Seguimento clinoceletrogr��fico de crian��cas e adolescentes com crise epil��ptica ��nica n��o-provocada

Os fen��menos convulsivos despertaram o interesse de estudiosos e pensadores j�� na Antig��idade, quando aspectos m��gicos e sobrenaturais eram a eles associados. No s��culo XIX foram lan��adas as bases dos conceitos atuais sobre a desestrutura����o funcional cerebral na epilepsia, e Berger, em 1929, marcou definitivamente a hist��ria com a descoberta dos ritmos cerebrais. Crise epil��ptica e epilepsia n��o s��o sin��nimos, j�� que o ��ltimo termo refere-se a crises recorrentes espont��neas. Ela costuma iniciar na inf��ncia, da�� a preocupa����o com o risco de repeti����o do primeiro epis��dio e com a decis��o de instituir tratamento medicamentoso. Fatores progn��sticos s��o apontados, mas n��o h�� consenso. No Brasil existem poucas pesquisas nesta linha, tanto de preval��ncia da epilepsia como de fatores envolvidos na recorr��ncia de crises. Este estudo teve como objetivo geral avaliar aspectos clinicoeletrogr��ficos capazes de auxiliar no progn��stico e no manejo da epilepsia da crian��a e do adolescente. Foram objetivos espec��ficos determinar a incid��ncia de crise epil��ptica n��o provocada recorrente; identificar fatores remotos implicados na ocorr��ncia de crise epil��ptica; relacionar tipo de crise com achados eletrencefalogr��ficos; relacionar tipo de crise, dura����o da crise, estado vig��lia/sono no momento da crise e achados eletrencefalogr��ficos com possibilidade de recorr��ncia; e identificar os fatores de risco para epilepsia. Foram acompanhados 109 pacientes com idades entre 1 m��s e 16 anos, com primeira crise n��o-provocada, em m��dia por 24 meses, a intervalos trimestrais, no Hospital de Cl��nicas de Porto Alegre (HCPA). Foram realizados eletrencefalogramas (EEG) ap��s a primeira crise; depois, solicitados anualmente. N��o foram inclu��dos casos com epilepsia ou s��ndrome epil��ptica bem definida, ou que fizeram uso pr��vio de drogas antiepil��pticas. A m��dia de idade foi 6 anos, com predom��nio da faixa et��ria de 6 a 12 anos. Setenta eram meninos e 39, meninas. Os indiv��duos brancos eram 92, e os n��o-brancos, 17. O n��vel de escolaridade dos casos esteve de acordo com a distribui����o da idade e, entre os respons��veis, predominaram 8 anos de escolaridade. Foi poss��vel concluir que as crises ��nicas n��o-provocadas mais freq��entes foram generalizadas, e sem predom��nio significativo do tipo de EEG. A incid��ncia de crise n��o-provocada recorrente foi 51,4%. Hist��ria de intercorr��ncias pr��-natais maternas aumentou em 2 vezes o risco de repeti����o de crises. Via de nascimento, escore de Apgar no 5�� minuto, rela����o peso ao nascer/idade gestacional, intercorr��ncias no per��odo p��s-natal imediato e desenvolvimento neuropsicomotor n��o tiveram influ��ncia na recorr��ncia. Hist��ria familiar de crises mostrou tend��ncia �� signific��ncia estat��stica para repeti����o dos epis��dios, com risco de 1,7. N��o foi encontrada associa����o entre tipo de crise e achado eletrencefalogr��fico. A maioria das crises foi de curta dura����o (at�� 5 minutos), mas este dado n��o esteve relacionado com a recorr��ncia. Estado de vig��lia teve efeito protetor na recorr��ncia. Se a primeira crise foi parcial, o risco de repeti����o foi 1,62, com tend��ncia �� signific��ncia. Quando o primeiro EEG foi alterado, houve rela����o significativa com primeira crise tanto generalizada como parcial. O primeiro EEG com altera����es parox��sticas focais apontou risco de repeti����o de 2,90. Quando as vari��veis envolvidas na repeti����o de crises foram ajustadas pelo modelo de regress��o de Cox, EEG alterado mostrou risco de 2,48, com riscos acumulados de 50%, 60%, 62% e 68%; com EEG normal, os riscos foram 26%, 32%, 34% e 36% em 6, 12, 18 e 24 meses respectivamente.

Foreign investment in Mexico after economic reform

Includes bibliography

Caracteriza����o qu��mica e mineral��gica de azulejos portugueses do centro hist��rico de S��o Lu��s-MA (Brasil): Uma aproxima����o �� mineralogia e �� temperatura de queima das mat��rias-primas

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior (CAPES)

Chemical and mineralogical characterization of portuguese ceramic tiles in the historic center of S��o Lu��s do Maranh��o (Brazil): an approximation of the mineralogy and firing temperature of the raw materials

Nesse trabalho, foram caracterizados, pela primeira vez, azulejos hist��ricos portugueses do Centro Hist��rico de S��o Lu��s (CHSL) do Maranh��o. A caracteriza����o foi realizada atrav��s dos ensaios de microscopia ��tica, difra����o de raios X (DRX) e an��lise qu��mica, visando ao uso dessa informa����o para a determina����o das poss��veis mat��rias-primas utilizadas na sua fabrica����o, bem como a prov��vel temperatura de queima desses materiais. Os resultados mostraram que a microestrutura desses materiais �� constitu��da por poros de tamanhos variados, apresentando incrusta����es de calcita e gr��os de quartzo de tamanhos inferiores a 500 ��m, distribu��dos numa matriz de cor rosa-amarelo, onde foram identificadas, por DRX, as fases minerais calcita, gelhenita, wollastonita, quartzo e amorfo. A partir da informa����o obtida, �� poss��vel inferir que as mat��rias-primas originais estiveram constitu��das, provavelmente, por mistura de argilas caolin��ticas (Al₂O₃���2SiO,₂���2H₂O), ricas em carbonatos de c��lcio e quartzo ou misturas de argilas caoliniticas, quartzo e calcita. Essas mat��rias-primas originais n��o atingiram a temperatura de coc����o de 950��C.

Early stroke case-fatality rates in three hospital registries in the Northeast and Southeast of Brazil

Few studies have addressed early cerebrovascular lethality in Brazil. Objective: To evaluate 10 and 28-day stroke case-fatality rates in three hospitals in three Brazilian cities. Methods: We described the stroke registries in Sao Paulo, Joao Pessoa, and Natal. Results: Out of a total of 962 first-ever events (mean age, 68.1 years-old; 53% men), 83.6% (804 cases) were classified as ischemic and 16.4% (158) as hemorrhagic stroke. Overall, the case-fatality rates and 95% confidence intervals (95% CI) for hemorrhagic stroke events were higher than for ischemic events, both at 10 (12.3%; 95% CI 7.2-17.4 versus 7.0%; 95% CI 5.3-8.8) and at 28 days (19.8%; 95% CI 13.6-26.0 versus 11.1%; 95% CI 8.9-13.3). Conclusions: We did not find any substantial differences in early case-fatality rates according to stroke subtypes, when comparing the three centers.

Early and One-Year Stroke Case Fatality in Sao Paulo, Brazil: Applying the World Health Organization's Stroke STEPS

Case fatality rate is considered a main determinant of stroke mortality trends. We applied the World Health Organization's Stroke STEPS to identify case fatality rates in a community hospital in Brazil. We evaluated all patients with first-ever stroke seeking acute care at the hospital's emergency ward between April 2006 and December 2008 to verify early and late case fatality according to stroke subtype. We used years of formal education as a surrogate for socioeconomic status. Of 430 first-ever stroke events, 365 (84.9%) were ischemic and 65 (15.1%) were intracerebral hemorrhage. After 1 year, we adjudicated 108 deaths (86 ischemic; 22 hemorrhagic). Age-adjusted case fatality rates for ischemic stroke and intracerebral hemorrhage were 6.0% v 19.8% at 10 days, 10.6% v 22.1% at 28 days, 17.6% v 29.1% at 6 months, and 21.0% v 31.5% at 1 year. Illiteracy or no formal education was a predictor of death at 6 months (odds ratio [OR], 4.31; 95% confidence interval [CI] 1.34-13.91) and 1 year (OR, 4.21; 95% CI, 1.45-12.28) in patients with ischemic stroke, as well as at 6 months (OR, 3.19; 95% CI, 1.17-8.70) and 1 year (OR, 3.30; 95% CI, 1.30-8.45) for all stroke patients. Other variables, including previous cardiovascular risk factors and acute medical care, did not change this association to a statistically significant degree. In conclusion, case fatality, particularly up to 6 months, was higher in hemorrhagic stroke, and lack of formal education was associated with increased stroke mortality.

Tracing AGN accretion and star formation in Herschel galaxies

In this Thesis, we study the physical properties and the cosmic evolution of AGN and their host galaxies since z���3. Our analysis exploits samples of star forming galaxies detected with Herschel at far-IR wavelengths (from 70 up to 500 micron) in different extragalactic surveys, such as COSMOS and the deep GOODS (South and North) fields. The broad-band ancillary data available in COSMOS and the GOODS fields, allows us to implement Herschel and Spitzer photometry with multi-wavelength ancillary data. We perform a multicomponent SED-fitting decomposition to decouple the emission due to star formation from that due to AGN accretion, and to estimate both host-galaxy parameters (such as stellar mass, M* and star formation rate, SFR), and nuclear intrinsic bolometric luminosities. We use the individual estimates of AGN bolometric luminosity obtained through SED-fitting decomposition to reconstruct the redshit evolution of the AGN bolometric luminosity function since z���3. The resulting trends are used to estimate the overall AGN accretion rate density at different cosmic epochs and to trace the first ever estimate of the AGN accretion history from an IR survey. Later on, we focus our study on the connection between AGN accretion and integrated galaxy properties. We analyse the relationships of AGN accretion with galaxy properties in the SFR-M* plane and at different cosmic epochs. Finally, we infer what is the parameter that best correlates with AGN accretion, comparing our results with previous studies and discussing their physical implications in the context of current scenarios of AGN/galaxy evolution.

Molekulare und supramolekulare Eigenschaften von neuen Donor-Akzeptor-Polymeren

Die organische Halbleitertechnologie befindet sich seit Jahrzehnten im Focus des Interesses, da sie eine kosteng��nstige und umweltvertr��gliche Alternative zu anorganischen Silizium-basierten Halbleitern darstellt. Die M��glichkeit der gezielten Funktionalisierung von definierten Strukturen durch synthetische Methoden, welche eine gro��e Vielfalt an Materialien erm��glicht, steht dabei besonders im Vordergrund. Die Modifikation von physikalischen Eigenschaften erm��glicht dabei eine stark erleichterte Anpassung f��r den geplanten Anwendungsbereich. Im Rahmen der vorliegenden Dissertation wurden organische Halbleitermaterialien basierend auf Cyclopenta[2,1-b:3,4-b']dithiophen (CDT) dargestellt und hinsichtlich ihrer strukturellen und elektronischen Eigenschaften untersucht. In Kombination mit Benzo[c][1,2,5]thiadiazol (BTZ) und weiteren Akzeptoren wurden zun��chst Donor(D)-Akzeptor(A)-Polymere synthetisiert und Struktur-Eigenschaft-Beziehungen aufgestellt. So konnte ein sehr hochmolekulares Polymer CDT-BTZ-Polymer (Mn = 36 kg mol-1, PDI = 2.6) erhalten werden, welches sich durch eine hohe lamellare Ordnung und eine gemessene Ladungstr��germobilit��t in FETs von ��ber 5.0 cm2V-1s-1 bei Raumtemperatur auszeichnete; bei niedrigen Temperaturen (240 K) war letztgenannte 6.5 cm2V-1s-1. Aufgrund dieses hohen Ladungstransports und der Abwesenheit niedermolekularer Polymerketten innerhalb des Polymers konnte erstmals eine Messung eines HALL-Effektes bewerkstelligt werden. Dies war der erste Beweis eines Band-artigen Ladungstransportes an einem Polymerhalbleiter. Des Weiteren wurde durch synthetische Ver��nderung der Grundstruktur des Polymers zu l��ngeren Alkylketten eine anisotrope Anordnung der Polymerketten erreicht und die Ladungstr��germobilit��t (6.5 cm2V-1s-1 bei Raumtemperatur) weiter gesteigert. Darauf aufbauend wurde der Einfluss von stereoisomeren Seitenketten an CDT-BTZ-Polymeren auf Packungsverhalten, Parametern (Sperrstrom, Einschaltstrom) in FETs und L��slichkeit in organischen L��sungsmitteln untersucht. Durch cis-trans-Isomerisierung der Seitenketten wurde hier eine neue Methode zur Optimierung des Packungsverhaltens von Polymeren in d��nnen Filmen und L��sung gefunden. Zuletzt wurden D-��-A-Farbstoffen, welche CDT als Verbr��ckungseinheit (��) beinhalten, dargestellt. Durch Variation von D und A konnten Struktur-Eigenschaft-Beziehungen in der Anwendung in Solarzellen (Feststoffsolarzellen, Fl��ssigsolarzellen) gefunden werden. Die Untersuchungen der photoinduzierten Absorption und der Photolumisenzenzquantenausbeute lieferten dabei Erkl��rungen f��r physikalische Prozesse wie Ladungsinjektion- und rekombination.

Detection of regional blood perfusion changes in epileptic seizures with dynamic brain perfusion CT--a pilot study

BACKGROUND AND PURPOSE: Perfusion CT (P-CT) is used for acute stroke management, not, however, for evaluating epilepsy. To test the hypothesis that P-CT may identify patients with increased regional cerebral blood flow during subtle status epilepticus (SSE), we compared P-CT in SSE to different postictal conditions. METHODS: Fifteen patients (mean age 47 years, range 21-74) underwent P-CT immediately after evaluation in our emergency room. Asymmetry indices between affected and unaffected hemispheres were calculated for regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and mean transit time (MTT). Regional perfusion changes were compared to EEG findings. RESULTS: Three patients in subtle status epilepticus (group 1) had increased regional perfusion with electro-clinical correlate. Six patients showed postictal slowing on EEG corresponding to an area of regional hypoperfusion (group 2). CT and EEG were normal in six patients with a first epileptic seizure (group 3). Cluster analysis of asymmetry indices separated SSE from the other two groups in all three parameters, while rCBF helped to distinguish between chronic focal epilepsies and single events. CONCLUSION: Preliminary results indicate that P-CT may help to identify patients with SSE during emergency workup. This technique provides important information to neurologists or emergency physicians in the difficult clinical differential diagnosis of altered mental status due to subtle status epilepticus.

Time to admission in acute ischemic stroke and transient ischemic attack

BACKGROUND AND PURPOSE: The effect of thrombolysis depends on the time from stroke onset to treatment and therefore also on the time when patients come to the hospital. This study was designed to analyze the variables that influence the time from symptom onset to admission (TTA) to the stroke unit. METHODS: We evaluated the medical records of 615 consecutive stroke or transient ischemic attack (TIA) patients admitted to our neurological department within 48 hours after symptom onset. RESULTS: The median TTA was 180 minutes. Referral by emergency medical services (EMS; P<0.001), high National Institutes of Health Stroke Scale (NIHSS) scores (P<0.001), strokes in the carotid territory (P<0.001), and strokes not attributable to small vessel disease (P<0.001) were associated with shorter prehospital delays. The TTA was adjusted for travel times (adjTTA), and all these variables remained significantly associated with time to admission. In addition, patients with previous experience with stroke or TIA had longer adjTTA (P=0.028). Regression analysis confirmed the independent association between referral by EMS (P=0.010), high NIHSS scores (P<0.001), carotid territory stroke (P<0.001), and first-ever cerebrovascular event (P=0.022) with shorter adjTTA. CONCLUSIONS: Factors such as NIHSS scores and stroke location influence the time to admission but, unlike referral pathways, cannot be modified. Educational programs and stroke campaigns should therefore not only teach typical and less common stroke symptoms and signs but also that EMS provides the fastest means of transportation to a stroke unit and the best chances to get treatment early.

Immunologic response to antiretroviral therapy in hepatitis C virus-coinfected adults in a population-based HIV/AIDS treatment program

BACKGROUND: We sought to characterize the impact that hepatitis C virus (HCV) infection has on CD4 cells during the first 48 weeks of antiretroviral therapy (ART) in previously ART-naive human immunodeficiency virus (HIV)-infected patients. METHODS: The HIV/AIDS Drug Treatment Programme at the British Columbia Centre for Excellence in HIV/AIDS distributes all ART in this Canadian province. Eligible individuals were those whose first-ever ART included 2 nucleoside reverse transcriptase inhibitors and either a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor and who had a documented positive result for HCV antibody testing. Outcomes were binary events (time to an increase of > or = 75 CD4 cells/mm3 or an increase of > or = 10% in the percentage of CD4 cells in the total T cell population [CD4 cell fraction]) and continuous repeated measures. Statistical analyses used parametric and nonparametric methods, including multivariate mixed-effects linear regression analysis and Cox proportional hazards analysis. RESULTS: Of 1186 eligible patients, 606 (51%) were positive and 580 (49%) were negative for HCV antibodies. HCV antibody-positive patients were slower to have an absolute (P<.001) and a fraction (P = .02) CD4 cell event. In adjusted Cox proportional hazards analysis (controlling for age, sex, baseline absolute CD4 cell count, baseline pVL, type of ART initiated, AIDS diagnosis at baseline, adherence to ART regimen, and number of CD4 cell measurements), HCV antibody-positive patients were less likely to have an absolute CD4 cell event (adjusted hazard ratio [AHR], 0.84 [95% confidence interval [CI], 0.72-0.98]) and somewhat less likely to have a CD4 cell fraction event (AHR, 0.89 [95% CI, 0.70-1.14]) than HCV antibody-negative patients. In multivariate mixed-effects linear regression analysis, HCV antibody-negative patients had increases of an average of 75 cells in the absolute CD4 cell count and 4.4% in the CD4 cell fraction, compared with 20 cells and 1.1% in HCV antibody-positive patients, during the first 48 weeks of ART, after adjustment for time-updated pVL, number of CD4 cell measurements, and other factors. CONCLUSION: HCV antibody-positive HIV-infected patients may have an altered immunologic response to ART.

Age-dependent differences in demographics, risk factors, co-morbidity, etiology, management, and clinical outcome of acute ischemic stroke

BACKGROUND : Comparisons between younger and older stroke patients including comorbidities are limited. METHODS : Prospective data of consecutive patients with first ever acute ischemic stroke were compared between younger (</= 45 years) and older patients (> 45 years). RESULTS : Among 1004 patients, 137 (14 %) were </= 45 years. Younger patients were more commonly female (57 % versus 34 %; p < 0.0001), had a lower frequency of diabetes (1 % versus 15 %; p < 0.0001), hypercholesterolemia (26 % versus 56 %; p < 0.0001), hypertension (19 % versus 65 %; p < 0.0001), coronary heart disease (14 % versus 40 %; p < 0.0001), and a lower mean Charlson co-morbidity index (CCI), (0.18 versus 0.84; p < 0.0001). Tobacco use was more prevalent in the young (39 % versus 26 %; P < 0.0001). Large artery disease (2 % versus 21 %; p < 0.0001), small artery disease (3 % versus 12 %; p = 0.0019) and atrial fibrillation (1 % versus 17 %; p = 0.001) were less common in young patients, while other etiologies (31 % versus 9 %; p < 0.0001), patent foramen ovale or atrial septal defect (44 % versus 26 %; p < 0.0001), and cervical artery dissection (26 % versus 7 %; p < 0.0001) were more frequent. A favorable outcome (mRS 0 or 1) was more common (57.4 % versus 46.9 %; p = 0.023), and mortality (5.1 % versus 12 %; p = 0.009) was lower in the young. After regression analysis, there was no independent association between age and outcome (p = 0.206) or mortality (p = 0.073). Baseline NIHSS score (p < 0.0001), diabetes (p = 0.041), and CCI (p = 0.002) independently predicted an unfavorable outcome. CONCLUSIONS : Younger patients were more likely to be female, had different risk factors and etiologies and fewer co-morbidities. There was no independent association between age and clinical outcome or mortality.

The Other Side of the Doors: Butte & Beyond -- Congressman Pat Williams ���In the Crucible of Change���

Pat Williams emerged from the Mining City of Butte, Montana with a sense of grassroots, people-oriented politics. His inherent belief in the power of ordinary citizens carried him through the Montana Legislature and into Congress for a record-setting period. The accomplishments of his long career partially obscured his innate progressive and populist instinct that is reflective of the period of ���in the Crucible of Change.��� This film addresses Pat���s early years when his progressive instincts and activities resulted in pushback from the giant Anaconda Company which had held Montana hostage for 75 years. Pat is joined for part of the film by former campaign staffer, and now prominent media consultant, Michael Fenenbock for reflections on Pat���s 1978 ���Door-to-Door to Congress��� campaign, which demonstrated the power of his belief in the people on the other side of the doors. Pat Williams (b. 1937) rose from teaching grade school in his hometown of Butte, MT, to serving for the longest number of consecutive terms (9 terms, 18 years) in the US House of Representatives of anyone in Montana history. Pat was a member of the National Guard and attended UM in Missoula and William Jewel College, graduating from the University of Denver. Pat also served in the Montana legislature for 2 terms (1966 & 1968 elections). In 1969. Pat helped his legislative seat-mate John Melcher get elected as Montana���s Eastern District Congressman in the Special Election that June. Pat went to Washington DC as Melcher���s Executive Assistant. Upon returning to Montana, Pat headed up the Montana offices of the innovative Mountain Plains Family Education Program. In 1974, Pat ran unsuccessfully for Montana���s Western District Congressional seat in a three-way race with former Congressman Arnold Olsen and state Legislator Max Baucus. After the drafting and passage of the 1972 Montana Constitution, Pat was named a member of Montana���s first-ever Reapportionment Commission. In 1978 he successfully ran for Congress, conducting a massive grass-roots door-to-door campaign of 1�� years, reaching 50,000 doors. In a hotly contested 6-way Democratic primary, Pat won going away and also handily won the general election. Pat served in Congress from January, 1979 until January of 1997, 14 years representing the Western District and 4 years representing the entire state. Upon his retirement from Congress, in 1997 Williams returned to Montana where has been an instructor at the University of Montana and Senior Fellow and Regional Policy Associate at the Center for the Rocky Mountain West. He is a former member of the Montana Board of Regents and serves on a number of national education-related boards. In Congress Pat was a Deputy Whip of the U.S. House of Representatives and sat on committees on: Budget, Natural Resources, Education and Labor, and Agriculture. Pat���s leadership helped pass trailblazing legislation to assist hard-working middle-class families and ensure opportunities for every child. Pat���s fingerprints are on many pieces of important legislation, including the College Middle Income Assistance Act, the Family and Medical Leave Act, the Toddlers and Childhood Disability Act, the Library Services and Construction Act, and the Museum Services Act. Pat successfully sponsored the Lee Metcalf Wilderness Area and the Rattlesnake Wilderness area, helped save the Bob Marshall Wilderness from oil and gas exploration, and helped ban geothermal energy drilling near the borders of Yellowstone National Park. As Chairman of The Post-Secondary Education Committee, he protected the National Endowment for the Arts from elimination, a remarkable undertaking during a very trying time for the Agency. Pat worked tirelessly with Tribal College Leaders to build Montana���s seven Tribal Colleges. He was also responsible for the legislation that created The American Conservation Corps, which became the Corporation for National Service, giving thousands of America���s young people a chance to serve their country and pursue higher education. Pat lives in Missoula with his wife Carol Griffith Williams, former Montana Senate Majority Leader. They have three children and five grandchildren.

Organized inpatient (stroke unit) care in very old patients

BACKGROUND AND PURPOSE: It is unclear whether very old patients benefit from organized inpatient (stroke unit) care. The aim of this work was to compare the clinical outcome of patients with first-ever ischemic stroke aged either >or=80 or <80 years who were treated conservatively (without cerebral revascularization) in a university-based stroke unit. PATIENTS AND METHODS: We included 147 (11%) patients >or=80 years and 1241 (89%) patients, <80 years. All patients underwent clinical examination, blood tests, electrocardiography (ECG), brain imaging and cerebrovascular ultrasound. Additional investigations were done at the discretion of the treating physician. The modified Rankin scale (mRS) score was used to assess the 3-month outcome (favorable: mRS, 0-1; poor: mRS, 2-6; death of any cause). RESULTS: Stroke severity did not differ between both groups [median National Institutes of Health Stroke Scale (NIHSS) score, 4]. Younger patients underwent magnetic resonance (MR) imaging of the brain, MR and catheter angiography and echocardiography (p<0.001) more frequently, whereas older patients underwent computed tomography of the brain and 24-hour ECG (p<0.001) more frequently. Stroke prevention included clopidogrel (p<0.001) and heparin (p=0.047) more often in older patients and aspirin (p=0.016) in younger patients. Recurrent ischemic events were similarly frequent in old (7%) and young (5%) patients. Favorable outcome was equally prevalent in old (71%) and young (76%) patients, whereas mortality was higher in older patients (7 and 3%, p=0.007). Admission NIHSS score >or=12 was the only independent predictor of unfavorable outcome (odds ratio, 19.6; 95% confidence interval, 9.7-39.6; p<0.001). CONCLUSION: Our work provides further evidence that also the oldest patients may benefit from conservative stroke unit care.

Increased sleep need and daytime sleepiness 6 months after traumatic brain injury: a prospective controlled clinical trial.

Post-traumatic sleep-wake disturbances are common after acute traumatic brain injury. Increased sleep need per 24 h and excessive daytime sleepiness are among the most prevalent post-traumatic sleep disorders and impair quality of life of trauma patients. Nevertheless, the relation between traumatic brain injury and sleep outcome, but also the link between post-traumatic sleep problems and clinical measures in the acute phase after traumatic brain injury has so far not been addressed in a controlled and prospective approach. We therefore performed a prospective controlled clinical study to examine (i) sleep-wake outcome after traumatic brain injury; and (ii) to screen for clinical and laboratory predictors of poor sleep-wake outcome after acute traumatic brain injury. Forty-two of 60 included patients with first-ever traumatic brain injury were available for follow-up examinations. Six months after trauma, the average sleep need per 24 h as assessed by actigraphy was markedly increased in patients as compared to controls (8.3 �� 1.1 h versus 7.1 �� 0.8 h, P < 0.0001). Objective daytime sleepiness was found in 57% of trauma patients and 19% of healthy subjects, and the average sleep latency in patients was reduced to 8.7 �� 4.6 min (12.1 �� 4.7 min in controls, P = 0.0009). Patients, but not controls, markedly underestimated both excessive sleep need and excessive daytime sleepiness when assessed only by subjective means, emphasizing the unreliability of self-assessment of increased sleep propensity in traumatic brain injury patients. At polysomnography, slow wave sleep after traumatic brain injury was more consolidated. The most important risk factor for developing increased sleep need after traumatic brain injury was the presence of an intracranial haemorrhage. In conclusion, we provide controlled and objective evidence for a direct relation between sleep-wake disturbances and traumatic brain injury, and for clinically significant underestimation of post-traumatic sleep-wake disturbances by trauma patients.