Epidemiología y características del ictus isquémico en el adulto joven en Aragón

Introducción Alrededor de 15 millones de personas sufren un ictus cada año, de los que un 10-15% ocurre en menores de 50 años (ictus en el adulto joven). La prevalencia de los distintos factores de riesgo vascular y las estrategias sanitarias para el manejo del ictus varían a nivel mundial, siendo interesante conocer la epidemiología y las características específicas de cada región. El objetivo de este estudio fue determinar la prevalencia de los diferentes factores de riesgo vascular, la etiología y las características de los ictus isquémicos en el adulto joven en la comunidad autónoma de Aragón. Métodos Estudio multicéntrico, de corte transversal, realizado por los Servicios de Neurología de todos los hospitales del Servicio Aragonés de Salud (SALUD). Se identificó a todos los pacientes entre 18 y 50 años que ingresaron en cualquiera de estos hospitales con el diagnóstico de ictus isquémico o AIT entre enero del 2005 y diciembre del 2015. Se recogieron variables demográficas, factores de riesgo vascular y tipo de ictus isquémico entre otras. Resultados En el periodo de estudio, 786 pacientes entre 18 y 50 años ingresaron con el diagnóstico de ictus isquémico o AIT en algún hospital del SALUD, con una tasa anual promedio de 12, 3 por 100.000 habitantes. La mediana de su edad fue de 45 años (RIQ: 40-48 años). El factor de riesgo vascular más prevalente fue el tabaquismo, 404 (51, 4%). La mayoría fue de causa indeterminada (36, 2%), seguida por «otras causas» (26, 5%). La mediana de puntuación en la escala NIHSS fue de 3, 5 (RIQ: 2, 07, 0). En total, 211 (26, 8%) de los ingresos fueron por AIT. De los pacientes que ingresaron con el diagnóstico de ictus isquémico, 59 (10, 3%) se fibrinolizaron. Conclusiones El ictus isquémico en el adulto joven no es infrecuente en Aragón y en un importante número de casos es de etiología indeterminada, por lo que es necesario implementar medidas que nos permitan mejorar su estudio, disminuir su incidencia y prevenir su recurrencia. Introduction: Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. Methods: A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. Results: During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. Conclusions: Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment

Background High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods We used data for exposure to risk factors by country, age group, and sex from pooled analyses of populationbased health surveys. We obtained relative risks for the eff ects of risk factors on cause-specifi c mortality from metaanalyses of large prospective studies. We calculated the population attributable fractions for- each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the eff ects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specifi c population attributable fractions by the number of disease-specifi c deaths. We obtained cause-specifi c mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the fi nal estimates. Findings In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10\ub78 million deaths, 95% CI 10\ub71\u201311\ub75) of deaths from these diseases in 2010 were attributable to the combined eff ect of these four metabolic risk factors, compared with 67% (7\ub71 million deaths, 6\ub76\u20137\ub76) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined eff ects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing eff ect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the globalresponse to non-communicable diseases

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

High Prevalence Anti-Trypanosoma cruzi Antibodies, among Blood Donors in the State of Puebla, a Non-endemic Area of Mexico

Blood transfusion is the second most common transmission route of Chagas disease in many Latin American countries. In Mexico, the prevalence of Chagas disease and impact of transfusion of Trypanosoma cruzi -contaminated blood is not clear. We determined the seropositivity to T. cruzi in a representative random sample, of 2,140 blood donors (1,423 men and 647 women, aged 19-65 years), from a non-endemic state of almost 5 millions of inhabitants by the indirect hemagglutination (IHA) and enzyme linked immunosorbent assay (ELISA) tests using one autochthonous antigen from T. cruzi parasites, which were genetically characterized like TBAR/ME/1997/RyC-V1 (T. cruzi I) isolated from a Triatoma barberi specimen collected in the same locality. The seropositivity was up to 8.5% and 9% with IHA and ELISA tests, respectively, and up to 7.7% using both tests in common. We found high seroprevalence in a non-endemic area of Mexico, comparable to endemic countries where the disease occurs, e.g. Brazil (0.7%), Bolivia (13.7%) and Argentina (3.5%). The highest values observed in samples from urban areas, associated to continuous rural emigration and the absence of control in blood donors, suggest unsuspected high risk of transmission of T. cruzi, higher than those reported for infections by blood e.g. hepatitis (0.1%) and AIDS (0.1%) in the same region

Evaluación del Diklason® ampollas en el dolor agudo

Antecedentes: El dolor agudo es definido como dolor de reciente comienzo y probablemente de duraci&oacute;n limitada que se relaciona de manera causal y temporal con un da&ntilde;o o enfermedad.Los antiinflamatorios no esteroideos modulan el dolor perif&eacute;rico por reducci&oacute;n de la producci&oacute;n de prostaglandinas y de los neurop&eacute;ptidos. Ejemplos t&iacute;picos de dolor agudo son: el dolor post-operatorio, lumbago, dolor por injuria de partes blandas o hueso y c&oacute;lico nefr&iacute;tico. Este tipo de dolor es incrementado por la ansiedad, el catastrofismo, neuroticismo y la depresi&oacute;n. El diclofenac pot&aacute;sico ha demostrado ser un f&aacute;rmaco seguro y efectivo en el manejo del dolor agudo.Material y M&eacute;todo: Se realiz&oacute; un estudio abierto, prospectivo y multic&eacute;ntrico en 220 pacientes con diagn&oacute;stico de dolor agudo, de intensidad severa y moderada a los cuales se les suministr&oacute; una dosis IM o IV de diclofenac pot&aacute;sico (Diklason&reg;) de 75 mg y se midi&oacute; la intensidad del dolor mediante las siguientes escalas: VAS 0-100, PID, SPID, Pain Relief y TOTPAR, medicaci&oacute;n de rescate y escala cl&iacute;nica de cambio.La inocuidad se evalu&oacute; por interrogatorio directo de efectos adversos.Las evaluaciones se realizaron al inicio, a las 0.5, 1, 2, 4, 6, 8 y 12 h de la administraci&oacute;n de la dosis.Resultados: Se produjo un descenso importante en los niveles de VAS desde los 30 min. de tratamiento y este descenso fue significativo entre los per&iacute;odos de evaluaci&oacute;n hasta las 8 horas, el efecto persisti&oacute; hasta las 12 horas. El 90,45% de los pacientes comenzaron a sentir alivio del dolor a los 30 min. Todas las escalas evaluadas mostraron cambios significativos en los per&iacute;odos evaluados desde los primeros 30 min. hasta las 8 horas (SPID), 12 h (SPID, PR, y TOTPAR).En el 92,72% de los pacientes los resultados fueron adecuados: excelentes (56,3%) y buenos (36,36%). Se presentaron 6 efectos adversos leves.Conclusiones: El diclofenac pot&aacute;sico (Diklason&reg;) resulta r&aacute;pido, efectivo y duradero en el manejo del dolor agudo de diferentes etiolog&iacute;as.Background: Acute pain is defined as a pain of recent onset and probably limited duration which is associated with a causal and temporal damage or disease.NSAIDs modulate peripheral pain by reducing prostaglandin and neuropeptides production. Typical examples of acute pain include post operatory, lumbago, bone or soft tissue injuries and, renal colic. This type of pain is increased by anxiety, catastropic events, neuroticism and depression. Diclofenac potassium is proved to be safe and effective in management acute pain.Materials and methods: We conducted a multicenter; prospective, open study in 220 patients with acute pain (moderate to severe intensity) which supply with IM or IV dose of diclofenac potassium (Diklason&reg;) 75 mg, the pain intensity was measured by the following scales: VAS 0-100, PID, SPID, Pain Relief and TOTPAR, rescue medication and clinical scale changes.The safety was assessed by direct questioning side effects.Evaluations were performed at baseline at 30 minutes, 1, 2, 4, 6, 8, and 12 hours after dosage.Results: There was a significant decrease in VAS levels from 30 minutes of treatment and this decrease was significant between the evaluation periods up to 8 hours, the effect persisted for 12 hours. In 90.45% of patients began to feel pain relief within 30 minutes. All scales evaluated showed significant changes in the periods evaluated from the first 30 minutes up to 8 hours (SPID), 12 h (SPID, PR, and TOTPAR).In 92.72% of results were suitable: excellent (56.3%) and good (36.36%). We found 6 mild adverse effects.Conclusions: Diclofenac potassium (Diklason&reg;) is quick, effective and durable in the management of acute pain of various etiologies