Search

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Recent years have seen considerable changes in the prevention and treatment of acute ischaemic stroke in adult patients. However, the low incidence of paediatric stroke makes the development of specific guidelines more challenging. This study aims to clarify the situation of these children in our region in order to establish a regional protocol to improve the care provided to these patients. Methods: We performed a regional incidence study of pediatric stroke (≤ 15 years of age) in Aragon, Spain (1 308 728 population, 15% aged ≤ 15 years) between 2008 and 2019. Data were obtained from hospital discharge records, including deaths, from the regional health service of Aragón, according to ICD codes for cerebrovascular disease. We analysed demographic, clinical, diagnostic/therapeutic, and prognostic variables. Results: A total of 21 events were recorded: 8 ischaemic (38.1%) and 13 haemorrhagic strokes (61.9%). The mean age (SD) was 9.3 years (1.0). The sample included 12 boys and nine girls. No statistically significant differences were found between ischaemic and haemorrhagic strokes, except in the chief complaint (language and motor impairment in ischaemic stroke and headache in haemorrhagic stroke). None of the patients with ischaemic stroke received reperfusion therapies. Including the 3 patients who died during hospitalisation, eight patients (42.1%) had modified Rankin Scale scores > 2 at 12 months. Motor deficits were the most common sequela (n = 9). Conclusion: Though infrequent, paediatric stroke has an important functional impact. In Spain, Madrid was the first region to adapt the existing code stroke care networks for adult patients. In Aragon, this review has enabled us to work closely with the different stakeholders to offer a care plan for acute paediatric ischaemic stroke. Nevertheless, prospective national registries would be valuable to continue improving the care provided to these patients. Resumen: Introducción: En los últimos años se han producido importantes cambios en la prevención y tratamiento del ictus isquémico agudo en el adulto. Sin embargo, la baja incidencia en edades pediátricas hace más difícil desarrollar protocolos y guías de asistencia específicas. Este trabajo busca conocer la situación de estos niños en nuestra región, con el objetivo de establecer un protocolo autonómico que mejore la atención a estos pacientes. Métodos: Estudio de incidencia de base hospitalaria del ictus infantil (≤ 15 años de edad) en Aragón (1.308.728 habitantes, 15% ≤ 15 años), desde 2008 a 2019. Los datos se extrajeron de los episodios de alta hospitalaria, incluidas las defunciones, del Servicio Aragonés de Salud, de acuerdo a los códigos de la Codificación Internacional de Enfermedades (CIE) definidos para enfermedad cerebrovascular. Se analizaron aspectos demográficos, clínicos, diagnóstico-terapéuticos y de pronóstico. Resultados: Se recogieron un total de 21 eventos, ocho isquémicos (38,1%) y 13 hemorrágicos (61,9%). La media de edad fue 9,3 años (desviación típica 1,0). Hubo 12 hombres y nueve mujeres. No se encontraron diferencias estadísticamente significativitas entre ictus isquémicos y hemorrágicos, salvo por el síntoma guía (déficit motor o del lenguaje en isquémicos, y cefalea en hemorrágicos). Ninguno de los eventos isquémicos recibió terapias de reperfusión. Incluyendo los tres pacientes que fallecieron durante el ingreso, ocho (42,1%) tenían una puntuación en la escala modificada de Rankin (mRS) > 2 a los 12 meses. El déficit motor fue la secuela más común (n = 9). Conclusiones: El ictus infantil, aunque infrecuente, supone una importante limitación funcional. En España, Madrid fue pionera en adaptar las redes de asistencia existentes del Código Ictus en el adulto. En el caso de Aragón, esta revisión nos ha permitido trabajar de cerca con los diferentes actores implicados, para poder ofrecer un plan autonómico de atención al ictus isquémico infantil. Sin embargo, registros nacionales prospectivos ayudarían a avanzar en la atención a estos niños.

Introduction: Neurological complications are the most frequent type of extracardiac complications of infective endocarditis (IE), and can be the initial manifestation. The objectives of this study were to determine the prevalence of neurological complications in patients with IE and to evaluate whether initial presentation with neurological symptoms causes a diagnostic delay. Material and methods: We conducted a retrospective observational study of patients with IE admitted to a tertiary hospital between 2003 and 2020. Results: The study included 222 patients with IE (67% men; mean [SD] age, 66.4 [14.2] years). Neurological complications occurred in 21.2% of patients, with ischaemic stroke (74.5%) and intracerebral haemorrhage (23.4%) being the most frequent. No differences in diagnostic delay were found between the group of patients in whom the disease manifested with neurological complications and the rest of the patients (4.4 vs 4.5; P = .76). Conclusions: A total of 21.2% of patients with IE presented neurological complications, with ischaemic stroke being the most frequent. Neurological symptoms as the initial manifestation of IE did not lead to a delay in diagnosis. Resumen: Introducción: Las manifestaciones neurológicas son las complicaciones extracardíacas más frecuentes de la endocarditis infecciosa (EI) y pueden ser el síntoma inicial. Los objetivos del estudio fueron determinar la prevalencia de complicaciones neurológicas en los pacientes con EI y evaluar si la clínica neurológica como debut condiciona un retraso diagnóstico. Material y métodos: Estudio de cohortes retrospectivo de pacientes con EI ingresados en un hospital de tercer nivel en el periodo entre 2003 y 2020. Resultados: Se han revisado 222 pacientes con EI (67% varones, edad 66,4 ± 14,2 años). El 21,2% presentaron complicaciones neurológicas durante el ingreso, siendo el ictus isquémico (74,5%) y la hemorragia cerebral (23,4%), las más frecuentes. No se encontraron diferencias entre el tiempo medio desde el ingreso hasta el diagnóstico en el grupo de pacientes que debutó con focalidad, en comparación con el resto de pacientes (4,4 vs. 4,5; p = 0,76). Conclusiones: Un 21,2% de los pacientes con EI presentaron complicaciones neurológicas durante el ingreso, siendo el ictus isquémico la más frecuente. La clínica neurológica como debut de la EI no conllevó un retraso diagnóstico.

Caminar es una tarea extraordinariamente compleja que requiere la intervención de todo el sistema nervioso, viéndose afectada por diversas patologías neurológicas. Los exoesqueletos de rehabilitación de la marcha actuales, aunque potencialmente evidencian una mejora tras la rehabilitación, aún no han mostrado su superioridad terapéutica respecto a la terapia convencional de manera concluyente. Además, los dispositivos robóticos y exoesqueletos de rehabilitación de la marcha actuales no permiten entrenar específicamente la transferencia de peso o requieren de un buen estado funcional para ser utilizados. En este artículo se presenta el modelo conceptual de un sistema robótico ambulatorio acoplado al exoesqueleto Exo-H3 para la rehabilitación de la marcha implementando estrategias de aprendizaje por refuerzo. Se espera que este sistema favorezca la plasticidad neuronal al aportar mayor libertad al usuario para explorar nuevos patrones de movimiento y aumentar su control motor voluntario y su participación activa, mientras el exoesqueleto se adapta y garantiza su equilibrio y estabilidad. Los pasos futuros contemplan el diseño y la fabricación de cada uno de los subsistemas robóticos, validando su funcionamiento individual y en conjunto, con la participación de sujetos sanos y patológicos.

Introduction: sequelae related to brain damage are the third leading cause of disability worldwide and the second cause of death. The subjectivity of the evaluator in assessing trophic tissue is always an element that must be taken into account. In this regard, the objectives of this pilot study were to observe the reliability and validity of the thermographic technique in patients with motor sequelae after brain damage. Material and method: twenty-eight patients with neuromuscular involvement were recruited. A blinded researcher, specialised in the assessment of neuromuscular damage, measured the impairment according to the Ashwort Scale determining the degree of restriction and resistance to bending of the ankle, while two researchers recorded thermal patterns. Results: in the first measurement, the temperature of the two legs separately did not exceed 30.2 °C in 75 % of cases, and in the second measurement it did not exceed 29.7 °C. The average of the measurements on the left and right legs offered maximum values of less than 31.9 °C for both. Overall, measurements had an average of 28.4 °C with a standard deviation of 1.928. In 75 % of the total measurements, the temperature was equal to or lower than 29.8 °C indicating that the temperature in these pathological patients generally appears to be lower than 32 °C. Conclusion: thermography is a reliable and valid tool for assessing patients with neuromuscular damage; however, further studies with a larger sample size are needed to clarify the role of this technique in relation to neuromuscular damage. [ABSTRACT FROM AUTHOR]

Introduction: We present the Spanish Society of Neurorehabilitation’s guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020. Development: We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research. Conclusions: All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45–60 minutes of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient’s clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes. Resumen: Introducción: Guía para la práctica clínica en neurorrehabilitación de personas adultas con daño cerebral adquirido (DCA) de la Sociedad Española de Neurorrehabilitación. Documento basado en la revisión de guías de práctica clínica internacionales publicadas entre 2013−2020. Desarrollo: Se establecen recomendaciones según el nivel de evidencia que ofrecen los estudios revisados referentes a aspectos consensuados entre expertos dirigidos a definir la población, características específicas de la intervención o la exposición bajo investigación. Conclusiones: Deben recibir neurorrehabilitación todos aquellos pacientes que, tras un DCA, hayan alcanzado una mínima estabilidad clínica. La neurorrehabilitación debe ofrecer tanto tratamiento como sea posible en términos de frecuencia, duración e intensidad (al menos 45–60 minutos de cada modalidad de terapia específica que el paciente precise). La neurorrehabilitación requiere un equipo transdisciplinar coordinado, con el conocimiento, la experiencia y las habilidades para trabajar en equipo tanto con pacientes como con sus familias. En la fase aguda y para los casos más graves, se recomiendan programas de rehabilitación en unidades hospitalarias procediéndose a tratamiento ambulatorio tan pronto como la situación clínica lo permita, y se puedan mantener los criterios de intensidad. La duración del tratamiento debe basarse en la respuesta terapéutica y en las posibilidades de mejoría en base al mayor grado de evidencia disponible. Al alta deben ofrecerse servicios de promoción de la salud, actividad física, apoyo y seguimiento para garantizar que se mantengan los beneficios alcanzados, detectar posibles complicaciones o valorar posibles cambios en la funcionalidad que hagan necesario el acceso a nuevos programas de tratamiento.

Objective: This article reviews the scientific evidence on the relationship between periodontitis and neurological disease, and particularly cerebrovascular disease and dementia. We also issue a series of recommendations regarding the prevention and management of periodontitis and these neurological diseases at dental clinics and neurology units. Development: In response to a series of questions proposed by the SEPA-SEN working group, a literature search was performed, with no restrictions on study design, to identify the most relevant articles on the association between periodontitis and cerebrovascular disease and dementia from the perspectives of epidemiology, treatment, and the biological mechanisms involved in these associations. Conclusions: Periodontitis increases the risk of ischaemic stroke and Alzheimer dementia. Recurrent bacterial infections and increased low-grade systemic inflammation seem to be possible biological mechanisms underlying this association. Limited evidence suggests that various oral health interventions can reduce the future risk of cerebrovascular disease and dementia. Resumen: Objetivo: Revisar la evidencia científica disponible sobre la relación entre la periodontitis y las enfermedades neurológicas, en particular la enfermedad cerebrovascular y la demencia. Además, se facilitan una serie de recomendaciones en relación a la prevención y manejo de la periodontitis y estas enfermedades neurológicas desde las consultas dentales y las unidades de neurología. Desarrollo: Se realizó una búsqueda bibliográfica sin restricción en cuanto al diseño de estudio para identificar aquellos artículos más relevantes sobre la asociación entre periodontitis, enfermedad cerebrovascular y demencia desde un punto de vista epidemiológico, de intervención, así como de mecanismos biológicos involucrados en estas relaciones para responder a diferentes preguntas planteadas por los miembros del grupo de trabajo SEPA-SEN. Conclusiones: La periodontitis aumenta el riesgo de ictus isquémico y demencia de tipo Alzheimer. Bacteriemias recurrentes con aumento de un estado inflamatorio sistémico de bajo grado parecen ser posibles mecanismos biológicos que explicarían esta asociación. Evidencia limitada apunta a que diferentes intervenciones de salud oral pueden reducir el riesgo futuro de padecer enfermedad cerebrovascular y demencia.

Fatigue is a complex, multidimensional syndrome that is prevalent in patients with acquired brain damage and has a negative impact on the neurorehabilitation process. It presents from early stages after the injury, and may persist over time, regardless of whether sequelae have resolved. Fatigue is conditioned by upper neuronal circuits, and is defined as an abnormal perception of overexertion. Its prevalence ranges from 29% to 77% after stroke, from 18% to 75% after traumatic brain injury, and from 47% to 97% after brain tumours. Fatigue is associated with factors including female sex, advanced age, dysfunctional families, history of specific health conditions, functional status (eg, fatigue prior to injury), comorbidities, mood, secondary disability, and the use of certain drugs. Assessment of fatigue is fundamentally based on such scales as the Fatigue Severity Scale (FSS). Advances have recently been made in imaging techniques for its diagnosis, such as in functional MRI. Regarding treatment, no specific pharmacological treatment currently exists; however, positive results have been reported for some conventional neurorehabilitation therapies, such as bright light therapy, neurofeedback, electrical stimulation, and transcranial magnetic stimulation. This review aims to assist neurorehabilitation professionals to recognise modifiable factors associated with fatigue and to describe the treatments available to reduce its negative effect on patients. Resumen: La fatiga es un síndrome multidimensional, complejo y frecuente en los pacientes con daño cerebral sobrevenido, influyendo negativamente en el proceso de neurorrehabilitación. Aparece desde etapas tempranas luego de la lesión y puede permanecer en el tiempo, recuperadas o no las secuelas del daño. La fatiga depende de circuitos neuronales superiores y se define como una percepción anómala de sobreesfuerzo. Tiene una prevalencia de 29% a 77% tras el ictus, 18% a 75% tras el traumatismo craneoencefálico (TCE) y 47% a 97% tras tumores cerebrales. La fatiga se asocia a factores como sexo femenino, edad avanzada, familia disfuncional, antecedentes patológicos específicos, estado funcional (p. ej. fatiga previa a la lesión), comorbilidades, estado anímico, discapacidad secundaria y uso de ciertos fármacos. Su estudio se realiza sobre todo a partir de escalas como la Escala de severidad de fatiga (Fatigue Severity Scale). Hoy en día existen avances en herramientas de imagen para su diagnóstico como la resonancia magnética funcional. En cuanto a su tratamiento, no existe aún terapia farmacológica definitiva, sin embargo, existen resultados positivos con terapias dentro de la neurorrehabilitación convencional, terapia lumínica y el uso del neurofeedback, estimulación eléctrica y magnética transcraneal. Esta revisión tiene como objetivo ayudar al profesional dedicado a la neurorrehabilitación a reconocer factores asociados modificables, así como terapias a su alcance para disminuir sus efectos nocivos en el paciente.

Copyright of Kranion is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Adicciones is the property of Sociedad Cientifica Espanola de Estudios sobre el Alcohol and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El ictus es la enfermedad neurológica más prevalente y una de las principales causas de discapacidad a largo plazo. La pérdida de calidad de vida después de un ictus es una preocupación significativa debido a las diversas secuelas físicas, cognitivas y emocionales que pueden surgir. Además, los cambios emocionales, como la depresión y la ansiedad, pueden afectar negativamente la salud mental y social. La rehabilitación post- ictus es crucial para ayudar a los pacientes a adaptarse a estas nuevas circunstancias y mejorar su calidad de vida. El objetivo es comprobar la efectividad de la Terapia en Espejo (TE) sobre los pacientes con ictus para la mejora de la calidad de vida (CV). Se ha realizado un estudio longitudinal con una muestra de 44 personas con ictus a los que se les valoró el nivel de calidad de vida antes de la intervención, después de la intervención y a largo plazo. Se dividió la muestra de forma aleatoria en grupo control y grupo experimental al que se aplicó la TE. Se llevó a cabo un análisis bivariado mediante un ANCOVA para determinar la existencia de mejoras existentes. Se observaron diferencias estadísticamente significativas tras la aplicación del tratamiento (p=0.009) y a largo plazo (p=0.022), mostrando el grupo experimental una mejora superior en su CV respecto al grupo control. La TE puede ser una herramienta efectiva para mejorar la CV en pacientes que han sufrido un ictus. Dada la prevalencia del ictus y sus consecuencias debilitantes en la calidad de vida, es crucial encontrar intervenciones terapéuticas que ayuden a los pacientes a adaptarse y recuperar funciones perdidas. Los resultados indicaron que los participantes que recibieron TE experimentaron mejoras significativas en su CV tanto inmediatamente después del tratamiento como a largo plazo, en comparación con el grupo de control.

Introduction: Direct oral anticoagulants (DOACs) are the first line of stroke prevention treatment in patients with non-valvular atrial fibrillation (NVAF). However, their inappropriate use is associated with increased risk of stroke, haemorrhagic complications, and mortality. The aim of this study is to analyse the factors associated with the non-prescription of anticoagulants and the underdosing of DOACs. Methods: We conducted a descriptive study of a prospective registry of patients admitted to a stroke unit due to ischaemic stroke or transient ischaemic attack (TIA) during an 1-year period. We included consecutive patients with history of NVAF with indication for anticoagulant therapy (ACT), according to the CHA2DS2-VASc scale. We analysed demographic factors, exposure to vascular risk factors, kidney function, polymedication, and short- and medium-term stroke progression. Results: Data were obtained from 60 patients admitted due to TIA or ischaemic stroke, with a previous diagnosis of NVAF, of whom 13 (21.7%) were not receiving ACT. Of the remaining 47, 25 (53.2%) were under treatment with DOACs, 21 (44.7%) with vitamin K antagonists, and 1 (2.1%) with heparin. Among patients on DOACs, 8 (32%) were receiving inappropriately low doses, with no differences between drugs.Age (80.8 vs 74.9 years, p=.05) and female sex (75% vs 35.3%, p=.05) were associated with underdosing of DOACs. Paroxysmal atrial fibrillation (46.2% vs 14.9%, p

Introducción. Los accidentes cerebrovasculares, también llamados ictus, son la segunda causa de muerte a nivel global y la primera de discapacidad adquirida. Dada la elevada incidencia de los ictus y la dependencia derivada de estos eventos, uno de los principales objetivos de su tratamiento es el reentrenamiento de la marcha, el cual busca recuperar la autonomía del paciente de cara a recobrar la funcionalidad en las actividades de la vida diaria y la inclusión social. Presentación del caso. Hombre de 46 años con diagnóstico de ictus hemorrágico hipertensivo en ganglios basales izquierdos con secuela motora de hemiparesia derecha. Se analizó la marcha de manera objetiva mediante dispositivos portátiles y se planteó el tratamiento rehabilitador específico oportuno en el paciente, quien había sufrido daño cerebral adquirido. Como sistemas de valoración se empleó la aplicación para teléfonos inteligentes Balanced Gait Test, y una electromiografía de superficie para registrar la actividad muscular durante la marcha. Al alta del tratamiento el paciente presentó un importante incremento de su capacidad funcional de la marcha, sin requerir productos de apoyo y con una velocidad que le permitía el desplazamiento en la comunidad sin limitaciones. Conclusiones. La incorporación de nuevas tecnologías al estudio de la marcha mediante dispositivos portátiles fáciles de aplicar en la práctica clínica permite hacer una evaluación precisa y objetiva de los resultados del tratamiento rehabilitador en pacientes con daño cerebral adquirido tras un accidente cerebrovascular.

Background: Ischaemic stroke may be a major complication of SARS-CoV-2 infection. Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. Methods: Data were collected retrospectively on consecutive patients with COVID-19 who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). Results: During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack).Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%).We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). Conclusions: In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19–associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients. Resumen: Introducción: El ictus isquémico puede ser una complicación grave en los pacientes con infección por SARS-CoV-2.Estudiar y caracterizar los diferentes subtipos etiológicos, las características clínicas y el pronóstico funcional podrá resultar útil en la selección de pacientes para un manejo y tratamiento óptimos. Métodos: La recogida de variables se hizo de forma retrospectiva en pacientes consecutivos con infección por COVID-19 que desarrollaron un episodio de isquemia cerebral focal (entre el 1 de Marzo 1, 2020, y el 19 de Abril, 2020). Se llevó a cabo en un hospital universitario de tercer nivel en la Comunidad de Madrid. (España). Resultados: Durante el período de estudio 1594 pacientes fueron diagnosticados de infección por COVID 19. Identificamos 22 pacientes con ictus isquémico (1.38%), de estos no cumplieron los criterios de inclusión 6. Un total de 16 pacientes con isquemia cerebral focal constituyeron la serie del estudio (15 con ictus isquémico y 1 con accidente isquémico transitorio).En la valoración basal en el National Institutes of Health Stroke Scale (NIHSS) la mediana fue de 9 (Rango Intercuartil RIQ: 16), la edad media fue de 73 años (DE ± 12.8). 12 pacientes fueros varones (75%). El tiempo desde los síntomas de COVID-19 hasta el ictus fue de 13 días. Se encontró oclusión de gran vaso en 12 pacientes (75%).El dímero –D estuvo elevado en el 87.5% y la proteína C reactiva en el 81.2% de los casos. La etiología más frecuente del ictus isquémico fue la aterotrombosis (9 pacientes, 56.3%) con un subtipo predominante que fue el trombo endoluminal sobre placa de ateroma (5 pacientes, 31.2%), 4 de ellos en la arteria carótida interna y uno de ellos en el arco aórtico. La mortalidad en nuestra serie fue del 44% (7 de 16 pacientes). Conclusiones: En los pacientes con ictus y COVID-19 la etiología más frecuente fue la aterotrombótica con una elevada frecuencia de trombo endoluminal sobre placa de ateroma (31.2% de los pacientes). Nuestros hallazgos clínicos y de laboratorio apoyan la coagulopatía asociada a COVID-19 como un mecanismo etiopatogénico relevante en el ictus isquémico en este contexto.

The role of diabetes mellitus as a risk factor for cardiovascular diseases, including stroke, is well known. However, the impact of type 1 diabetes mellitus (DM1) is particularly important in this scenario, when considering that DM1 predominantly affects younger individuals. Indeed, numerous studies indicate middle-aged subjects with DM1 have a considerably higher risk of stroke in comparison with those without DM1. Therefore, defining risk parameters in the assessment to screen subjects with higher risk should become a routinely practice in the care of patients with DM1. The objective of this review is to evaluate the epidemiologic aspects correlating DM1 with the development of stroke, as well, as the pathophysiological mechanisms explaining this relationship. [ABSTRACT FROM AUTHOR]

Objective: Focal status epilepticus requires timely diagnosis and treatment. Stroke is a common cause of epileptic seizures, but stroke-induced epilepsia partialis continua (SIEPC) is a rare type of focal status epilepticus with unknown management and prognosis. The aim of the study was to present a single-center case series of patients admitted to a third-level referral hospital diagnosed with SIEPC. Methods: We performed a retrospective review assessing all in-hospital consultations from July 2021 to July 2022 describing patients who presented with a diagnosis of SIEPC during hospital admission. Patients received standard diagnostic approaches (including electroencephalographic assessment) and treatment protocols. We defined EPC as focal, continuously repeated seizures with preserved consciousness lasting at least 1 h, confirmed with electroencephalography. Results: We identified 1054 patients seen by the neurology department as in-patient consultations. We found 268 patients with a diagnosis of stroke or epilepsy and then excluded 265 patients due to an alternate diagnosis. We finally identified three patients with (SIEPC). Conclusions: Although cerebrovascular disorders are a common cause of hospital admission, and SIEPC is rare, this condition is relevant to the practicing clinician. This study draws attention to this distinct clinical entity with variable presentation, diagnosis, treatment, and prognostic issues. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVD), primarily ischemic heart disease and stroke, are the leading cause of global mortality and a major contributor to disability. The burden of CVD is influenced by genetic, metabolic, behavioral, environmental and social determinants. However, low physical activity and blood pressure play a central role as risk factors for CVD. The prevalent cases of CVD are 523 million in 2019 and the number of deaths from these pathologies increased constantly to reach 18.6 million in the same period, so, currently, heart disease and strokes were the first and the second cause of death in America, while globally, stroke remained the second cause of death. It is evident that monitoring the burden of cardiovascular diseases is of vital importance, this article reviews the total epidemiology of cardiovascular diseases, including the underlying causes of cardiovascular death and related risk factors, using global estimates and available population-level data sources. on incidence, prevalence, lethality, mortality and health risks in Latin American countries and the world in the last five years, hence this narrative update of documentary design is proposed, which aims to contribute to the knowledge of this important problem of public health, contributing to prevention actions and effective interventions to curb the burden of CVD diseases, especially in regions with lower sociodemographic indices. [ABSTRACT FROM AUTHOR]

Copyright of Acta Neurológica Colombiana is the property of Colombian Association of Neurology / Asociacion Colombiana de Neurologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: La enfermedad cerebrovascular es la afección neurológica de mayor prevalencia; globalmente representa el 11 % del total de defunciones anuales y en Cuba es la tercera causa de muerte. Objetivo: Caracterizar la mortalidad temprana en los pacientes con ictus isquémico. Métodos: Se realizó un estudio observacional, descriptivo y prospectivo de los pacientes que sufrieron un ictus isquémico durante un año. Se emplearon medidas de resumen y dispersión, con un intervalo de confianza del 95 % para la prueba t de Student. Resultados: La mortalidad fue de un 15,1 %, con ligero predominio del sexo femenino y prevaleció el color blanco de la piel. Casi 2 tercios de los fallecidos (58,9 %) ocurrieron en los primeros 7 días del evento isquémico agudo y en más de la mitad de los pacientes se presentó edema cerebral como causa directa de muerte. Los factores de riesgo vascular que predominaron fueron la hipertensión arterial, el tabaquismo y la diabetes mellitus, y prevaleció el subtipo de ictus aterotrombótico de gran vaso. Al comparar los valores de la media entre los pacientes vivos y fallecidos, resultaron ser estadísticamente significativos las variables: Edad, escala National Institute of Health Stroke Scale, leucocitos, glucemia, índice leuco-glucémico, eritrosedimentación y la proteína C reactiva. Conclusiones: La mortalidad por ictus, en el Hospital "Julio Trigo", es similar, desde el punto de vista clínico y epidemiológico, a lo reportado por otros autores en otras regiones geográficas y también en Cuba.

Introducción: Se realizó una revisión narrativa de los estudios publicados desde 2016 hasta 2021 sobre los aspectos clínicos, etiológicos, imagenológicos y terapéuticos de las diferentes formas clínica de la enfermedad cerebral vascular en los ancianos. Se consultaron las bases de datos de Medline (PubMed), SciELO, Cochrane y Google Académico. Se tuvieron en cuenta los artículos originales, publicados en revistas con revisión por pares, que incluyeran pacientes mayores de 65 años, con diagnóstico de enfermedad vascular cerebral. Objetivo: Actualizar sobre las particularidades de la enfermedad vascular cerebral en el adulto mayor. Desarrollo: En la enfermedad cerebrovascular del adulto mayor se observan condiciones particulares: Biológicas, psicológicas y sociales, que son menos frecuente o incluso pueden estar ausentes, en los grupos etarios más jóvenes. La arterioesclerosis de grandes vasos, el cardioembolismo, la enfermedad de pequeños vasos y la angiopatía cerebral amiloidea constituyen las etiologías predominantes, aunque pueden existir otras causas. El deterioro cognitivo vascular representa la segunda causa de demencia y es una forma clínica de presentación de la enfermedad vascular cerebral en este grupo etario. Conclusiones: La enfermedad cerebrovascular en el adulto mayor, presenta características particulares que se resumen en: Mayor comorbilidad y riqueza de factores de riesgo, que obligan a un enfoque diagnóstico sistémico, dialécticamente interrelacionado y personalizado, en el cual las neuroimágenes ocupan un lugar de singular importancia; que en interacción con la clínica, permitirán un diagnóstico y seguimiento evolutivo más integral de estos pacientes.

Introduction: Management of code stroke (CS) is complex, and the collection of information for subsequent evaluation is crucial. We present data obtained using a mobile application on the management of CS between 2020 and 2021 at the Hospital General Universitario Dr. Balmis (HGUB), a tertiary-level hospital that is the reference centre for endovascular treatment (EVT) in the province of Alicante. Material and methods: We conducted a prospective, observational study of all patients attended after CS activation at the HGUB in 1 year. Data were collected using a specifically designed mobile application (CODICT). We present a descriptive analysis of patients' baseline characteristics, call flow, acute phase care, treatment rates, and mortality and functional outcomes at discharge and at 3 months in patients receiving EVT. Results: A total of 1018 CS activations were recorded. Revascularisation treatment (intravenous fibrinolytic treatment [IVT], EVT, or EVT+IVT) was performed in 252 patients (24.75%), of whom 177 (17.38%) received EVT, amounting to a mean rate of 9.43 per 100 000 population. By healthcare district, the lowest rate was 3.16 and the highest was 16.40. A total of 49.32% of patients receiving EVT presented favourable functional status (mRS≤2) at 90 days. Conclusion: The data collected during IC care can be traced in real time through mobile applications. The potential of this approach is demonstrated by the volume of data collected during 1 year. These data show considerable disparities in access to EVT in the province of Alicante, which could be suggested as an area for improvement. Resumen: Introducción: La atención al Código Ictus (CI) es compleja y resulta crucial recopilar información para su posterior evaluación. Exponemos los datos obtenidos mediante aplicación móvil, del manejo del CI durante 2020–2021 en el Hospital General Universitario Dr.Balmis (HGUB), hospital terciario referencia para tratamiento endovascular (TEV) de la provincia de Alicante. Material y métodos: Estudio observacional prospectivo de todos los sujetos atendidos por activación de CI en el HGUB en un año. Recogida de variables mediante aplicación móvil (CODICT) desarrollada para tal fin. Análisis descriptivo de las características basales de los pacientes, flujo de llamadas, atención en fase aguda, tasas de tratamiento y resultados funcionales y de mortalidad al alta y a los tres meses en los casos sometidos a TEV. Resultados: Se recibieron 1018 activaciones de CI. 252 pacientes (24,75%) recibieron tratamiento revascularizador (Fibrinólisis intravenosa (FIV), TEV o TEV + FIV), de ellos, 177 (17,38%) recibieron TEV lo que supuso una tasa media de 9,43 por 100.000 habitantes. Por departamentos de salud la tasa más baja fue de 3,16 y la máxima de 16,40. Un 49,32% de los pacientes sometidos a TEV alcanzaron situación funcional favourable (mRS ≤ 2) a los 90 días. Conclusión: La trazabilidad de los datos recopilados durante la atención al CI es susceptible de realizarse a tiempo real mediante aplicaciones móviles. Su potencial queda patente en el volumen de datos recogidos durante un año. Se ha manifestado una fuerte disparidad en el acceso a TEV en la provincia de Alicante, susceptible de proponerse como área de mejora.

Introduction: Ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD) is a rare entity, and few data are available on the use of such reperfusion therapies as intravenous fibrinolysis and mechanical thrombectomy in these patients. We analysed the use of these treatments in patients with IS due to CAD and compared them against patients receiving reperfusion treatment for IS of other aetiologies. Methods: We conducted an observational, retrospective, multicentre study of patients with IS due to CAD recorded in the National Stroke Registry of the Spanish Society of Neurology during the period 2011−2019. Comparative analyses were performed between: a) patients with CAD treated and not treated with reperfusion therapies and b) patients treated with reperfusion for IS due to CAD and patients treated with reperfusion for IS due to other causes. Epidemiological data, stroke variables, and outcomes at discharge and at 3 months were included in the analysis. Results: The study included 21,037 patients with IS: 223 (1%) had IS due to CAD, of whom 68 (30%) received reperfusion treatment. Reperfusion treatments were used less frequently in cases of vertebral artery dissection and more frequently in patients with carotid artery occlusion. Compared to patients with IS due to other causes, patients with CAD were younger, more frequently underwent mechanical thrombectomy, and less frequently received intravenous fibrinolysis. Rates of haemorrhagic complications, mortality, and independence at 3 months were similar in both groups. Conclusions: Reperfusion therapy is frequently used in patients with IS due to CAD. The outcomes of these patients demonstrate the efficacy and safety of reperfusion treatments, and are comparable to the outcomes of patients with IS due to other aetiologies. Resumen: Introducción: El ictus isquémico (II) por disección arterial cervico-cerebral (DAC) es una entidad infrecuente y existen pocos datos sobre el uso de terapias de reperfusión como la fibrinolisis intravenosa y la trombectomía mecánica. Se analizó el uso de dichas terapias en pacientes con II por DAC y se comparó con aquellos pacientes reperfundidos con II por otras causas. Método: Estudio observacional retrospectivo multicéntrico de pacientes con II por DAC basado en el Registro Nacional de Ictus de la Sociedad Española de Neurología durante el periodo 2011−2019. Se realizaron análisis comparativos entre: a) pacientes con DAC tratados y no con terapias de reperfusión y b) pacientes reperfundidos con II por DAC y pacientes reperfundidos con II por otras causas. Se incluyeron variables epidemiológicas, del ictus y resultados al alta y a los 3 meses. Resultados: Un total de 21.037 pacientes con II fueron incluidos. 223 (1%) fueron por DAC y 68 (30%) recibieron tratamiento de reperfusión. El uso de tratamientos de reperfusión fue menor en los casos de DAC de arteria vertebral y mayor en los casos de oclusión carotídea. Los pacientes con II por DAC reperfundidos respecto a aquellos con II reperfundidos por otras causas fueron más jóvenes, la TM se utilizó más y la FIV menos. Las complicaciones hemorrágicas, la mortalidad y la autonomía a los 3 meses fueron similares. Conclusiones: Las terapias de reperfusión se usan con frecuencia en los pacientes con II por DAC. Los resultados demuestran eficacia y seguridad y son equiparables a los pacientes tratados con terapias de reperfusión por II de otras causas.

Objective: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres’ internal protocols, serving as a reference for nursing care. Methods: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. Results: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient’s arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. Conclusions: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management. Resumen: Objetivo: Proporcionar un conjunto de recomendaciones actualizadas y basadas en la evidencia disponible para el manejo del ictus agudo. Nuestro objetivo es proporcionar una base para el desarrollo de los protocolos internos de cada centro, sirviendo de referencia para los cuidados de enfermería. Métodos: Revisión de evidencias disponibles sobre los cuidados del ictus agudo. Se han consultado las guías nacionales e internacionales más recientes. Los niveles de evidencia y grados de recomendación se han basado en la clasificación del Centro de Medicina Basada en la Evidencia de Oxford. Resultados: Se describen la atención y los cuidados del ictus agudo en la fase prehospitalaria, el funcionamiento de código ictus, la atención por el equipo de ictus a la llegada al hospital, los tratamientos de reperfusión y sus limitaciones, el ingreso en la unidad de ictus (UI), los cuidados de enfermería en la UI y el alta hospitalaria. Conclusiones: Estas pautas proporcionan recomendaciones generales basadas en la evidencia actualmente disponible para guiar a los profesionales que atienden a pacientes con ictus agudo. En algunos casos, sin embargo, existen datos limitados demostrando la necesidad de continuar investigando sobre el manejo del ictus agudo.

Introduction: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. Methods: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. Results: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. Conclusion: In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study. Resumen: Introducción: La eficacia de la trombectomía mecánica en territorio carotídeo en las primeras 24 horas se ha probado con trabajos publicados recientemente. Métodos: Revisión retrospectiva a partir de un registro prospectivo en nuestro centro de referencia de ictus para valorar la eficacia y seguridad del tratamiento endovascular realizado más allá de las 6 horas de evolución de los síntomas en pacientes con ictus isquémico agudo y oclusión de gran vaso en territorio carotídeo, entre noviembre de 2016 y abril de 2019. Resultados: Se recopilaron datos de 59 pacientes (55,9% mujeres, mediana de edad 71 años). Treinta y tres pacientes fueron detectados al despertar. El 57,6% de los casos fueron traslados secundarios. La mediana de NIHSS basal fue 16. La mediana del ASPECTS fue 8 y el 94,9% de los pacientes presentó > 50% de tejido salvable. El 88,1% de los pacientes logró una recanalización satisfactoria, en 5 pacientes después de 24 horas de evolución. El 67,8% de los casos logró la independencia funcional a los 90 días de seguimiento. Los pacientes que no lograron la independencia funcional presentaban mayor edad, mayor proporción de fibrilación auricular, mayor tiempo punción-recanalización y mayor puntuación NIHSS, tanto basal como al alta. Conclusión: En nuestra experiencia la trombectomía mecánica después de las 6 horas se asoció con buenos resultados de funcionalidad a los 90 días. La edad, la puntuación NIHSS, el tiempo punción-recanalización y la prevalencia de fibrilación auricular fueron factores determinantes en el pronóstico funcional. La eficacia de este tratamiento por encima de las 24 horas merece ser estudiada.

Introduction: Stroke is highly prevalent in Latin America and one of the leading causes of morbidity and mortality in the world. Educating children about stroke has been established as an effective method to detect symptoms early, reduce hospital visits, and raise awareness among adults. Objective: To analyze the effectiveness of a mobile application to improve knowledge and understanding of stroke among children. Method: We conducted a focus group session including 12 children in order to analyze the behavior of 6 questions previously validated by expert neurologists. Subsequently, 105 primary school students between the ages of 7 and 12 completed a questionnaire on stroke symptoms and how to contact the emergency services before and after using an application on stroke symptoms. Qualitative analyses and the Student t test were used to verify the existence of differences between pre- and post-intervention test results. Results: After a single 40-min working session with the application, between 50% and 67% of the children were able to identify the signs of stroke, and 96.2% knew the national emergency services telephone number. Statistical analysis revealed statistically significant differences before and after the intervention with the digital application (t = 19.54; p

Resumen: Objetivo: Determinar los factores de riesgo asociados a discapacidad en pacientes que presentaron accidente cerebrovascular (ACV) en el noreste de México. Diseño: Estudio observacional, retrospectivo y transversal. Sitio: Estudio llevado a cabo en la Unidad de Medicina Familiar (UMF) Núm. 33 del Instituto Mexicano del Seguro Social (IMSS) en Cd. Reynosa, Tamaulipas, México. Participantes: Se contó con 344 participantes, 198 varones y 146 mujeres, mayores de 18 años derechohabientes del IMSS, adscritos a la UMF Núm. 33 con diagnóstico de ACV entre los años 2018-2021. Intervenciones: Se aplicó a los participantes el índice de Barthel (IB) que evalúa el grado de dependencia para realizar actividades básicas de la vida diaria (AVD) y recolección de variables sociodemográficas, biológicas y antropométricas de la historia clínica digital. Medidas principales: Se realizó un análisis estadístico univariado, correlacional y de regresión logística ordinal entre variables independientes y dependientes. Se obtuvieron medidas de frecuencia, porcentajes y riesgos asociados. Resultados: Los factores de riesgo asociados a discapacidad fueron la edad con odds ratio (OR) de 1,03 (intervalo de confianza [IC] 1,01-1,05), sobrepeso con OR 1,81 (IC 1,03-3,1), obesidad grado I OR 2,74 (IC 1,46-5,1), obesidad grado II OR 4,38 (1,44-13), obesidad grado III OR 9,99 (IC 2,12-47); tipo de ACV: isquémico OR 4,60 (IC 2,6-8) o trombótico OR 4,95 (1,57-15). El número de comorbilidades se asocia a discapacidad cuando se tiene una comorbilidad OR 2,80 (1,22-6,4), dos comorbilidades OR 3,43 (IC 1,37-8,5), tres comorbilidades OR 2,71 (IC 1,01-7,3), y con cinco comorbilidades OR 3,17 (IC 1,01-9,9). Conclusiones: Los factores de riesgo para discapacidad son la edad, el sobrepeso, la obesidad y el tipo de ACV isquémico y trombótico. Ser cuidado por un familiar y/o cónyuge reduce la probabilidad de presentar discapacidad. Abstract: Objective: To determine the risk factors associated with disability in patients who had a stroke in northeastern Mexico. Design: This was an observational, retrospective, cross-sectional study. Site: Conducted at the Family Medicine Unit No. 33 of the Mexican Institute of Social Security in Reynosa, Tamaulipas, Mexico. Participants: One hundred and ninety-eight males and 146 females, above 18 years old, beneficiaries of the Mexican Institute of Social Security with a diagnosis of stroke between 2018 and 2021. Interventions: The Barthel index that assesses the degree of dependence to perform basic activities of daily living was applied to the participants and sociodemographic, biological and anthropometric variables were collected from the digital medical record. Main measures: A univariate, correlational and ordinal logistic regression statistical analysis was performed between independent and dependent variables to obtain measures of frequency, percentages, and associated risks. Results: The risk factors associated with disability were age (OR 1.03, CI 1.01–1.05), overweight (OR 1.81, CI 1.03–3.1), obesity grade I (OR 2.74, CI 1.46–5.1), obesity grade II (OR 4.38, CI 1.44–13), obesity grade III (OR 9.99, CI 2.12–47); type of stroke: ischemic (OR 4.60, CI 2.6–8) or thrombotic (OR 4.95, CI 1.57–15). The number of comorbidities was associated with disability when having one comorbidity (OR 2.80, CI 1.22–6.4), two comorbidities (OR 3.43, CI 1.37–8.5), three comorbidities (OR 2.71, CI 1.01–7.3), and with five comorbidities (OR 3.17, CI 1.01–9.9). Conclusions: The risk factors found for disability were age, overweight, obesity, and type of ischemic and thrombotic stroke. Being cared for by a relative and/or spouse reduces the probability of disability.

Introduction: Strokes continue to be considered public health problems due to the great social and health impact they entail. They are the second cause of death in the world, with a high incidence and prevalence. They are time-dependent diseases, and more than 80% of cases could be avoidable with greater management of risk factors. Objective: to analyze the factors that influence prehospital time in a stroke code. Assess the population's knowledge of stroke symptoms and teach them how to act when a case is suspected. Document the continued training of health professionals for the early identification of patients with a suspected stroke. Demonstrate the importance of calling EMS as the first contact to reduce delays in prehospital time in a stroke. Methodology: A bibliographic review was carried out focusing on articles published between December 2014 and August 2023. The following databases were consulted: Pubmed (Medline), Dialnet, Google Scholar, Web of Science (WOS), Scielo, Scopus, and ScienceDirect. Results: After applying the article selection criteria and evaluating the quality of the methodology, a total of 18 articles were obtained. The results affirm that the importance of achieving a reduction in prehospital time is based mainly on knowledge of the symptoms and the use of new technologies. Conclusions: The evidence supports that the prehospital time of action in the stroke code is affected by numerous factors. These factors are determining factors in the time of action to achieve good effectiveness in the treatment of the pathology. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos de Ciências da Saúde da UNIPAR is the property of Associacao Paranaense de Ensino e Cultura and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain. Methods: We performed a cross-sectional study based on an ad-hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year. Results: The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. A mean (standard deviation) of 4 (3) neurologists were assigned to each stroke unit/team; 98% of stroke units (and 38% of stroke teams) have an on-call neurologist available 24 hours a day, 98% of units (79% of stroke teams) included specialised nurses, 86% of units (71% of stroke teams) included a social worker, and 81% of units (71% of stroke teams) included a rehabilitation physician. Most stroke units (80%) had 4--6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds was 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring was 3 (1) days. All stroke units and 86% of stroke teams had intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams were able to perform mechanical thrombectomy, whereas the remaining centres had referral pathways in place. Telestroke systems were in place at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases. Conclusions: Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care. Resumen: Introducción: El objetivo del trabajo es describir las características de las unidades (UI) y equipos (EI) de ictus en España. Método: Estudio transversal basado en un cuestionario ad-hoc, diseñado por 5 expertos y dirigido a los neurólogos responsables de las UI/EI con al menos un año de funcionamiento. Resultados: Participaron 43 UI (61% del total) y 14 EI. La media (±DE) de neurólogos adscritos a las UI/EI es de 4 ± 3. 98% de las UI frente a 38% de EI cuentan con neurólogo de guardia 24 h/7d. Disponen de enfermería especializada 98% de las UI frente a 79% de los EI, de médico rehabilitador 81% frente a 71% y de trabajador social 86% frente a 71%. La mayoría de UI (80%) tienen 4-6 camas con monitorización continua no invasiva. El número medio de camas no monitorizadas de las UI es de 14 ± 8 y de 12 ± 7 en los EI. La estancia media de los pacientes en las camas monitorizadas de las UI es de 3 ± 1 días. Todas las UI y el 86% de EI pueden realizar trombólisis intravenosa; el 81% de UI y 21% de EI trombectomía mecánica; el resto de los centros tiene posibilidad de derivación. El 44% de UI dispone del sistema teleictus, dando soporte a 4 ± 3 centros. La actividad se recoge sistemáticamente en el 77% de UI y 50% de EI, pero su cumplimentación es < 75% en un 25% de los casos. Conclusiones: La mayoría de las UI y de los EI cumple las recomendaciones actuales. Para seguir mejorando la atención del paciente, resulta necesario optimizar el registro sistemático de su actividad.

The presentation of cardiac tumors is rare, and cardiac myxomas (CM) are the most common; it is estimated that they account for 70% of all primary benign cardiac tumors, and of these, more than 75% of myxomas originate in the left atrium. A 40-year-old woman presented with syncope reported by a witness, followed by bradyphrenia and hypoactivity, and a weight loss of 13 kg. On admission, she reported paresis in the hands and feet of the left half of the body, mild dysarthria, and decreased left facial mimicry. Brain MRI showed multiple foci of ischemic behavior, considering thromboembolic disease. Echocardiography revealed a mass with mobile images suggestive of myxoma as the primary option, with a high probability of tumor embolism. Given these findings, referral to cardiovascular surgery was requested due to an intracardiac mass with a very high embolic risk, where histopathological study confirmed that the mass corresponded to an atrial myxoma. The presence of intracardiac masses is rare, with a low overall prevalence. The prevalence of myxomas is 58.14% [95% CI = 51.95; 64.09%], concluding myxoma as the most common. The clinical triad it may generate consists of syncopal episodes, thromboembolisms, and constitutional symptoms. Imaging studies are the first-line approach for identification. [ABSTRACT FROM AUTHOR]

Hypertone is a possible complication of central nervous system injury. The neurophysiological mechanisms underlying the development of hypertone are not entirely clear. Data from the literature in neurophysiology and pharmacology suggest that hypertone may be interpreted as a defense mechanism consequent to perceptual discoherence and that rehabilitation intervention may play a crucial role in the reorganization of muscle tone. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Kranion is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Lay training is essential to manage emergencies properly, although patients or bystanders need increased recognition of medical urgencies such as strokes. In Italy, as defined by Legislative Decree 81/08, all companies must train employees responsible for correctly recognizing and managing medical emergencies. Our study aims to evaluate the characteristics of medical emergencies concerning patients with a possible stroke in the Lombardy Region. Methods. A retrospective observational study was conducted. All missions performed by Regional Agency for Emergencies and Urgencies (Agenzia Regionale Emergenza Urgenza - AREU) in which the patient presented a possible stroke, recorded in the SAS-Areu database, were analyzed. The study period was from January 1, 2019, to December 31, 2019. Results. 10,201 patients with possible stroke were rescued, of whom only 540 (5.3%) occurred in workplaces. In workplaces, the percentage of males with a possible stroke was higher (62.2% vs 45.2%; p<0.01) and the mean age of rescued patients was lower (64.7 vs 77.5; p<0.01). Conclusions. A stroke occurs less frequently in the workplace, while most events occur at home. Mandatory training on early stroke recognition should be extended to schools and conveyed through a media information campaign. Lay training is the first point in the chain of survival; redefining training is critical for the future. [ABSTRACT FROM AUTHOR]

Copyright of Logopedia e Comunicazione is the property of Edizioni Centro Studi Erickson SpA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aimed to determine the incidence and trends of cerebrovascular disease (CVD) in the healthcare district of Lleida. Material and methods: We performed a population-based prospective cohort study including the entire population of the healthcare district of Lleida (440 000 people). Information was gathered from the minimum basic data set from the emergency department and hospital discharges for the period from January 2010 to December 2014. All types of stroke were included. We evaluated crude and age-standardised rates using the world population as a reference. Patients without neuroimaging confirmation of the diagnosis were excluded. Results: We identified 4397 patients: 1617 (36.8%) were aged 80 years or over; 3969 (90.3%) presented ischaemic stroke, and 1741 (39.6%) were women. The crude incidence rate ranged from 192 (95% confidence interval [CI], 179-205) to 211 (95% CI, 197-224) cases per 100 000 population, in 2012 and 2013, respectively. Age-standardised rates ranged from 93 (95% CI, 86-100) to 104 (95% CI, 96-111) cases per 100 000 population, in 2012 and 2013, respectively. For all years, incidence rates increased with age, and were significantly higher among men than among women. Conclusion: The impact of CVD in Lleida is comparable to that observed in other European regions. However, population ageing induces a high crude incidence rate, which remained stable over the five-year study period. Resumen: Objetivo: Determinar la incidencia de la enfermedad cerebrovascular (ECV) y su tendencia en el área sanitaria de Lleida. Material y métodos: Estudio de cohortes de base poblacional que incluyó a toda la población del área sanitaria de Lleida (440.000 personas). Se utilizaron los listados del Conjunto Mínimo Básico de Datos (CMBD) de urgencias y de las altas hospitalarias en el periodo comprendido entre enero de 2010 y diciembre de 2014. Se seleccionaron todos los episodios de ictus. Se evaluaron las tasas brutas y las tasas estandarizadas por edad utilizando la población mundial como referencia. Se excluyeron aquellos casos sin confirmación diagnóstica por neuroimagen. Resultados: Se incluyeron 4.397 casos, de los cuales 1.617 (36,8%) fueron ≥ 80 años; 3.969 (90,3%) sujetos sufrieron un ictus isquémico, mientras que 1.741 (39,6%) casos correspondieron a mujeres. La tasa de incidencia cruda osciló entre los 192 (intervalo de confianza [IC] del 95%: 179-205) en 2012 y los 211 (IC 95%: 197-224) en 2013 casos cada 100.000 habitantes. Las tasas estandarizadas por edad oscilaron entre los 93 (IC 95%: 86-100) en 2012 y los 104 (IC 95%: 96-111) en 2013 casos por cada 100.000 habitantes. En todos los años, las tasas de incidencia fueron significativamente mayores entre los varones en comparación con las mujeres; y se incrementaron con la edad. Conclusiones: El impacto de la ECV en Lleida es equiparable a otras regiones europeas, pero el envejecimiento de la población se traduce en una incidencia bruta elevada que se mantiene estable en los 5 años analizados.

Background: Advanced interatrial block (IAB) is an independent risk factor for ischaemic stroke. This study aimed to analyse whether advanced IAB predicts recurrence of embolic stroke of undetermined source (ESUS). Methods: 104 patients with a confirmed diagnosis of ESUS were followed up for a median period of 15 months (interquartile range, 10-48). We recorded data on clinical variables, P-wave characteristics, and presence of IAB on the electrocardiogram (ECG). ECG findings were interpreted by a blinded, centralised rater at (XXXX2). ESUS recurrence was the primary outcome variable. Results: Median age was 47 years (range, 19-85); 50% of patients were women. IAB was detected in 36 patients (34.6%); IAB was partial in 29 cases (27.9%) and advanced in 7 (6.7%). Sixteen patients (15.4%) presented stroke recurrence; of these, 5 had partial and 4 had advanced IAB (P = .01; odds ratio [OR] = 9.44; 95% confidence interval [CI], 1.88-47.46; relative risk [RR] = 4.62; 95% CI, 2.01-10.61). Median P-wave duration was longer in patients with stroke recurrence (P = .009). The multivariate logistic regression analysis identified the following independent risk factors for stroke recurrence: advanced IAB (P

Background: Hospital on-call neurology shifts are frequently on-site, but some on-call services may be off-site or mixed. Intravenous tissue plasminogen activator (tPA) is one of the main reperfusion treatments for acute ischaemic stroke (AIS). This study assesses door-to-needle times (DNT) when the neurologist is on-site or off-site. Methods: We performed a prospective, observational study from 2012 to 2017, including patients with AIS and treated with tPA. Data were collected on sex, age, door-to-scan time, scan-to-needle time, and DNT. The on-duty neurologist was on-site from 08:00 to 20:00, and on call but off-site from 20:00 to 8:00. Three groups were formed: on-site, off-site, and off-site with resident present. Results: Our sample included 138 patients. The mean age was 69.7 years, and 45.7% of patients were women. Ninety-six patients were admitted during the on-site shift, 25 during the off-site shift, and 17 during the off-site–resident present shift. Patients admitted during the on-site and off-site shifts presented DNTs of 59 and 72 minutes, respectively (P = .003). DNTs were 59, 74, and 68 minutes (P = .001), respectively, for the on-site, off-site, and off-site–resident present shifts; the difference between DNTs for on-site and off-site shifts was statistically significant. No differences were observed between DNTs according to time of day (morning, afternoon, or night), or between weekdays and weekends. Conclusion: DNT is influenced by whether the on-duty neurologist is on- or off-site at the time of code stroke activation. The presence of a neurology resident can reduce DNT. Resumen: Introducción: La guardia de Neurología es frecuentemente presencial; es decir, con el neurólogo presente en el centro hospitalario; pero en algunos centros, puede ser localizada o mixta. La Fibrinólisis Intravenosa (FIV) es uno de los principales tratamientos reperfusores en el Ictus Isquémico Agudo (IIA). El objetivo del siguiente trabajo es comparar el Tiempo Puerta-Aguja (TPA) durante la guardia presencial y la guardia localizada. Material y Métodos: Estudio prospectivo, observacional, desde el año 2012 hasta el 2017, en el que se incluyeron pacientes con IIA y FIV. Se recogieron datos como sexo, edad, hora del inicio de los síntomas, hora de llegada al hospital, hora de TAC, hora de inicio de FIV. Se consideró guardia de «Presencia» desde las 8:00 hasta las 20:00 y «Localizado» desde las 20:00 hasta las 08:00, dividido en 3 grupos: guardia «Presencial», guardia «Localizada» y guardia «Localizada con Residente». Resultados: N = 138. Edad media 69,7 años; mujeres 45,7%. Pacientes en guardia de «Presencia» 96, «Localizada» 42, de los cuales 17 con Residente. Ambos grupos presentaban características basales similares. Los TPA de los grupos «Presencia» y «Localizado» fueron 59 y 72 minutos respectivamente (p = 0,003). Los TPA de grupos «Presencia», «Localizada» y «Localizada con Residente» respectivamente 59; 74 y 68 minutos (p = 0,001), con significación entre «Presencia» y «Localizado». No se observaron diferencias entre el TPA dependiendo de la franja horaria de mañana, tarde y noche ni entre días laborales y días de fin de semana. Conclusión: La presencia o ausencia del neurólogo en el centro hospitalario en el momento del código ictus, influye en la demora de administración de tratamiento fibrinolítico. La presencia de residente de Neurología puede acelerar la realización del proceso.

Copyright of Kranion is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ankylosing spondylitis is a chronic inflammatory disease that is associated with adverse cardiovascular events. This study aimed to determine the relationship between ankylosing spondylitis and the risk of stroke. A systematic literature search in PubMed/MEDLINE, Scopus, and Web of Science were conducted from inception to December 2021 to identify relevant articles investigating the risk of stroke in patients with ankylosing spondylitis. A random-effects model (DerSimonian and Laird) was used to estimate a pooled hazard ratio (HR) and 95% confidence intervals (CI). Meta-regression based on the length of follow-up and subgroup analysis based on the type of stroke, study location, and year of publication to investigate the source of heterogeneity. A total of eleven studies comprising 1.7 million participants were included in this study. Pooled analysis showed a significantly increased stroke risk (56%) among patients with ankylosing spondylitis (HR: 1.56, 95% CI 1.33–1.79). Subgroup analysis revealed a higher risk of ischemic stroke among patients with ankylosing spondylitis (HR: 1.46, 95% CI: 1.23–1.68). However, meta-regression analysis showed no association between the duration of ankylosing spondylitis and stroke incidence (Coef = −0.0010, P = 0.951). This study reveals that ankylosing spondylitis was associated with an increased risk of suffering a stroke. Management of cerebrovascular risk factors and the control of systemic inflammation should be considered in patients with ankylosing spondylitis. [ABSTRACT FROM AUTHOR]

Perception is an emergent property that integrates internal and external inputs, giving them a meaning that results in the subject’s action. In practice, perception represents not only the conscious interpretation of information conveyed by the sense organs, but also has a motor aspect. In fact, motor gesture may be necessary to complete the interpretation of the sensory stimulus. Indeed, functional movement is not possible in the absence of sensory stimulus. The present study, carried out through the enrollment of patients with ischemic or hemorrhagic stroke that has occurred for at least three months, highlights the perceptual “incoherence” that patients have of their upper limb compared to what can instead be detected by quantitative assessment tools available in rehabilitation settings. This highlights how perception is an aspect dependent on the person’s experience and subjectivity, and that standardized, quantitative assessment methods alone are often insufficient to properly investigate the patient’s problems and to set up appropriate rehabilitation treatment. [ABSTRACT FROM AUTHOR]