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BackgroundStroke patients may present severe cognitive impairments, primarily related to executive functions. Transcranial direct current stimulation has shown promising results, with neuromodulatory and neuroplastic effects. This study is a double-blind, sham-controlled clinical trial aiming to compare the long-term effects of stimulation in two different cognitive regions after a stroke.Methods/DesignSixty patients who suffer from chronic strokes will be randomized into one of four groups: dorsolateral prefrontal cortex, cingulo-opercular network, motor primary cortex and sham stimulation. Each group will receive transcranial direct current stimulation at an intensity of 2 mA for 20 minutes daily for 10 consecutive days. Patients will be assessed with a Dysexecutive Questionnaire, Semantic Fluency Test, categorical verbal fluency and Go-no go tests, Wechsler Adult Intelligence Scale, Rey Auditory-Verbal Learning Test, Letter Comparison and Pattern Comparison Tasks at baseline and after their tenth stimulation session. Those who achieve clinical improvement with neurostimulation will be invited to receive treatment for 12 months as part of a follow-up study.DiscussionLong-term stimulation could be analyzed in regard to possible adaptive changes on plasticity after structural brain damage and if these changes are different in terms of clinical improvement when applied to two important cognitive centers.Trials registrationClinicaltrials.gov, NCT02315807. 9 December 2014.

Objective: To investigate the predictive factors for amputations in southern Brazil. Methods: This was a review of medical records from amputated patients in a tertiary hospital in southern Brazil. Results: One hundred and fifteen medical reports regarding to admissions of 51 amputated patients (31.37% women and 68.62% men) were analyzed. The main cause of amputation in diabetics was the neuropathy and its complications. Among nondiabetics, the main causes of amputation were polydactyly (31.58%) and traumatism (traffic accidents, home accidents, and work accidents). This data showed that the investigated amputations are predominantly in male, aging approximately sixty years old, presenting comorbidities like diabetes and arterial hypertension. Moreover, the most amputations were performed as the minor type. Conclusion: These data can contribute for implementation of targeted health education strategies and interventions, improving the prevention of amputations in persons with diabetes.

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