is the "cytokine storm", causing a pro-inflammatory state, related to cardiac and pulmonary damage. There is also a less effective role of lymphocyte B and T in the humoral immunity due to the reduction of their proliferative response. The physiopathology of ASD (Autism Spectrum Disorder) involves several modifications at the genetic and at the immune level, such as the increase of inflammatory cytokines and abnormal immune response in several levels. We hypothesize that ASD could be a risk-factor as the other conditions are.

Hemorrhagic transformation (HT) is a common neurological complication after ischemic stroke. The influence of symptomatic HT upon clinical outcomes post-stroke is well established, however, the role of asymptomatic HT upon prognosis is still unclear. We aimed to analyze the relationship between HT, clinical complications and outcomes in patients not submitted to reperfusion therapies (RT).We included 448 randomly selected patients admitted with acute ischemic stroke to a tertiary hospital stroke unit from 2015 to 2017. Patients submitted to RT were excluded. All patients were evaluated with computed tomography (CT) at admission and within 7 days from the initial CT. Patients with HT were divided into two groups: symptomatic and asymptomatic cases based on the ECASS II definition. A good clinical outcome was defined as a modified Rankin Scale (mRS) 0-2 at discharge.A total of 95 patients (21.2%) had HT (51 asymptomatic and 44 symptomatic). Age, NIHSS at admission and symptomatic HT were associated with a higher risk of developing pneumonia and seizures during hospitalization. Symptomatic HT was also associated with a prolonged length of hospitalization and death and inversely associated with good clinical outcomes at discharge (OR 0.96, 95% CI 0.94-0.98, p0.001). In an adjusted analysis, even asymptomatic HT was independently associated with worse clinical outcomes at discharge (mRS 4-6) (OR 5.99, 95% CI 1.83-19.58, p = 0.003).Symptomatic HT is associated with a higher risk of clinical complications, prolonged hospitalization, death and worse clinical outcome at discharge. Furthermore, even patients with asymptomatic HT had a higher chance of worse clinical outcomes at discharge.

Background: Hemorrhagic transformation (HT) is a common complication after ischemic stroke. It may be associated to poor outcomes. Some predictors of HT have been previously identified, but there remain controversies. Objective: To describe the risk factors for HT more frequently reported by a panel of experts surveyed for this project. Methods: We sent a standard questionnaire by e-mail to specialists in Vascular Neurology from 2014 to 2018. Forty-five specialists were contacted and 20 of them responded to the invitation. Predictors cited by three or more specialists were included in a table and ranked by the frequency in which they appeared. A review of the literature looking for published predictive scores of HT was performed, comparing to the answers received. Results: The 20 responding specialists cited 23 different risk factors for HT. The most frequent factors in the order of citation were the volume of ischemia, previous use of antithrombotic medication, neurological severity, age, hyperglycemia at presentation, hypertension on admission, and cardioembolism. Most variables were also found in previously published predictive scores, but they were reported by the authors with divergences of frequency. Conclusion: Although many studies have evaluated HT in patients with acute ischemic stroke, the published risk factors were neither uniform nor in agreement with those cited by the stroke specialists. These findings may be helpful to build a score that can be tested with the goal of improving the prediction of HT. RESUMO Introdução: A transformação hemorrágica (TH) é uma complicação comum após a isquemia cerebral e pode estar associada a desfechos desfavoráveis. Alguns fatores de risco para TH têm sido identificados, mas ainda há controvérsias. Objetivo: Descrever os fatores de risco para TH mais frequentemente reportados por um painel de especialistas consultados para esse projeto. Métodos: Enviamos um questionário padronizado por e-mail para 45 especialistas em Neurologia Vascular no período de 2014 a 2018. Vinte dos 45 especialistas responderam ao convite. Preditores citados por três ou mais especialistas foram incluídos em uma tabela e classificados pela frequência em que foram reportados. Uma revisão de literatura foi realizada em busca de escores preditivos de TH publicados anteriormente, comparando-os com as respostas recebidas. Resultados: Os 20 especialistas citaram 23 diferentes fatores de risco para TH. Os fatores mais frequentemente citados foram, pela ordem, volume da isquemia, uso prévio de medicação antitrombótica, gravidade neurológica, idade, hiperglicemia na apresentação, hipertensão na admissão e cardioembolismo. A maioria das variáveis também foi incluída em escores preditivos de TH já publicados, mas sem a mesma frequência e com divergências entre os especialistas consultados. Conclusão: Embora muitos estudos tenham avaliado a TH em pacientes com isquemia cerebral, os fatores de risco já publicados não foram uniformes na concordância com aqueles reportados pelos neurologistas vasculares consultados. Esses achados podem ser úteis para elaborar um escore que possa ser testado para aperfeiçoar a predição de transformação hemorrágica.

RESUMO Introdução O ensino por meio de metodologia ativa vem ganhando cada vez mais destaque no cenário da educação médica, complementando, ou mesmo substituindo, o método de ensino tradicional. Diante disso, o sistema de gameficação, bem aceito por estudantes, inova, uma vez que o aprendizado se torna lúdico e participativo, contribuindo para a formação holística dos acadêmicos. Objetivos: Descrever a realização de uma gincana – composta por quatro fases e de caráter competitivo –, bem como comprovar a eficácia do método como uma forma inovadora de aprendizagem. Ao todo, 16 acadêmicos de Medicina participaram da gincana. Metodologia Caracteriza-se como um estudo de delineamento observacional transversal, com uso de metodologias quantitativas e qualitativas. O estudo é composto pela aplicação de um método de ensino e aprendizado baseado no processo de gameficação, com posterior aplicação de um questionário avaliativo aos alunos, para análise crítica. Resultados Foi observada satisfação dos alunos quanto à atividade, sendo unânime a afirmação de que a técnica utilizada facilita o aprendizado. Entre os integrantes, 87,5% preferiram a aplicação de práticas de metodologias ativas em detrimento das tradicionais, e 81,25% dos participantes apontaram a necessidade de integrar métodos com abordagens lúdicas às suas atividades curriculares. Por outro lado, 12,5% dos estudantes concordaram em que a atividade lúdica aplicada não contribui para o trabalho em equipe e 6,25% preferiram adesão às práticas de metodologia tradicional. Conclusão O método de gameficação desenvolve um ambiente propício ao aprendizado, com grande adesão dos estudantes. Percebe-se também a necessidade de mudança, apoiada pelos alunos, nas formas de ensino utilizadas na graduação, devendo-se buscar metodologias que abranjam o desenvolvimento de múltiplas competências e que possam usar a ludicidade como atrativo para o processo de aprendizado. ABSTRACT Introduction Education through active methodology is increasingly gaining attention in the medical education scenario, complementing, or even replacing, the traditional teaching method. Bearing this in mind, the system of gamification, a well-accepted one among students, innovates, since the learning process becomes playful and participatory, contributing to the holistic formation of the students. Objectives To describe the accomplishment of a four-round, competitive championship, and to prove the effectiveness of the method as an innovative form of learning. In all, 16 medical students participated in the championship. Methods This was a cross-sectional, observational study, using quantitative and qualitative methodologies. The study consists of the application of a teaching and learning method based on the gamification process and the subsequent application of an evaluation questionnaire to the students for critical analysis. Results Student satisfaction with the activity was observed, with the unanimous assertion that the technique used facilitates learning. 87.5% of the members preferred the application of active methodologies over traditional ones. 81.25% of the participants asserted the need to integrate methods with playful approaches into their curricular activities. On the other hand, 12.5% of the students agreed that the applied leisure activity does not corroborate for teamwork and 6.25% preferred the traditional teaching methods. Conclusion It was demonstrated that the method of gamification develops a propitious environment for the learning process, with substantial student support. The requirement for change in the educational methods used in undergraduate training could also be perceived, as well as support for such changes among students, and hence the need to seek more and more methodologies that support the development of multiple competences and that can use playfulness as an incentive for the learning process.