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Objectives: To evaluate maternal cerebral hemodynamics in patients with preeclampsia (PE) from diagnosis to clinical resolution using transcranial Doppler (TCD) and compare these findings with those of healthy pregnant women. Furthermore, we sought to describe the prevalence of vasoconstriction (VC) and related clinical parameters in PE. Study design: Case-control study including consecutive patients with PE at diagnosis and healthy pregnant women at week 36 of pregnancy. We prospectively collected clinical and neuroimaging data. TCD was repeated at inclusion and on days 1, 7, and 30 postpartum. Main outcome measures: Evolution of intracranial arteries hemodynamics (mean velocities (MV), resistance index). VC diagnosis and related features are described. Results: A total of 165 patients (80 with PE) underwent 467 TCD procedures. Patients with PE presented higher MAP. Intracranial arteries MV were significantly higher in patients with PE (at diagnosis and days 1 and 7 postpartum) but were normalized by day 30, without correlation with MAP evolution or treatment. VC was present in 32.5% of patients with PE (p < 0.001) and was mainly mild according to the Lindegaard index. Severe PE was associated with VC (50.0% vs. 22.6%; odds ratio 3.484; 95% confidence interval 1.425-8.520; p = 0.014). No other independent risk factors for reversible VC were identified. Conclusions: Patients with PE presented significantly higher MV in the anterior circulation compared to healthy controls, which worsened by day 7 and reverted by day 30 after delivery. VC was present in one-third of PE but was mainly mild and asymptomatic. Severe PE was associated with VC development. Sin financiación 2.899 JCR (2020) Q2, 37/83 Obstetrics & Gynecology 0.95 SJR (2021) Q1, 33/192 Obstetrics and Gynecology No data IDR 2020 UEM

This study shows the feasibility of an eHealth solution for tackling eating habits and physical activity in the adolescent population. The participants were children from 11 to 15 years old. An intervention was carried out on 139 students in the intervention group and 91 students in the control group, in two schools during 14 weeks. The intervention group had access to the web through a user account and a password. They were able to create friendship relationships, post comments, give likes and interact with other users, as well as receive notifications and information about nutrition and physical activity on a daily basis and get (virtual) rewards for improving their habits. The control group did not have access to any of these features. The homogeneity of the samples in terms of gender, age, body mass index and initial health-related habits was demonstrated. Pre- and post-measurements were collected through self-reports on the application website. After applying multivariate analysis of variance, a significant alteration in the age-adjusted body mass index percentile was observed in the intervention group versus the control group, as well as in the PAQ-A score and the KIDMED score. It can be concluded that eHealth interventions can help to obtain healthy habits. More research is needed to examine the effectiveness in achieving adherence to these new habits.

Objective: To examine the effects of pretreatment with statins at high doses (40 mg of rosuvastatin or 80 mg of any other statin) and low to moderate doses ( Methods: Observational study of IS admissions to our stroke unit over a 3-year period (2008–2010). Mild stroke severity was defined as NIH Stroke Scale score ≤5 on admission. Multivariable regression models and matched propensity score analyses were used to quantify the association of statin pretreatment at high and low to moderate doses with mild stroke severity. Results: Of the 969 IS patients, 23% were taking low to moderate doses and 4.1% were taking high doses of statins prior to the stroke. Statins were associated with lower NIHSS scores on admission (median [interquartile range] 4 [9] for nonstatin patients, 4 [9] for low to moderate doses of statins, and 2 [4] for high doses of statins; p = 0.010). After multivariable adjustment, pretreatment with statins was associated with a higher probability of mild stroke severity in the unmatched analysis (odds ratio [OR] = 1.637, 95% confidence interval [CI] 1.156–2.319 for the low to moderate doses and OR = 3.297, 95% CI 1.480–7.345 for the high doses of statins) as well as in the propensity score matched analysis (OR = 2.023, 95% CI 1.248–3.281 for the low to moderate doses and OR = 3.502, 95% CI 1.477–8.300 for the high doses of statins). Conclusion: Pretreatment with statins is associated with lower stroke severity, at high as well as at low to moderate doses.

Background: Several studies have shown that high-density lipoprotein (HDL) cholesterol provides protection against bacterial infections. Our aim was to investigate the influence of HDL cholesterol levels on the risk of developing in-hospital infectious complications after an acute ischemic stroke (IS) as well as the possible effect of prestroke statin treatment on this association. Methods and Results: Observational study that included consecutive IS patients during a 5-year period (2006-2010). We analyzed vascular risk factors, prestroke treatments (including statins), laboratory data (including HDL cholesterol levels), stroke severity, and the development of infectious complications (pneumonia, urinary tract infection and sepsis). A multivariate analysis that included HDL cholesterol levels, prior statin treatment and the interaction between both variables was performed to identify those factors associated with the presence of infectious complications. A total of 1,385 patients were included, 130 of whom (9.4%) developed in-hospital infections. The receiver operating characteristic curve showed the predictive value of HDL cholesterol with an area under the curve of 0.597 (95% CI, 0.526-0.668; p = 0.006) and pointed to 38.5 mg/dl of HDL cholesterol (65.5% sensitivity and 53.4% specificity) as the optimal cutoff level for developing infectious complications during hospitalization. An HDL cholesterol level ≥38.5 mg/dl was an independent predictive factor for lower risk of infection (OR 0.308; 95% CI 0.119-0.795), whereas prestroke statin treatment was not associated with the development of infection. Conclusions: An HDL cholesterol level ≥38.5 mg/dl was independently associated with lower risk for developing infectious complications in acute IS patients. Statins do not influence this association.

Background: Whether migraine is associated with a higher prevalence of hypercoagulable states (HS) in ischemic stroke patients is unknown. Methods: This was a prospective study of patients under 55 years of age with brain ischemia. A systematic questionnaire addressed the antecedent of migraine with aura (MA) or without aura (MO). We investigated the presence of HS by an extensive battery of haematological tests. The presence of patent foramen ovale (PFO) was assessed by trans-oesophageal echocardiography. Results: A total of 154 patients (95 men; mean ± SD age, 44.12 ± 8.4 years) were included; 44 had migraine, 15 had MA. HS were more frequent in the migraine than non-migraine group (38.6% vs. 16.4%, p Conclusion: In young patients with ischemic stroke, migraine may be associated with a higher frequency of HS.

Background and Purpose: Echogenicity of atheroma carotid plaques is related to a higher risk of stroke. Clinical and subjective ultrasound criteria are used to identify symptomatic plaques, but the standardized grayscale median (GSM) value may be an objective tool for this diagnosis. Our aim was to analyze the utility of assessing the echogenicity of atheroma carotid plaques in the identification of symptomatic plaques. Methods: Observational prospective study with inclusion of acute noncardioembolic anterior cerebral circulation ischemic stroke patients. Only patients with bilateral atheroma plaques were included. Echogenicity of plaques was measured by a digital and standardized grayscale system in carotid ultrasound B-mode (longitudinal projection) conducted within the first week after admission. Results: Sixty-six patients were included and 132 plaques were examined. Symptomatic atheroma plaques were less echogenic than asymptomatic ones (GSM 20.0 vs. 29.0; p = 0.002). A ROC curve analysis showed the predictive value of GSM with an AUC of 0.707 (95% CI 0.592–0.823; p = 0.002) and pointed to a value of 24.4 as the optimal cut-off level to identify a plaque as symptomatic (74% sensitivity; 67% specificity). This GSM cut-off point remained significantly associated with a high probability of symptomatic plaque even after the inclusion of the degree of carotid stenosis (either >70% or >50%) in the multivariate logistic regression models. Conclusions: The assessment of echogenicity of atheroma carotid plaques by the GSM value combined with clinical characteristics and stenosis degree may be useful in the identification of symptomatic plaques.

Introduction: our primary objective was to analyze the efficacy of a Telestroke system in terms of an increase in the number of patients treated with intravenous thrombolysis (IVT) and a shorter door-to-needle time, in the metropolitan area of Madrid, Spain. Our secondary objective was to analyze the safety of Telestroke in terms of mortality and symptomatic hemorrhagic transformation (SHT). Methods: prospective observational cohort study: 1) cohort exposed to Telestroke: acute ischemic stroke patients attended at Infanta Sofia University Hospital (community hospital) connected by Telestroke with the Stroke Center at La Paz University Hospital; 2) Non-exposed cohort: acute stroke patients who are attended at Severo Ochoa University Hospital (community hospital) connected by phone with the Stroke Center at Ramon y Cajal University Hospital. The number of patient attended, number of IVT, times (min), 3-months outcome (mRS), the number of unnecessary transfers and safety parameters (mortality and SHT by ECAS III criteria) were recorded. We analyzed the first 34 months of the Telestroke (March 2011-december 2013). Results: in the Telestroke cohort the system was activated in 59 patients, being stroke code in 42 cases. In the non-exposed cohort 45 phone calls were made, being stroke code in 42 cases. In the Telestroke cohort, IVT were administrated in 61.9% (26/42) of patients whereas in the non-exposed only 28.6% (12/42) received this treatment (P=0,002). The door-to-needle time was shorter in Telestroke cohort than in the non-exposed cohort (mean [SD]) (86.9 [41.7] vs. 149.7 [68.2], P=0.001). The 3-month outcomes were better in the Telestroke cohort (mRS 0-3: 92.9% vs. 73.8%, P=0.038). Mortality (4,8% vs. 4.8%) and SHT (0% vs. 4.8%) were similar in both groups (P = NS). In addition, there were fewer unnecessary secondary transfers in the Telestroke cohort (4.3% vs. 20%, P=0.027). Conclusion: the implementation of a Telestroke system in a metropolitan area is effective and safe, increasing the number of IV thrombolysis and reducing the door-to-needle times. Furthermore, the Telestroke reduces the number of unnecessary secondary transfers.

A telestroke system was established between a community hospital lacking an on-call neurologist and a comprehensive stroke center only 13 km away. Our goal was to analyze the impact of telestroke on the number of intravenous thrombolysis (IVT), door-to-needle times and stroke outcomes. An observational before-and-after study of patients with acute ischemic stroke (IS) who were attended in a community hospital during the 2 years before the telestroke system was implemented (pre-telestroke group) and the first 2 years after telestroke was established (telestroke group). The number of IVT, the door-to-needle time (min), the outcomes [modified Rankin Scale (mRS)] and the safety (mortality and hemorrhagic transformations) were compared between groups. During the pre-telestroke years, 259 patients with IS were attended (28 phone activations), 12 of whom received IVT (4.7 %). During the telestroke years, 225 patients with IS were attended (42 telestroke activations), of whom 18 (8 %) received IVT. The door-to-needle times were lower in the telestroke group [median interquartile range: 66 (54) vs. 143.5 (48) min, P < 0.0001]. The safety was similar in both groups; however, the 3-month mRS scores were lower in the telestroke group (P = 0.049). The multiple linear regression analysis showed a negative association between telestroke and door-to-needle time [β-coefficient (SE) = −59.089 (14.461)], adjusted for confounders. In conclusion, telestroke systems are effective, even between nearby hospitals, shortening door-to-needle time and improving stroke outcomes.

To the Editor: Stroke occurring during pregnancy and postpartum is a diagnostic challenge because there are several specific causes to be considered in its management and differential diagnosis, including postpartum angiopathy (PPA).1 Thus, we read with great interest the recent article by Fugate et al2 reviewing clinical features, patient characteristics, and neuroimaging in PPA. Although the evidence of multifocal narrowing of cerebral arteries in cerebral angiography is a requisite for its diagnosis, up to 39% of initial angiograms of patients with PPA may be normal as Fugate et al found in this multicenter series. However, the possible role of transcranial Doppler (TCD) in helping achieve early diagnosis as well as better monitoring of response to treatment has not been mentioned in this review. TCD is a valid noninvasive and easily available tool that can be performed as many times as necessary to identify/quantify the severity of cerebral arterial vasoconstriction and monitor the response to treatment in …

Martinez-Sanchez et al. addressed the issue of nonrandomization of trial participants taking statins before stroke (confounding by indication), using propensity scores.1 This statistical method may not fully account for prestroke imbalances, which may affect the probability that a patient would be prescribed a statin as an outpatient. For example, older patients with atrial fibrillation (AF) who are likely to have larger strokes may be less likely to be prescribed statins (table 1).1 Comparing tables 1 and 2, what …