Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

The diploma thesis deals with a problematic of management of the nursing care by a patient with intracranial hemorrhage. Most of the patients who survive intracranial hemorrhage stay permanently reliant on the care from others. That is why it is so important for this care to be as qualitative as possible and to have a fluent continuity. The aim of the thesis was to find out what is the role of a nurse by the patient with intracranial hemorrhage, then also find out, if the nurses know the warning signs of a worsening state of such patient, how do they cooperate with his/her family and what are the possibilities of the following care. In the empirical part of the diploma thesis, qualitative-quantitative research was used. For a complex view on a management of nursing care, the chosen technique of research was semi-structured questionnaire with patients with intracranial hemorrhage and non-standardized questionnaire with nurses who take care of these patients. For the quantitative part of the research, two hypotheses to two aims of the diploma thesis were set. Both hypotheses weren't proven by statistical methods. For qualitative research, four research questions were set. The respondents described the role of a nurse, especially in helping the patient, in rehabilitation and in also her role in educating the patient. Addressed respondents agreed on appropriate and swift reactions of the nurses in case the state of the patient starts to worsen. The cooperation of nurses and families is according to the patients without problems. It showed in the interviews with respondents, that there is a problem with insufficient awareness of the patients about the existing possibilities of following care. The outcome of the diploma thesis is a coherent educational material about nursing care by a patient with intracranial hemorrhage, which can serve to either the students or the nurses taking care of these patients.

published_or_final_version / abstract / Medicine / Master / Doctor of Medicine

published_or_final_version / Medicine / Master / Doctor of Medicine

Stroke is amongthe leading causes of death worldwide and requires immediate care to prevent death or permanent disability. Unfortunately, the current stateof stroke diagnosis is limited to fixed neuroimaging facilities that do not allow rapid stroke diagnosis. Hence, a portable stroke-diagnosis device could assist in the pre-hospital triage of patients. Moreover, such a portable device could also be useful for bedside stroke monitoring of patients in the Neuro Intensive Care Unit (Neuro-ICU) to avoid unnecessary neuroimaging. Recent animal studies and numerical simulations have supported the idea of implementing Electrical Bioimpedance (EBI) in a portable device, allowing non-invasive assessment as a useful tool for the pre-hospital triage of stroke and Traumatic Brain Injury (TBI) patients. Unfortunately, these studies have not reported any results from human subjects in the acute phase of the stroke. The numerical simulations are also based on simple models that sometimes lack necessary details. Finite Element Method (FEM) simulations on a realistic numerical head model as well as experimental Bioimpedance Spectroscopy (BIS) measurements from human subjectsin the acute, subacute and chronic phasesof stroke were used to answer the following research questions: (i) Does stroke modify the electrical properties of brain tissue in a way that is detectable via EBI? (ii) Would it be possible to detect stroke via EBI as early as in the acute and sub-acute phase?(iii) Is EBI sensitive enough to monitor changes caused by stroke pathogenesis? Using FEM to simulate electrical current injection on the head and study the resulting distribution of electrical potential on the scalp, it was shown that Intra-Cranial Hemorrhage (ICH) affects the quasi-symmetric scalp potential distribution,creating larger left-right potential asymmetry when compared to the healthy head model. Proof-of-concept FEM simulations were also tested in a small cohort of 6ICH patients and 10 healthy controls, showing that the left-right potential difference in the patients is significantly (p&lt;0.05) larger than in the controls. Using bioimpedance measurements in the acute,  subacute and chronic phasesof stroke and examining simple features, it was also shown that the head EBI measurements of patients suffering stroke are different from controls, enabling the discrimination of healthy controls and stroke patients at any stage of the stroke. The absolute change in test-retest resistance measurements of the control group (~5.33%) was also found to be significantly (p&lt;0.05) smaller than the EBI measurements of patients obtained 24 hours and 72 hours after stroke onset (20.44%). These results suggested that scalp EBI is sensitive to stroke pathogenesis changesand thususeful for bedside monitoring in the Neuro-ICU. These results suggested that EBI is a potentially useful tool for stroke diagnosis and monitoring. Finally, the initial observations based on a small number of patients, addressing the proposed future work of this thesis, suggested that the average head resistance amplitude of hemorrhagic stroke patients is smaller than in healthy controls, while ischemic stroke patients show a larger resistance amplitude than the controls. Scalp potential asymmetry analysis of healthy, hemorrhagic and ischemic stroke subjects also suggests that these three groups can be separated. However, these results are based on a small number of patients and need to be validated using a larger cohort. Initial observations also showed that the resistance of the EBI measurements of controls is robust between test and retest measurements, showing no significant difference (less than 2% and p&gt;0.05). Subject position during EBI recording (supine or sitting) did not seem to affect the resistance of the EBI measurements (p&gt;0.05). However, age, sex and head size showed significant effects on the resistance measurements. These initial observations are encouraging for further research on EBI for cerebral monitoring and stroke diagnosis. However, at this stage, considering the uncertainties in stroke type differentiation, EBI cannot replace CT but has the potential to be used as a consultation tool. / <p>QC 20151109</p>

As a beneficial component with critical impact, computer-aided decision making systems have infiltrated many fields, such as economics, medicine, architecture and agriculture. The latent capabilities for facilitating human work propel high-speed development of such systems. Effective decisions provided by such systems greatly reduce the expense of labor, energy, budget, etc. The computer-aided decision making system for traumatic injuries is one type of such systems that supplies suggestive opinions when dealing with the injuries resulted from accidents, battle, or illness. The functions may involve judging the type of illness, allocating the wounded according to battle injuries, deciding the severity of symptoms for illness or injuries, managing the resources in the context of traumatic events, etc. The proposed computer-aided decision making system aims at estimating the severity of blood volume loss. Specifically speaking, accompanying many traumatic injuries, severe hemorrhage, a potentially life-threatening condition that requires immediate treatment, is a significant loss of blood volume in process resulting in decreased blood and oxygen perfusion of vital organs. Hemorrhage and blood loss can occur in different levels such as mild, moderate, or severe. Our proposed system will assist physicians by estimating information such as the severity of blood volume loss and hemorrhage , so that timely measures can be taken to not only save lives but also reduce the long-term complications as well as the cost caused by unmatched operations and treatments. The general framework of the proposed research contains three tasks and many novel and transformative concepts are integrated into the system. First is the preprocessing of the raw signals. In this stage, adaptive filtering is adopted and customized to filter noise, and two detection algorithms (QRS complex detection and Systolic/Diastolic wave detection) are designed. The second process is to extract features. The proposed system combines features from time domain, frequency domain, nonlinear analysis, and multi-model analysis to better represent the patterns when hemorrhage happens. Third, a machine learning algorithm is designed for classification of patterns. A novel machine learning algorithm, as a new version of error correcting output code (ECOC), is designed and investigated for high accuracy and real-time decision making. The features and characteristics of this machine learning method are essential for the proposed computer-aided trauma decision making system. The proposed system is tested agasint Lower Body Negative Pressure (LBNP) dataset, and the results indicate the accuracy and reliability of the proposed system.

There is conflicting data on the effects of statins on cerebral vasospasm and clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH) patients. In this retrospective cohort study, patients were divided into those who received pravastatin (PRAV group) 40mg/d and those who did not (NP group). Data were analyzed using multivariate logistic regression. Eighty-one patients met inclusion criteria. There was a statistically significant decreased in the incidence of vasospasm in the PRAV group; however, this association did not retain significance after adjusting for WFNS, race, elevated WBC, and clipping (59% PRAV vs. 88% NP, p=0.08). There was no statistically significant difference in proportion of severe radiological vasospasm or mortality between groups. However, there was a trend towards a decreased mean length of stay (P=0.06) and a significantly higher proportion of survivors discharged to home in the PRAV group (P<0.0001). In conclusion, there was a trend towards a decrease in the incidence of vasospasm in the aSAH receiving pravastatin, but this trend did not achieve statistical significance after adjusting for potential confounders. Pravastatin was associated with other favorable clinical outcomes.

Orientador: José Paes de Oliveira Filho / Resumo: A Trombastenia de Glanzmann (TG) é uma doença hereditária autossômica recessiva caracterizada por alterações na agregação plaquetária, culminando em sinais clínicos como hemorragias e epistaxe. Duas mutações (c.122G>C e g.1456_1466del) no gene Integrin subunit alpha2β (ITGA2B) foram descritas como responsáveis pela ocorrência da TG em equinos de diversas raças, dentre elas: Quarto de Milha, Puro Sangue Inglês, Standardbred, Oldenburg e Passo Fino. Este gene codifica a subunidade αIIb da integrina αIIbβ3, que é receptora de fibrinogênio nas plaquetas. Embora a TG tenha sido diagnosticada nos EUA, Canadá, Japão e Austrália, estudos de prevalência em equinos no Brasil e no mundo são inexistentes. Objetivou-se determinar a prevalência destas mutações em equinos no Brasil. Utilizou-se 1.053 amostras, oriundas do banco de DNA do LBMCV, de equinos Quarto de Milha (n=679) e Warmblood (n=374) clinicamente saudáveis. Segmentos do DNA foram amplificados por PCR e sequenciados. O genótipo de cada animal foi analisado e comparado à sequência de nucleotídeos do gene ITGA2B depositada no GenBankTM. As mutações responsáveis pela TG não estavam presentes na população estudada. Em outras palavras, todos os animais testados apresentaram genótipo wild type. Sendo assim, nas condições em que este estudo foi realizado, pode-se inferir que, apesar de não ser possível afirmar que não existam cavalos carreadores de alelos mutados para a doença no Brasil, a TG parece ser uma doença extremamente rara n... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Glanzmann thrombasthenia (GT) is an autosomal recessive inherited disorder characterized by changes in platelet aggregation, leading to hemorrhage and epistaxis. Two different mutations (c.122G>C and g.1456_1466del) in the Integrin subunit alpha2β gene (ITGA2B) have been identified in different breeds, i.e., Quarter Horse, Thoroughbred, Standarbred, Oldenburg and Paso Fino. ITGA2B codifies the αIIb subunit of the αIIbβ3 integrin, also termed platelet fibrinogen receptor. Horses with GT have been diagnosed in USA, Canada, Japan and Australia. However, there are no studies on prevalence of GT in equines in the world. The aim of this study was to evaluate the prevalence of the mutations responsible for GT in horses in Brazil. A total of 1,053 DNA samples of clinically healthy Quarter Horse (n = 679) and Warmblood horses (n = 374) were used. DNA fragments were amplified by PCR and sequenced. Subsequently, the genotype of each animal was analyzed and compared to the nucleotide sequence of the ITGA2B gene found on GenBankTM. The mutations involved with GT in horses were not prevalent in the cohort of horses assessed. In other words, all animals tested were wild type. Therefore, under the conditions in which this study was carried out, it can be inferred that, although it is not possible to state the absence of mutated allelles in Brazilian horses, GT seems to be extremely rare in the population of Quarter Horse and Warmblood in Brazil. / Mestre

Role of blood biomarkers in spontaneous intracerebral hemorrhage Background: The study of blood biomarkers can offer new possibilities in diagnostics, prognostication, determination of etiology, and management of spontaneous intracerebral hemorrhage. The aim of our study was to assess the relationship between a panel of selected blood biomarkers and clinical and radiodiagnostic parameters in patients with spontaneous intracerebral hemorrhage. Primarily, the aim was to find a prognostic biomarker which could help in deciding on the optimal categorization of treatment. Patients and methods: A total of 70 patients were prospectively included in this study. The following blood biomarkers were determined: glial fibrillary acidic protein, S100B protein, matrix metalloproteinase 9, interleukin 6, interleukin 10, 25-hydroxyvitamin D, 1,25- dihydroxyvitamin D, total cholesterol, leukocyte counts, blood glucose and C-reactive protein. These were then correlated with selected clinical and radiodiagnostic parameters. Results: Relative to hematoma volume a statistically significant positive correlation was found for S100B, interleukin 10, interleukin 6 and blood glucose (S100B: ρ= 0,54, p< 0,001, IL-10: ρ= 0,43, p< 0,001, IL-6: ρ= 0,26, p= 0,027, blood glucose: ρ= 0,24, p= 0,045). Using multivariate analysis, a...

Esta pesquisa analisa experimentalmente as diferenças de comportamento entre a versão clássica e a modificada da craniotomia subtemporal quanto à retração do lobo temporal. A retração é medida pelo ângulo de visão, através do microscópio, obtido ao mirar-se estruturas previamente estabelecidas. Estudou-se a correlação estatística entre a retração cerebral e os diâmetros transversos do crânio, a profundidade da fossa temporal e a altura da bifurcação medida em relação à tenda do cerebelo e à clinóide posterior. É considerada a relação entre estes achados e os aspectos pertinentes à opção entre as craniotomias pterional e subtemporal para o tratamento cirúrgico dos aneurismas da porção superior da artéria basilar. / This paper is an experimental analysis between the classic and the modified subtemporal procedures, regarding the cerebral retraction required to approach the interpeduncular cistern and the basilar artery bifurcation. The retraction is assumed to be proportional to the angle of sight, through the microscope, required to observe the basilar bifurcation and other structures. The statistical correlations between the degree of brain retraction and the transverse diameters of the skull, the vertical length of the temporal fossa and the position of the basilar bifurcation in relation to the posterior clinoid and the tentorium are analysed. Considerations are made regarding these findings and the many aspects involved in the options between the pterional and the subtemporal approaches in the surgical treatment of the basilar bifurcation aneurysms