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.

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.

OBJETIVO: Determinar os obstáculos à efetiva redução da transmissão materno-infantil do HIV em Campos dos Goytacazes (RJ). MÉTODOS: Estudo de coorte, com acompanhamento médico de gestantes com diagnóstico confirmado de infecção pelo HIV e de seus bebês, atendidos no Serviço Municipal de Atendimento Especializado de Doenças Sexualmente Transmissíveis e AIDS, no período de janeiro de 2004 a abril de 2007; coleta de informações relativas às variáveis de exposição e desfecho a partir dos prontuários; determinação de frequências das variáveis e análise bivariada entre os fatores de exposição e o desfecho; cálculo de riscos relativos de transmissão materno-infantil do HIV associados às variáveis de exposição, com intervalo de confiança de 95%; e avaliação de significância estatística de associações de risco. RESULTADOS: Foram acompanhados 78 binômios, sendo de 7,7% a taxa de transmissão materno-infantil do HIV. As variáveis que mostraram associações estatisticamente significantes com a transmissão materno-infantil do HIV foram: a não utilização de antirretrovirais para profilaxia ou tratamento na gestação (RR = 21,00; IC95% 2,64-166,74, p = 0,001); e o diagnóstico materno após a gestação (RR = 6,80; IC95% 1,59-29,17, p = 0,025). Novas gestações em mulheres com outros filhos já expostos ao HIV ocorreram em 19,12% dos casos. CONCLUSÕES: Não houve redução da taxa de transmissão materno-infantil do HIV no período de 2004-2007 em relação ao triênio anterior. Foram caracterizados como obstáculos determinantes desta não redução: a baixa cobertura pela testagem anti-HIV no pré-natal, impossibilitando tratamento ou profilaxia materna eficiente; e o uso incorreto do teste rápido na admissão para o parto.

OBJECTIVE: To determine impediments to the effective reduction of maternal-infant transmission of HIV in the municipality of Campos dos Goytacazes, RJ, Brazil. METHODS: This is a cohort study, with medical follow-up, of pregnant women with confirmed diagnosis of HIV infection, and their infant children, assisted at the Municipal Specialized Service of Sexually Transmitted Diseases/AIDS from January 2004 to April 2007. Information regarding exposure and outcome variables was collected from their medical records. Frequencies of variables were determined and bivariate analysis performed for exposure factors and transmission of HIV. Relative risks of HIV transmission associated with exposure variables were calculated using 95% confidence intervals. Statistical significance of risk associations was evaluated. RESULTS: Seventy-eight mother-child pairs were studied; the rate of maternal-infant transmission of HIV was 7.7%. Variables showing significant association with maternal-infant transmission of HIV were the non-utilization of antiretrovirals for prophylaxis or treatment during pregnancy (RR = 21.00; 95%CI 2.64-166.74, p = 0.001) and diagnosis of maternal disease after pregnancy (RR = 6.80; 95%CI 1.59-29.17, p = 0.025). New pregnancies in women with other children also exposed to HIV occurred in 19.12% (15/78) of cases. CONCLUSIONS: There was no reduction in the rate of maternal-infant transmission of HIV in the period 2004-2007 in relation to the preceding triennium. The following were recognized as impediments to the effective reduction of maternal-infant transmission of HIV: low prenatal screening coverage of maternal HIV infection, impairing maternal treatment or prophylaxis; and the incorrect use of the rapid screening test at admission for delivery.