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IScore, a useful prognostic tool for patients with acute ischemic stroke treated with intravenous thrombolysis: a validation study
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Scavasine, Valéria Cristina

; Costa, Rebeca Teixeira

; Zétola, Viviane de Hiroki Flumignan

; Lange, Marcos Christiano

Arquivos de Neuro-Psiquiatria

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2023, Volume 81 N. 2 Pages 107 - 111

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Stroke is one of the major causes of disability and mortality worldwide. Up to 30% of individuals who experience stroke die within 30 days, and more than 50% of those who survive will have some degree of disability. There are some predetermining factors based on admission data that could be used to objectively assess the odds of poor outcomes, including the Ischemic Stroke Predictive Risk Score (IScore). Objective To analyze and validate the IScore in patients undergoing intravenous thrombolysis for stroke and compare the results of this predictor with actual death and disability outcomes. Methods In a retrospective study, data were collected from a database housed at the Stroke Unit of the Teaching Hospital of Universidade Federal do Paraná, Southern Brazil. The IScore was applied to admission data from 239 patients, and the results were compared with actual outcomes (death and disability) within 30 days and 1 year after the stroke event. Data analysis was performed using an analysis of the receiver operating characteristic (ROC) curve to determine the sensitivity and specificity of the IScore in the study population. Results The IScore demonstrated moderate sensitivity and high specificity in patients with stroke who underwent thrombolysis when evaluated after 30 days and 1 year of the event. Conclusions The IScore can be applied to in stroke patients undergoing thrombolysis; therefore, it may be used as an objective prognostic tool to guide clinical decision-making. Understanding the prognosis of patients in the acute phase can assist clinicians in making the best therapeutic decisions and enable better end-of-life care.

Resumo Antecedentes O acidente vascular cerebral (AVC) é uma das principais causas de morte e incapacidade no mundo. Até 30% dos indivíduos evoluem a óbito nos primeiros 30 dias. Dos sobreviventes, mais da metade ficam com alguma sequela. Certas variáveis identificadas já na admissão podem sinalizar maior risco de desfecho desfavorável. Uma dessas ferramentas prognósticas é a Escala de Previsão de Riscos de AVC Isquêmico (Ischemic Stroke Predictive Risk Score, IScore, em inglês). Objetivo Analisar e validar a aplicação do IScore em pacientes com AVC isquêmico submetidos a trombólise endovenosa e comparar os resultados obtidos com a aplicação da escala aos verdadeiros desfechos de morte e incapacidade funcional. Métodos Trata-se de um estudo retrospectivo, cujos dados foram obtidos do banco de dados da Unidade de AVC do Hospital de Clínicas da Universidade Federal do Paraná. A IScore foi aplicada conforme os dados de admissão de 239 pacientes. Os pacientes foram acompanhados ambulatorialmente, e os resultados da escala foram comparados aos desfechos reais de mortalidade e incapacidade. Os resultados foram demonstrados por meio da curva característica de operação do receptor (receiver operating characteristic, ROC, em inglês) para determinar sensibilidade e especificidade da escala. Resultados Em pacientes com AVC submetidos a trombólise, a IScore demonstrou moderada sensibilidade e alta especificidade para predizer desfechos tanto de óbito quanto de incapacidade, nos intervalos de 30 dias e 1 ano após o evento. Conclusões A IScore pode ser aplicada em pacientes com AVC isquêmico, na população específica submetida a trombólise; portanto, pode ser usada como uma ferramenta prognóstica útil, que pode guiar decisões terapêuticas. Entender o prognóstico de paciente na fase aguda pode auxiliar os clínicos a fazer as melhores decisões terapêuticas e possibilitar melhores cuidados ao fim da vida.

https://doi.org/10.1055/s-0042-1758397

Comparison of right-to-left shunt characteristics in cryptogenic embolic ischemic stroke and non-cardioembolic ischemic stroke
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Scavasine, Valeria Cristina

; Chamma, Jamileh Ferreira

; Bazan, Rodrigo

; Braga, Gabriel Pereira

; Lange, Marcos Christiano

; Zétola, Viviane de Hiroki Flumignan

Arquivos de Neuro-Psiquiatria

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oct 2021, Volume 79 N. 10 Pages 859 - 863

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Antecedentes: Uma das potenciais fontes embólicas no acidente vascular cerebral (AVC) de origem indeterminada é o forame oval patente (FOP). Objetivo: O objetivo do presente estudo foi identificar as características do shunt direita-esquerda em paciente com AVC de etiologia indeterminada, presumidamente embólica, e comparar tais características com pacientes apresentando AVC por outras causas não embólicas. Métodos: Trata-se de um estudo retrospectivo com 168 pacientes com AVC e forame oval patente, separados em dois grupos: AVC embólico de etiologia indeterminada e AVC por outras causas não embólicas. Todos os pacientes foram submetidos a Doppler transcraniano, para avaliar a presença de shunt direita-esquerda por meio do teste de embolia paradoxal. Além da quantificação de microbolhas, também foi avaliada a presença de shunt em repouso e sob manobra de Valsalva. Resultado: Do total, 96 pacientes foram incluídos no primeiro grupo (AVC indeterminado) e 72, no segundo grupo (AVC não embólico). No primeiro grupo, 65 pacientes exibiram shunt com passagem de mais de 10 microbolhas (67,5%), enquanto no segundo grupo isso aconteceu em 51,4% (p=0,038) dos casos. Além disso, 75 pacientes (78,1%) do primeiro grupo tiveram teste positivo ao repouso, comparados com 42 pacientes (58,3%) no segundo grupo (p=0,007). Conclusão: O presente estudo demonstrou que até 70% dos pacientes com AVC de etiologia indeterminada e forame oval apresentaram shunts maiores; em mais de 75%, houve passagem de microbolhas ao repouso. Esses achados sugerem que as características do shunt, como quantidade de microbolhas e passagem ao repouso, devem ser levadas em consideração na avaliação do FOP como possível mecanismo subjacente ao AVC.

Abstract Background: Patent foramen ovale (PFO) has been considered a potential mechanism of embolic stroke of undetermined origin. Objective: The aim of the present study was to identify the features of the right-to-left shunt (RLS) in patients with undetermined embolic ischemic stroke and compare them with those of patients with non-cardioembolic ischemic stroke. Methods: A retrospective study was conducted with 168 patients with stroke and RLS separated into the following two groups: the undetermined embolic stroke group (UES group) and non-cardioembolic stroke group (NCES group). All patients were assessed by transcranial Doppler to evaluate the presence and quantification of microembolic signals (MES) at rest and under Valsalva maneuver. Results: Of all patients evaluated in the current study, 96 were included in the UES group and 72 in the NCES group. In the UES group, 65 patients had RLS with ≥10 MES (67.7%), which was higher than that observed in the NCES group (51.4%, p=0.038). According to the moment of the cardiac cycle, 75 patients (78.1%) in the UES group had a positive test at rest compared to 42 (58.3%) in the NCES group (p=0.007). Conclusions: The current study demonstrated that almost 70% of patients with undetermined embolic stroke and PFO presented a large RLS and more than 75% had RLS at rest. These findings suggest that the size of the shunt should be taken into account when evaluating whether PFO could be a possible mechanism underlying cryptogenic stroke.

https://doi.org/10.1590/0004-282x-anp-2020-0430 113 downloads

Embolic Stroke of Undetermined Source (ESUS) and Stroke in Atrial Fibrillation Patients: not so Different after all?
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Scavasine, Valeria Cristina

; Ribas, Gustavo da Cunha

; Costa, Rebeca Teixeira

; Ceccato, Guilherme Henrique Weiler

; Zétola, Viviane de Hiroki Flumignan

; Lange, Marcos Christiano

International Journal of Cardiovascular Sciences

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oct 2021, Volume 34 N. 5 Pages 517 - 522

Abstract: En | Text: En | PDF: En

Abstract Background: Stroke related to atrial fibrillation (AF) is associated with high recurrence and mortality rates. Embolic Stroke of Undetermined Source (ESUS) is associated with fewer vascular risk factors, less disability, and a high recurrence rate. Objective: To compare risk factors, functional outcomes and the occurrence of primary endpoint (a composite of recurrent stroke, cardiovascular death, and myocardial infarction) between AF stroke and ESUS patients. Method: A retrospective analysis was conducted including all consecutive patients with first-ever ischemic stroke admitted to the Hospital de Clinicas (Clinical Hospital) of the Federal University of Paraná from October 2012 to January 2017 (n=554). There were 61 patients with stroke due to AF and 43 due to ESUS. Both groups were compared for demographic characteristics and vascular risk factors. Logistic regression models were performed to assess the impact of each variable on the primary endpoint in a 12-month follow-up. Statistical significance was considered for p-values < 0.05. Results: ESUS patients, as compared to AF patients, were younger and more likely to be smokers. ESUS patients presented a mean CHADS2VASc score of 4, while the AF group presented a score of 5 (p <0.001). The primary endpoint was observed in 9 (20.9%) ESUS and 11 (18.0%) AF patients over a 12-month period (p=0.802). Higher glucose levels upon hospital admission (p=0.020) and a higher modified Rankin Scale upon hospital discharge (p=0.020) were predictors of the primary endpoint occurrence. Conclusion: AF and ESUS stroke patients presented very similar independence rates upon hospital discharge and outcomes after 12 months, despite some baseline differences, including stroke recurrence, vascular death, and myocardial infarction.

https://doi.org/10.36660/ijcs.20190191 86 downloads

Small vessel occlusion and syphilis in patients with first-ever ischemic stroke
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Ferreira, Matheus Gomes

; Scavasine, Valeria Cristina

; Breda, Giovanni Luís

; Almeida, Bernardo Montesanti Machado de

; Zétola, Viviane de Hiroki Flumignan

; Lange, Marcos Christiano

Arquivos de Neuro-Psiquiatria

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feb 2021, Volume 79 N. 2 Pages 103 - 106

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: A sífilis é uma doença endêmica, especialmente em países de baixa e média renda, com acometimento vascular descrito em grandes vasos (aortite), porém nenhuma relação clara foi reconhecida em paciente com acidente vascular cerebral, exceto para aqueles com sífilis meningovascular. Objetivos: Investigar a relação entre história positiva de sífilis determinada pelo status sorológico e o mecanismo do acidente vascular cerebral isquêmico, particularmente doença de pequenos vasos. Métodos: Ao todo, 269 pacientes com AVC isquêmico foram testados para sífilis. Pacientes com diagnóstico de neurossífilis foram excluídos. Todos os pacientes foram classificados segundo o fenótipo ASCOD quando a doença de pequenos vasos era o mecanismo causal provável (S1) ou não-pequenos vasos quando este mecanismo era incerto (S2), pouco provável (S3) ou não detectado (S0). Resultados: O teste para sífilis foi positivo em 32 (12%) pacientes. Quando comparados, pacientes com sorologia positiva e o grupo com teste não reagente, a única diferença significativa foi a doença de pequenos vasos como mecanismo causal (S1) em pacientes com sorologia positiva: 9 (28%) vs. 22 (9%), p<0.01. Conclusão: O presente estudo mostra que o teste sorológico positivo para sífilis tem maior ocorrência em pacientes com o primeiro AVC isquêmico com a doença de pequenos vasos como um mecanismo causal possível. Tal achado pode estar relacionado à disfunção endotelial que ocorre durante a sífilis.

ABSTRACT Background: Syphilis is an endemic disease, particularly in low- and middle-income countries, with vascular involvement in large vessels (aortitis), but no clear relationship with stroke patients, except for those who presented with meningovascular neurosyphilis. Objective: To investigate the relationship between a positive history of syphilis determined by serological testing and ischemic stroke etiology, particularly small vessel disease (SVD). Methods: In total, 269 first-ever ischemic stroke patients admitted to the stroke unit were tested for syphilis. Patients with neurosyphilis were excluded. All patients were classified according to the ASCOD phenotyping as SVD — when SVD was the potential causal mechanism (S1) — or non-SVD — when SVD was uncertain (S2), unlike (S3), or not detected (S0). Results: Syphilis was positive in 32 (12%) patients. When comparing patients with positive and negative serology, the only significant difference was SVD as the causal mechanism (S1) in patients with positive results: 9 (28%) vs. 22 (9%), p<0.01. Conclusion: The current study showed that the frequency of positive syphilis serological test was higher in patients with first-ever ischemic stroke and SVD as the potential causal mechanism. This finding could be related to the endothelial dysfunction occurring in syphilis.

https://doi.org/10.1590/0004-282x-anp-2020-0178 628 downloads

Management of acute stroke and urgent neurointerventional procedures during COVID-19 pandemic: recommendations on the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, Brazilian Society of Cerebrovascular Diseases and Brazilian Society of Neuroradiology
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MONT’ALVERNE, Francisco José Arruda

; LIMA, Fabrício Oliveira

; NOGUEIRA, Raul Gomes

; FREITAS, Carlos Clayton Macedo de

; NETO, Octávio Marques Pontes

; SILVA, Gisele Sampaio

; OLIVEIRA, Maura Salaroli de

; FRUDIT, Michel

; CALDAS, Jose Guilherme Mendes Pereira

; ABUD, Daniel Giansante

; CONFORTO, Adriana Bastos

; CARVALHO, Fernanda Martins Maia

; DIAS, Francisco Antunes

; BAZAN, Rodrigo

; AVELAR, Wagner Mauad

; MORO, Carla Heloísa Cabral

; MAGALHÃES, Pedro Silva Correa de

; MIRANDA, Maramelia

; BARBOSA, Leandro de Assis

; FIOROT JUNIOR, José Antonio

; CARDOSO, Fabrício Buchdid

; REBELLO, Leticia Costa

; PARENTE, Bruno de Sousa Mendes

; FARIA, Mário de Barros

; FREITAS, Gabriel Rodriguez de

; ZÉTOLA, Viviane de Hiroki Flumignan

; OLIVEIRA-FILHO, Jamary

; BEZERRA, Daniel da Cruz

; RODRIGUES, Jorge Luis Nobre

; KUSTER, Gustavo

; MARTINS, Sheila

; CARVALHO, João José Freitas de

Arquivos de Neuro-Psiquiatria

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jul 2020, Volume 78 N. 7 Pages 440 - 449

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: A pandemia causada pelo novo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2, COVID-19) apresenta novos e importantes desafios à gestão de saúde no Brasil. Além da difícil missão de prestar atendimento aos milhares de pacientes infectados pelo COVID-19, os sistemas de saúde têm que manter a assistência às emergências médicas comuns em períodos sem pandemia, tais como o acidente vascular cerebral (AVC), que continuam ocorrendo e requerem tratamento com presteza e eficiência. A alocação de recursos materiais e humanos para o enfrentamento à pandemia não pode comprometer o atendimento ao AVC agudo, uma emergência cujo tratamento é tempo-dependente e se não realizado implica em importante impacto na mortalidade e incapacitação a longo prazo. Objetivo: Este trabalho resume as recomendações do Departamento Científico de Doenças Cerebrovasculares da Academia Brasileira de Neurologia, da Sociedade Brasileira de Doenças Cerebrovasculares e da Sociedade Brasileira de Neurorradiologia para o tratamento do AVC agudo e para a realização de procedimentos de neurointervenção urgentes durante a pandemia de COVID-19, incluindo o uso adequado de ferramentas de triagem e equipamentos de proteção pessoal (para pacientes e profissionais de saúde), além da alocação apropriada de pacientes.

ABSTRACT Introduction: Although the 2019 severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2, COVID-19) pandemic poses new challenges to the healthcare system to provide support for thousands of patients, there is special concern about common medical emergencies, such as stroke, that will continue to occur and will require adequate treatment. The allocation of both material and human resources to fight the pandemic cannot overshadow the care for acute stroke, a time-sensitive emergency that with an inefficient treatment will further increase mortality and long-term disability. Objective: This paper summarizes the recommendations from the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Society of Cerebrovascular Diseases and the Brazilian Society of Neuroradiology for management of acute stroke and urgent neuro-interventional procedures during the COVID-19 pandemic, including proper use of screening tools, personal protective equipment (for patients and health professionals), and patient allocation.

https://doi.org/10.1590/0004-282x20200053 2310 downloads

Stroke recurrence in the different subtypes of ischemic stroke. The importance of the intracranial disease
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Lange, Marcos C

; Ribas, Gustavo

; Scavasine, Valeria

; Ducci, Renata Dal-Prá

; Mendes, Danielle C.

; Zétola, Viviane de Hiroki Flumignan

; Cabral, Norberto

; Rundek, Tatjana

Arquivos de Neuro-Psiquiatria

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oct 2018, Volume 76 N. 10 Pages 649 - 653

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O objetivo do presente estudo é analisar a taxa de recorrência a longo prazo em pacientes com o primeiro AVCi secundário à aterosclerose de grande artéria intracraniana em uma amostra brasileira. Métodos: Pacientes admitidos entre outubro de 2012 e setembro de 2015 foram analisados. Os subtipos do mecanismo de AVC foram classificados como cardioembolismo, aterosclerose de grandes artérias, oclusão de pequenos vasos, outras etiologias determinadas e AVCi de causa indeterminada. Resultados: Foram avaliados 359 pacientes com primeiro AVCi. O tempo médio de seguimento foi de 21,6 ± 15,1 meses. A aterosclerose de grande artéria, intracraniana (38,9%) e extracraniana (24,6%), apresentou a maior taxa de recorrência. A aterosclerose de grande artéria intracraniana [HR, 10,2 (3,6–29,1); p < 0,001] e extracraniana [HR, 5,05 (1,79–14,2); p = 0,002] demonstraram correlação positiva com a taxa de recorrência, após o ajuste para fatores de risco, trombólise e gravidade dos sintomas na admissão. Conclusão: A aterosclerose de grande artéria, tanto intracraniana como extracraniana, apresenta maior recorrência comparado aos outros mecanismos de AVCi em uma amostra do Sul do Brasil.

ABSTRACT The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. Methods: All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. Results: The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6–29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79–14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. Conclusion: Intracranial LAA presents a higher incidence of recurrence of ischemic stroke when compared with other etiologies in a Southern Brazilian population.

https://doi.org/10.1590/0004-282x20180095 2211 downloads

Physicians are not well informed about the new guidelines for the treatment of acute stroke
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Gatto, Luana Antunes Maranha

; Koppe, Gelson Luis

; Demartini Junior, Zeferino

; Zétola, Viviane de Hiroki Flumignan

Arquivos de Neuro-Psiquiatria

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oct 2017, Volume 75 N. 10 Pages 718 - 721

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O tratamento da doença cerebrovascular tem avançado rapidamente nas últimas duas décadas. Dados recentes acrescentaram desafios ao tratamento do AVC isquêmico na fase aguda (AIFA). Objetivo: Avaliar o conhecimento médico sobre o tratamento do AIFA. Métodos: Um questionário on-line foi submetido a todos os médicos inscritos no Conselho Regional de Medicina. Resultados: 456 médicos de diferentes especialidades responderam às perguntas. A maioria deles não sabia que a trombectomia endovascular mecânica é freqüentemente considerada como tratamento padrão-ouro nos casos de AIFA. 85% não realizariam trombectomia junto com a trombólise intravenosa. O tempo máximo para atuar no evento agudo também apresentou muitas divergências, mesmo em relação à infusão de rtPA. A falta de estrutura, medicação e neurologista foram consideradas as principais barreiras ao tratamento. Conclusão: Os médicos não estão bem informados sobre as novas diretrizes para o tratamento do AIFA. A maioria dos médicos errou a maioria das perguntas desse questionário.

ABSTRACT Treatment of cerebrovascular disease has advanced rapidly in the last two decades. Recent data has added challenges to the treatment of ischemic stroke in the acute phase. Objective: To evaluate the knowledge of physicians about the treatment of ischemic stroke in the acute phase. Methods: An online questionnaire was submitted to all physicians enrolled in the Regional Council of Medicine in Brazil. Results: 456 physicians from different specialties answered the questions. Most of them did not know that mechanical endovascular thrombectomy is often considered as the gold standard treatment in cases of ischemic stroke in the acute phase; and 85% of them did not realize that thrombectomy together with intravenous thrombolysis was possible. The maximum time to act in an acute event also presented many divergences, even with regard to the infusion of rtPA. The lack of structure, medication and absence of a neurologist were considered the main barriers to treatment. Conclusion: Physicians are not well informed about the new guidelines for the treatment of acute stroke. Most physicians incorrectly answered most of the questions on the questionnaire.

https://doi.org/10.1590/0004-282x20170122 1661 downloads

Does the side of middle cerebral artery compromise matters in the mortality after thrombolysis in ischemic stroke?
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Ducci, Renata Dal-Prá

; Lange, Marcos Christiano

; Moro, Carla Heloísa

; Harger, Rodrigo

; Longo, Alexandre Luiz

; Cabral, Norberto Luiz

; Germiniani, Francisco Manoel Branco

; Nóvak, Edison Matos

; Zétola, Viviane de Hiroki Flumignan

Arquivos de Neuro-Psiquiatria

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aug 2015, Volume 73 N. 8 Pages 644 - 647

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O impacto do lado de acometimento da artéria cerebral média (ACM) não é bem estabelecido. Nosso objetivo é analisar as diferenças entre pacientes com acidente vascular isquêmico (AVCi) de ACM direita (ACMD) e esquerda (ACME) submetidos à trombólise endovenosa e a influência do lado acometido na mortalidade em 3 meses. Método Pacientes com AVCi ACMD e ACME submetidos à trombólise endovenosa entre Março de 2010 a Dezembro de 2012 em duas Unidades de AVC brasileiras foram incluídos. Diferenças entre AVCi ACMD e ACME foram identificadas pela análise univariada. Resultados Quarenta e cinco pacientes com AVCi de ACMD e 67 de ACME foram analisados. Pacientes com AVCi de ACME tiveram maior incidência de fibrilação atrial (p = 0,031), enquanto de ACMD maior de AVCi prévio (p = 0,034). A mortalidade em 3 meses foi similar em ambos os grupos (OR = 1,20; 0,37 -4,29, p = 0,772). Conclusão O lado de acometimento da ACM no AVCi não influencia na mortalidade.

The impact of the side in middle cerebral artery (MCA) ischemic stroke is not well established. Our aim was to analyze the differences between right (RMCA) and left middle cerebral artery (LMCA) stroke in patients submitted to intravenous thrombolysis and the influence of the affected side in the patient’s mortality after 3 months. Method Patients with MCA ischemic stroke submitted to intravenous thrombolysis from March 2010 to December 2011 at two Brazilian Stroke Centers were included. Differences between patients with RMCA and LMCA stroke were identified by univariate analysis. Results Forty-five patients with RMCA stroke and 67 with LMCA stroke were analyzed. Patients with LMCA had a higher incidence of atrial fibrillation (p = 0.031), although patients with RMCA more often had a previous ischemic stroke (p = 0.034). The mortality over 3 months was similar for either side (OR = 1.20 ;0.37 - 4.29, p = 0.772). Conclusion The side of the MCA ischemic stroke did not influence the patients mortality.

https://doi.org/10.1590/0004-282X20150079 5137 downloads

Peripheral neuropathy investigation in the early stage of bone marrow transplantation
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Zétola, Viviane de Hiroki Flumignan

Arquivos de Neuro-Psiquiatria

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sep 1997, Volume 55 N. 3A Pages 505 - 505

Abstract: En | Text: En | PDF: En

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Glossary and search help

You can enrich your search in a very simple way. Use the search indexes combined with the connectors (AND or OR) and specify more your search.

For example, if you want to search for articles about
cases of dengue in Brasil in 2015, use:
ti:dengue and publication_year:2015 and aff_country:Brasil

See below the complete list of search indexes that can be used:

Index code	Element
ti	article title
au	author
kw	article keywords
subject	subject (title words, abstract and keywords)
ab	abstract
ta	journal short title (e.g. Cad. Saúde Pública)
journal_title	journal full title (e.g. Cadernos de Saúde Pública)
la	publication language code (e.g. pt - Portuguese, es - Spanish)
type	document type
pid	publication identifier
publication_year	publication year of publication
sponsor	sponsor
aff_country	country code of the author's affiliation
aff_institution	author affiliation institution
volume	article volume
issue	article issue
elocation	elocation
doi	DOI number
issn	journal ISSN
in	SciELO colection code (e.g. scl - Brasil, col - Colômbia)
use_license	article usage license code

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