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  1. Article ; Online: Early Mobilization Decision after an Acute Ischemic Stroke: Protocol for an Umbrella Review.

    Fernandes, Catarina / Sousa, João André / Bernardo-Castro, Sara / Silva, Fernando / Donato, Helena / Sargento-Freitas, João

    Acta medica portuguesa

    2024  

    Abstract: Introduction: Stroke is considered one of the greatest public health challenges worldwide, with the ischemic subtype being the most prevalent. Various acute stroke clinical guidelines recommend early rehabilitation interventions, including very early ... ...

    Abstract Introduction: Stroke is considered one of the greatest public health challenges worldwide, with the ischemic subtype being the most prevalent. Various acute stroke clinical guidelines recommend early rehabilitation interventions, including very early mobilization. However, despite the studies conducted in recent years regarding when to initiate mobilization after an acute stroke, there are few systematic and personalized protocols based on the factors for which patient mobilization should ideally be performed. We aim to conduct an umbrella review of systematic reviews and meta-analyses to study the early mobilization decision after an acute ischemic stroke in comparison with conventional care and correlate the different approaches with patient clinical outcomes.
    Methods and analysis: We will perform a systematic search on PubMed/MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Epistemonikos and Web of Science Core Collection databases. Retrieved studies will be independently reviewed by two authors and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias in the selected studies. We will use the 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist as the critical appraisal tool to assess cumulative evidence and risk of bias of the different studies. This will be the first umbrella review that compares early mobilization approaches in post-acute ischemic stroke. This study may help to define the optimal early mobilization strategy in stroke patients. PROSPERO registration number: CRD42023430494.
    Language English
    Publishing date 2024-03-15
    Publishing country Portugal
    Document type Journal Article
    ZDB-ID 603078-6
    ISSN 1646-0758 ; 0870-399X
    ISSN (online) 1646-0758
    ISSN 0870-399X
    DOI 10.20344/amp.20715
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Recanalisation of an occluded fenestrated branch of a basilar artery.

    Sousa, João André / Cruz, Luis Rito / Almendra, Luciano / Sargento-Freitas, Joao

    BMJ case reports

    2022  Volume 15, Issue 4

    MeSH term(s) Basilar Artery/diagnostic imaging ; Cerebral Angiography ; Humans ; Intracranial Aneurysm
    Language English
    Publishing date 2022-04-04
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2022-249086
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The Twitter factor: How does Twitter impact #Stroke journals and citation rates?

    Sousa, João André / Alves, Inês Alexandra / Donato, Helena / Sargento-Freitas, João

    International journal of stroke : official journal of the International Stroke Society

    2022  Volume 18, Issue 5, Page(s) 586–589

    Abstract: Background: Twitter is a social media platform popularly used by health practitioners, a trend that has been followed by medical journals. The impact of Twitter in bibliometrics of stroke-related literature is yet to be determined.: Aims: We aimed to ...

    Abstract Background: Twitter is a social media platform popularly used by health practitioners, a trend that has been followed by medical journals. The impact of Twitter in bibliometrics of stroke-related literature is yet to be determined.
    Aims: We aimed to qualitatively assess the usage of Twitter by stroke journals and study the relationship between Twitter activity and citation rates of stroke articles.
    Methods: We used Journal Citation Reports to identify stroke journals. We collected the 2021 Impact Factor (IF) and the top 50 articles contributing to each journal IF. Relevant metrics were collected through Twitonomy, Altmetric, and Web of Science. The association between Twitter activity and citation rates was tested by a negative binomial regression model adjusted to journal's IF. A bivariate correlation and a log-linear regression model adjusted to journal's IF tested the relationship between number of tweets, tweeters, and the number of citations.
    Results: We collected 450 articles across nine stroke-dedicated journals, five of which had a Twitter account. Only 95 (21%) articles had no Twitter mentions. The median number of citations in articles with versus without Twitter activity was 19 (10-39) versus 11(7-17) (
    Conclusions: Tweeted stroke articles tend to have higher citation rates which can be predicted by the number of tweets.
    MeSH term(s) Humans ; Stroke ; Periodicals as Topic ; Bibliometrics ; Journal Impact Factor ; Social Media
    Language English
    Publishing date 2022-11-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2303728-3
    ISSN 1747-4949 ; 1747-4930
    ISSN (online) 1747-4949
    ISSN 1747-4930
    DOI 10.1177/17474930221136704
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Letter to the Editor about the Article "Barrett or Barré?: The Need to End a Common Mispronunciation Among Portuguese Physicians".

    Reis Carneiro, Diogo / Sousa, João André

    Acta medica portuguesa

    2020  Volume 34, Issue 1, Page(s) 67

    MeSH term(s) Humans ; Physicians ; Portugal
    Language English
    Publishing date 2020-11-20
    Publishing country Portugal
    Document type Letter ; Comment
    ZDB-ID 603078-6
    ISSN 1646-0758 ; 0870-399X
    ISSN (online) 1646-0758
    ISSN 0870-399X
    DOI 10.20344/amp.15052
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  5. Article ; Online: Diagnostic accuracy of CT angiography and CT perfusion imaging for detecting distal medium vessel occlusions: Protocol for a systematic review and meta-analysis.

    Sousa, João André / Sondermann, Anton / Bernardo-Castro, Sara / Varela, Ricardo / Donato, Helena / Sargento-Freitas, João

    PloS one

    2023  Volume 18, Issue 4, Page(s) e0284116

    Abstract: Background: Distal medium vessel occlusions (DMVOs) represent 25-40% of all acute ischemic strokes (AIS). DMVO clinical syndromes are heterogenous, but as eloquent brain regions are frequently involved, they are often disabling. Since current ... ...

    Abstract Background: Distal medium vessel occlusions (DMVOs) represent 25-40% of all acute ischemic strokes (AIS). DMVO clinical syndromes are heterogenous, but as eloquent brain regions are frequently involved, they are often disabling. Since current intravenous fibrinolytic therapies may fail to recanalize up to two-thirds of DMVOs, endovascular treatment is progressively being considered in this setting. Nevertheless, the optimal imaging method for diagnosis remains to be defined. Stroke centers that use computed tomography as a routine stroke imaging approach rely on either isolated computed tomography angiography (CTA) or combined perfusion (CTP) studies. Despite a simplified non-CTP-dependent approach seeming reasonable for large vessel occlusion AIS diagnosis, CTP may still hold advantages for DMVOs workup. Therefore, this systematic review aims to compare the diagnostic performance of CTA and CTP in detecting DMVOs.
    Methods: We will perform a systematic search in PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials. In addition, grey literature and ClinicalTrials.gov will be scanned. We will include any type of study that presents data on the diagnostic accuracy of CTA and/or CTP for detecting DMVOs. Two authors will independently review retrieved studies, and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias in the selected studies. Data will be combined in a quantitative meta-analysis following the guidelines provided by the Cochrane Handbook for Systematic Reviews of Interventions. We will assess cumulative evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
    Discussion: This will be the first systematic review and meta-analysis that compares two different imaging approaches for detecting DMVOs. This study may help to define optimal acute ischemic stroke imaging work-up.
    Trial registration: PROSPERO registration: CRD42022344006.
    MeSH term(s) Humans ; Computed Tomography Angiography/methods ; Ischemic Stroke ; Systematic Reviews as Topic ; Meta-Analysis as Topic ; Stroke/diagnostic imaging ; Stroke/therapy ; Perfusion Imaging/methods
    Language English
    Publishing date 2023-04-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0284116
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis.

    Sousa, João André / Sondermann, Anton / Bernardo-Castro, Sara / Varela, Ricardo / Donato, Helena / Sargento-Freitas, João

    AJNR. American journal of neuroradiology

    2023  Volume 45, Issue 1, Page(s) 51–56

    Abstract: Background: The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined.: Purpose: The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs.: Data sources: We ... ...

    Abstract Background: The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined.
    Purpose: The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs.
    Data sources: We searched PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials up to March 31, 2023 (PROSPERO: CRD42022344006).
    Study selection: A total of 12 studies reporting accuracy values of CTA and/or CTP were included, comprising 2607 patients with 479 cases (18.3%) of DMVOs.
    Data analysis: Pooled sensitivity and specificity of both imaging methods were compared using a random-effects model. Subgroup analyses were performed based on the technique used in CTA (multi or single-phase) and the subtype of DMVOs (M2-only vs. M2 and other DMVOs). We applied Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality assessment criteria.
    Data synthesis: CTA demonstrated significantly lower sensitivity compared to CTP in detecting DMVOs [0.74, 95%CI (0.63-0.82) vs. 0.89, 95% CI (0.82-0.93),
    Limitations: We identified an overall high risk of bias and low quality of evidence, attributable to the design and reference standards of most studies.
    Conclusions: Our findings highlight a significantly lower sensitivity of single-phase CTA compared to multi-phase CTA and CTP in diagnosing DMVOs.
    MeSH term(s) Humans ; Sensitivity and Specificity ; Vascular Diseases/diagnostic imaging
    Language English
    Publishing date 2023-12-29
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 603808-6
    ISSN 1936-959X ; 0195-6108
    ISSN (online) 1936-959X
    ISSN 0195-6108
    DOI 10.3174/ajnr.A8080
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  7. Article ; Online: The evolution of blood-brain barrier permeability changes after stroke and its implications on clinical outcome: A systematic review and meta-analysis.

    Bernardo-Castro, Sara / Sousa, João André / Martins, Emanuel / Donato, Helena / Nunes, César / d'Almeida, Otília C / Castelo-Branco, Miguel / Abrunhosa, Antero / Ferreira, Lino / Sargento-Freitas, João

    International journal of stroke : official journal of the International Stroke Society

    2023  Volume 18, Issue 7, Page(s) 783–794

    Abstract: Background: Blood-brain barrier permeability (BBBp) is a key process involved in ischemic stroke pathophysiology. However, there is a lack of consensus on how BBBp evolves after the ischemia injury, and its clinical relevance at different timepoints ... ...

    Abstract Background: Blood-brain barrier permeability (BBBp) is a key process involved in ischemic stroke pathophysiology. However, there is a lack of consensus on how BBBp evolves after the ischemia injury, and its clinical relevance at different timepoints post stroke.
    Aims: The main objective of this study is to assess BBBp evolution through stroke phases and its implications on patient outcomes.
    Methods: We screened PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials up to 31 December 2021. We included research quantitatively using neuroimaging to assess BBBp in stroke patients. BBBp in the different phases was evaluated by a random-effect model based on the standardized mean difference (SMD) between the ipsilateral and contralateral sides of the brain. We performed a subgroup analysis on clinical outcome, reperfusion treatment, haemorrhagic transformation, and imaging method.
    Results: We identified 3761 studies, of which 22 (1592 patients and 1787 evaluations) were included in our study. Overall, 17 studies reported BBBp for the hyperacute phase, 8 for the acute, 5 for the subacute, and 2 for the chronic phase. All phases were associated with increased BBBp: 0.74 (0.48-0.99), 1.68 (0.94-2.42), 1.98 (0.96-3.00), and 1.00 (0.45-1.55), respectively. An increase in BBBp was associated with hemorrhagic transformation in the hyperacute phase and with improved functional outcomes in the late subacute phase.
    Conclusion: BBBp is persistently increased after stroke, peaking in the acute and subacute phases. The degree of BBBp influences patient outcomes depending on stroke phase. Our findings support the clinical relevance of BBBp dynamics in stroke care.
    MeSH term(s) Humans ; Stroke/diagnostic imaging ; Stroke/therapy ; Blood-Brain Barrier/diagnostic imaging ; Tomography, X-Ray Computed/methods ; Brain ; Permeability
    Language English
    Publishing date 2023-04-01
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2303728-3
    ISSN 1747-4949 ; 1747-4930
    ISSN (online) 1747-4949
    ISSN 1747-4930
    DOI 10.1177/17474930231166306
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  8. Article ; Online: Ultrasonographic Vasospasm and Outcome of Posterior Reversible Encephalopathy and Cerebral Vasoconstriction Syndromes.

    Pinto, Maria João / Schon, Miguel / Sousa, João André / Filipe, João / Costa, Andreia / Azevedo, Elsa / Sargento-Freitas, João / Silva, Fernando / Fonseca, Ana Catarina / Castro, Pedro

    Ultraschall in der Medizin (Stuttgart, Germany : 1980)

    2023  Volume 44, Issue 5, Page(s) 487–494

    Abstract: Purpose: Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are often complicated by vasospasm and ischemia. Monitoring with transcranial color-coded Doppler (TCCD) could be useful, but its role ... ...

    Title translation Ultrasonografischer Vasospasmus und Outcome bei posteriorer reversibler Enzephalopathie und zerebralen Vasokonstriktionssyndromen.
    Abstract Purpose: Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are often complicated by vasospasm and ischemia. Monitoring with transcranial color-coded Doppler (TCCD) could be useful, but its role is not established. We studied the incidence of ultrasonographic vasospasm (uVSP) in PRES/RCVS and its relationship with ischemic lesions and clinical outcome.
    Materials and methods: We conducted a multicenter retrospective study of all patients with PRES/RCVS from 2008 to 2020 who underwent TCCD and magnetic resonance imaging (MRI). TCCD exams were analyzed for uVSP. Diffusion-weighted MRI was analyzed for positive lesions (DWI-positive). Functional outcome was assessed by modified Rankin scale (mRS) at 90 days. The associations with outcomes were determined by logistic regression.
    Results: We included 80 patients (mean age of 46 (standard deviation, 17) years; 66% females; 41 with PRES, 28 with RCVS and 11 with overlap phenotype). uVSP was detected in 25 (31%) patients. DWI-positive lesions were more often detected in uVSP-positive than uVSP-negative patients (36% vs. 15%; adjusted odds ratio [aOR] 4.05 [95% CI 1.06 - 15.5], P=0.04). DWI-positive lesions were independently associated with worse functional prognosis (mRS 2-6, 43% vs. 10%; aOR, 10 [95% CI 2.6 - 43], P<0.01). Having additional uVSP further increased the odds of a worse outcome (P interaction=0.03).
    Conclusion: Ultrasonographic vasospasm was detected in a third of patients with PRES/RCVS and was associated with brain ischemic lesions. TCCD bedside monitoring can help to stratify patients at risk for cerebral ischemia, a strong predictor of functional outcome.
    MeSH term(s) Female ; Humans ; Middle Aged ; Male ; Vasoconstriction ; Retrospective Studies ; Posterior Leukoencephalopathy Syndrome/diagnostic imaging ; Magnetic Resonance Imaging ; Prognosis ; Vasospasm, Intracranial/diagnostic imaging
    Language English
    Publishing date 2023-08-23
    Publishing country Germany
    Document type Multicenter Study ; Journal Article
    ZDB-ID 801064-x
    ISSN 1438-8782 ; 1439-0914 ; 1431-4894 ; 0172-4614
    ISSN (online) 1438-8782
    ISSN 1439-0914 ; 1431-4894 ; 0172-4614
    DOI 10.1055/a-2127-9459
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Reconsidering the role of blood-brain barrier in Alzheimer's disease: From delivery to target.

    Sousa, João André / Bernardes, Catarina / Bernardo-Castro, Sara / Lino, Miguel / Albino, Inês / Ferreira, Lino / Brás, José / Guerreiro, Rita / Tábuas-Pereira, Miguel / Baldeiras, Inês / Santana, Isabel / Sargento-Freitas, João

    Frontiers in aging neuroscience

    2023  Volume 15, Page(s) 1102809

    Abstract: The existence of a selective blood-brain barrier (BBB) and neurovascular coupling are two unique central nervous system vasculature features that result in an intimate relationship between neurons, glia, and blood vessels. This leads to a significant ... ...

    Abstract The existence of a selective blood-brain barrier (BBB) and neurovascular coupling are two unique central nervous system vasculature features that result in an intimate relationship between neurons, glia, and blood vessels. This leads to a significant pathophysiological overlap between neurodegenerative and cerebrovascular diseases. Alzheimer's disease (AD) is the most prevalent neurodegenerative disease whose pathogenesis is still to be unveiled but has mostly been explored under the light of the amyloid-cascade hypothesis. Either as a trigger, bystander, or consequence of neurodegeneration, vascular dysfunction is an early component of the pathological conundrum of AD. The anatomical and functional substrate of this neurovascular degeneration is the BBB, a dynamic and semi-permeable interface between blood and the central nervous system that has consistently been shown to be defective. Several molecular and genetic changes have been demonstrated to mediate vascular dysfunction and BBB disruption in AD. The isoform ε4 of Apolipoprotein E is at the same time the strongest genetic risk factor for AD and a known promoter of BBB dysfunction. Low-density lipoprotein receptor-related protein 1 (LRP-1), P-glycoprotein, and receptor for advanced glycation end products (RAGE) are examples of BBB transporters implicated in its pathogenesis due to their role in the trafficking of amyloid-β. This disease is currently devoid of strategies that change the natural course of this burdening illness. This unsuccess may partly be explained by our misunderstanding of the disease pathogenesis and our inability to develop drugs that are effectively delivered to the brain. BBB may represent a therapeutic opportunity as a target itself or as a therapeutic vehicle. In this review, we aim to explore the role of BBB in the pathogenesis of AD including the genetic background and detail how it can be targeted in future therapeutic research.
    Language English
    Publishing date 2023-02-16
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2558898-9
    ISSN 1663-4365
    ISSN 1663-4365
    DOI 10.3389/fnagi.2023.1102809
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Ultrasonographic Vasospasm and Outcome of Posterior Reversible Encephalopathy and Cerebral Vasoconstriction Syndromes

    Pinto, Maria João / Schon, Miguel / Sousa, João André / Filipe, João / Costa, Andreia / Azevedo, Elsa / Sargento-Freitas, João / Silva, Fernando / Fonseca, Ana Catarina / Castro, Pedro

    Ultraschall in der Medizin - European Journal of Ultrasound

    2023  Volume 44, Issue 05, Page(s) 487–494

    Abstract: Purpose: Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are often complicated by vasospasm and ischemia. Monitoring with transcranial color-coded Doppler (TCCD) could be useful, but its role ... ...

    Abstract Purpose: Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are often complicated by vasospasm and ischemia. Monitoring with transcranial color-coded Doppler (TCCD) could be useful, but its role is not established. We studied the incidence of ultrasonographic vasospasm (uVSP) in PRES/RCVS and its relationship with ischemic lesions and clinical outcome.
    Materials and Methods: We conducted a multicenter retrospective study of all patients with PRES/RCVS from 2008 to 2020 who underwent TCCD and magnetic resonance imaging (MRI). TCCD exams were analyzed for uVSP. Diffusion-weighted MRI was analyzed for positive lesions (DWI-positive). Functional outcome was assessed by modified Rankin scale (mRS) at 90 days. The associations with outcomes were determined by logistic regression.
    Results: We included 80 patients (mean age of 46 (standard deviation, 17) years; 66% females; 41 with PRES, 28 with RCVS and 11 with overlap phenotype). uVSP was detected in 25 (31%) patients. DWI-positive lesions were more often detected in uVSP-positive than uVSP-negative patients (36% vs. 15%; adjusted odds ratio [aOR] 4.05 [95% CI 1.06 – 15.5], P=0.04). DWI-positive lesions were independently associated with worse functional prognosis (mRS 2–6, 43% vs. 10%; aOR, 10 [95% CI 2.6 – 43], P<0.01). Having additional uVSP further increased the odds of a worse outcome (P interaction=0.03).
    Conclusion: Ultrasonographic vasospasm was detected in a third of patients with PRES/RCVS and was associated with brain ischemic lesions. TCCD bedside monitoring can help to stratify patients at risk for cerebral ischemia, a strong predictor of functional outcome.
    Keywords Reversible vasoconstriction syndrome ; Posterior reversible encephalopathy syndrome ; vasospasm ; Transcranial ultrasound
    Language English
    Publishing date 2023-08-23
    Publisher Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 801064-x
    ISSN 1438-8782 ; 0172-4614 ; 1439-0914 ; 1431-4894
    ISSN (online) 1438-8782
    ISSN 0172-4614 ; 1439-0914 ; 1431-4894
    DOI 10.1055/a-2127-9459
    Database Thieme publisher's database

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