Relationship between Sleep Architecture and Global Prognosis in Patients with Total Cerebral Infarction of Anterior Circulation

Los accidentes cerebrovasculares isquémicos conforman un grupo de afecciones de la vasculatura cerebral resultante de la oclusión de un vaso suplementario del encéfalo. Definir el pronóstico de estos pacientes durante la fase aguda, es un complejo ejercicio de estimación, pues intervienen diversos e interrelacionados factores. El objetivo del presente trabajo consiste en estimar la posible relación entre la Arquitectura del Sueño y el pronóstico clínico, vital y funcional de pacientes con Infarto Cerebral Total de la Circulación Anterior (ITCA) durante la fase aguda. Se realizó un estudio analítico, longitudinal, en 35 pacientes adultos con ITCA, desde marzo 2017–marzo 2018. El pronóstico global y sus categorías se evaluaron utilizando las escalas de NIHSS, Índice de Barthel y Rankin modificada. De la estadística inferencial se aplicaron el test de independencia basado en la distribución Chi-cuadrado y la prueba t de Student. Se utilizó la regresión logística para determinar si la duración de la fase REM del sueño se comportaba como un predictor pronóstico independiente. Los resultados arrojaron que la disminución del tiempo transcurrido en la fase REM, se relacionó muy significativamente con mayor riesgo de muerte (t=-7.28; p=0.000); su duración se correlacionó negativamente con el grado de déficit neurológico (r=-0.529; p=0.001), y con el nivel de incapacidad medido por la mRS a los 3 meses del Ictus (r=-0.903; p=0.000), demostrándose además una relación muy significativa y directa con las puntuaciones del IB (r=0.868; p=0.000). La disminución de una unidad en la duración del sueño REM, multiplica en 2.29 la posibilidad del resultado no favorable en estos pacientes. Se concluyó que las alteraciones de la Arquitectura del Sueño, especialmente las que implican disminución de la fase REM, impactan negativamente en la evolución de pacientes con ITCA a corto y a largo plazo.Ischemic strokes make up a group of disorders of the cerebral vasculature resulting from the occlusion of an extra vessel in the brain. Defining the prognosis of these patients during the acute phase is a complex estimation exercise, since various and interrelated factors are involved. The objective of this work is to estimate the possible relationship between Sleep Architecture and the clinical, vital and functional prognosis of patients with Total Cerebral Infarction of the Anterior Circulation (ITCA) during the acute phase. An analytical, longitudinal study was carried out in 35 adult patients with ITCA, from March 2017 to March 2018. The global prognosis and its categories were evaluated using the NIHSS scales, Barthel Index and modified Rankin. From inferential statistics, the independence test based on the Chi-square distribution and the Student's t-test were applied. Logistic regression was used to determine whether REM sleep duration behaved as an independent prognostic predictor. The results showed that the decrease in the time spent in the REM phase was very significantly related to a higher risk of death (t=-7.28; p=0.000); its duration was negatively correlated with the degree of neurological deficit (r=-0.529; p=0.001), and with the level of disability measured by the mRS 3 months after the stroke (r=-0.903; p=0.000), demonstrating in addition, a very significant and direct relationship with the BI scores (r=0.868; p=0.000). The decrease of one unit in the duration of REM sleep multiplies by 2.29 the possibility of an unfavorable result in these patients. It was concluded that the alterations of the Sleep Architecture, especially those that imply a decrease in the REM phase, have a negative impact on the evolution of patients with ITCA in the short and long term

Quiste dermoide del filum terminal con parálisis de ambos nervios ciático poplíteo externo. Informe de caso

Introduction: dermoid cysts (DC) are benign lesions that originate from ectodermal tissue that remains in the thickness of tissues during embryonic development of multipotential cells or perhaps epithelial implantation. DC appears in many regions of the body and is presented as a soft, painless and scrollable mass. Most are small, but some have exceeded 12cm. It often distend the mucosa in such a way that some of the contents may be visible. Dermoid cysts can be seen between 15 and 35 years of age. Case report: a clinical case of a dermoid cyst located in the Filum Terminal is presented, which presents as a bilateral paralysis of both external Popliteal Sciatic nerves and a dorsal sensory level D12, a Nuclear Magnetic Resonance of the Dorso-Lumbar spine is performed and the presence of an intradural extramedullary tumor, which is surgically intervened. Conclusions: it is concluded histologically as a Dermoid Cyst.Introducción: los quistes dermoides son lesiones benignas que se originan a partir del tejido ectodérmico que permanece en el espesor de los tejidos durante el desarrollo embrionario de células multipotenciales o tal vez de la implantación de epitelio. Aparece en muchas regiones del cuerpo y se presenta como una masa blanda, indolora y desplazable. Presentación del caso: se presenta un paciente con un quiste dermoide localizado en el filum terminal que se muestra como una parálisis bilateral de ambos nervios ciáticos poplíteos externos y un nivel sensitivo dorsal D12. Se le realizó una resonancia magnética nuclear de columna dorso-lumbar que mostró la presencia de un tumor extramedular intradural y fue intervenido quirúrgicamente. Conclusiones: es importante una evaluación clínica amplia para poder llegar al diagnóstico positivo de estas formas atípicas de presentación de lesiones medulares con afectación de nervios periféricos

Epidemiological and clinical variables’ behavior in patients with stroke of Villa Clara

Background: cerebrovascular disease represents the most common health problem related to neurological care, it is important to study it in different contexts and from different approaches.Objective: to describe epidemiological and clinical variables’ behavior in patients admitted for stroke.Methods: descriptive and cross-sectional study, carried out in Arnaldo Milián Castro Hospital’s Neurology service from Villa Clara, Cuba, which included all patients with a clinical diagnosis of cardioembolic or atherothrombotic stroke, admitted to the ward during 2019. The information was obtained from the medical records stored in the Hospital Archive; and it was processed in the statistical package SPSS. v. 21. A descriptive statistical analysis was applied, in a frequency distribution.Results: female patients predominated (51.6%). There was a higher incidence in men older than 79 years (47.7%), and in women older than 70 (86.0%). In 67.3% the cardioembolic cause was demonstrated. Arterial hypertension was the main associated risk factor (83.6%). The motor defect was observed as the most frequent clinical finding on admission (96.7%). Hemorrhagic transformation of the infarct and nosocomial bronchopneumonia were identified as the main neurological and non-neurological complications, respectively. Patients discharged alive prevailed (68.6%).Conclusions: ischemic strokes are more frequent in elderly patients; early identification and timely management of the established disease can largely prevent the appearance of complications, and consequently death.</p

Combination therapy of Epidermal Growth Factor and Growth Hormone-Releasing Hexapeptide in acute ischemic stroke: a phase I/II non-blinded, randomized clinical trial

ObjectiveThis study tested the hypothesis that a neuroprotective combined therapy based on epidermal growth factor (EGF) and growth hormone-releasing hexapeptide (GHRP6) could be safe for acute ischemic stroke patients, admitting up to 30% of serious adverse events (SAE) with proven causality.MethodsA multi-centric, randomized, open-label, controlled, phase I-II clinical trial with parallel groups was conducted (July 2017 to January 2018). Patients aged 18–80 years with a computed tomography-confirmed ischemic stroke and less than 12 h from the onset of symptoms were randomly assigned to the study groups I (75 μg rEGF + 3.5 mg GHRP6 i.v., n=10), II (75 μg rEGF + 5 mg GHRP6 i.v., n=10), or III (standard care control, n=16). Combined therapy was given BID for 7 days. The primary endpoint was safety over 6 months. Secondary endpoints included neurological (NIHSS) and functional [Barthel index and modified Rankin scale (mRS)] outcomes.ResultsThe study population had a mean age of 66 ± 11 years, with 21 men (58.3%), a baseline median NIHSS score of 9 (95% CI: 8–11), and a mean time to treatment of 7.3 ± 2.8 h. Analyses were conducted on an intention-to-treat basis. SAEs were reported in 9 of 16 (56.2%) patients in the control group, 3 of 10 (30%) patients in Group I (odds ratio (OR): 0.33; 95% CI: 0.06–1.78), and 2 of 10 (20%) patients in Group II (OR: 0.19; 95% CI: 0.03–1.22); only two events in one patient in Group I were attributed to the intervention treatment. Compliance with the study hypothesis was greater than 0.90 in each group. Patients treated with EGF + GHRP6 had a favorable neurological and functional evolution at both 90 and 180 days, as evidenced by the inferential analysis of NIHSS, Barthel, and mRS and by their moderate to strong effect size. At 6 months, proportion analysis evidenced a higher survival rate for patients treated with the combined therapy. Ancillary analysis including merged treated groups and utility-weighted mRS also showed a benefit of this combined therapy.ConclusionEGF + GHRP6 therapy was safe. The functional benefits of treatment in this study supported a Phase III study.Clinical Trial RegistrationRPCEC00000214 of the Cuban Public Registry of Clinical Trials, Unique identifier: IG/CIGB-845I/IC/1601

Main prognostic, clinical and epidemiological factors in patients with total cerebral infarction of previous circulation

Foundation: The epidemiological behavior of cerebral infarction leads to the need for studies aimed at characterizing the prognosis of patients, and establishing factors correlated with evolution, summarized in models that allow directing treatment actions towards these determinants. Objective: to describe the main prognostic, clinical and epidemiological factors in patients with total cerebral infarction of anterior circulation. Methods: descriptive study, in adult patients (N=35) with total cerebral infarction of previous circulation, admitted to the Stroke Unit, of the Arnaldo Milián Castro Hospital, from March 2017 to March 2018. Clinical-demographic variables were analyzed and related to ischemic injury, and were associated with the overall prognosis of patients. The Independence Test based on the Chi-square Distribution and the Student t-test were applied. Results: 81.82 % of patients between 75 and 85 years evolved unfavorably, and the probability of a worse prognosis in older patients was higher (X2 = 10.59; p = 0.007). In those who presented higher levels of mean blood pressure and longer time with oxygen saturation less than 90 % during sleep, the probability of an unfavorable final prognosis was higher (p =0.000). None of the factors associated with ischemic injury was significantly related to the prognosis (p&gt;0.05). Conclusion: age, average mean blood pressure, and oxygen saturation time of less than 90 % during sleep in the acute phase of stroke are associated with a higher probability of presenting an unfavorable overall prognosis

Lepra neural pura. Informe de caso

Introduction: Hansen's disease or leprosy is an infectious and contagious disease of chronic evolution caused by a bacillus, Mycobacterium leprae. Pure, or primary, neural leprosy presents as peripheral neuropathy without the presence of skin lesions.Patient information: a young man, 19 years old, was presented with a history of sensory alterations in both legs of approximately two months of evolution. Physical examination revealed hypoesthesia in patches in both lower limbs. Diagnostic confirmation was established by biopsy of the sural nerve. Antileprosy treatment was started and clinical improvement was achieved with few weeks of evolution.Conclusions: clinical diagnosis is difficult and the disease may go unnoticed for years, with neural damage with increasing disability, so an exhaustive clinical approach is required to achieve accurate diagnoses. Multidisciplinary management improves the prognosis and quality of life of patients with this disease.Introducción: la enfermedad de Hansen o lepra es una enfermedad infectocontagiosa de evolución crónica causada por un bacilo, el Mycobacterium leprae. La lepra neural pura, o primaria, se presenta como una neuropatía periférica sin presencia de lesiones cutáneas.Información del paciente: se presenta un hombre joven, de 19 años de edad, con historia de alteraciones sensitivas en ambas piernas de aproximadamente dos meses de evolución. Al examen físico se constató hipoestesia en parches en ambos miembros inferiores. Se estableció confirmación diagnóstica por biopsia del nervio sural. Se comenzó tratamiento antileproso y se logró mejoría clínica con pocas semanas de evolución.Conclusiones: el diagnóstico clínico es difícil y la enfermedad puede pasar desapercibida durante años, con daño neural cada vez con mayor discapacidad, por lo que se requiere de un enfoque clínico exhaustivo para lograr diagnósticos acertados. El manejo multidisciplinario mejora el pronóstico y la calidad de vida de los pacientes con esta enfermedad

Factores de mal pronóstico en pacientes con Accidente Cerebrovascular Isquémico Agudo

Resumen Objetivo. Determinar factores de mal pronóstico en pacientes con Infarto Cerebral, en el Hospital Arnaldo Milián Castro, Villa Clara, en el año 2019. Métodos. Estudio observacional, analítico, transversal, durante enero-diciembre de 2019, en Hospital “Arnaldo Milián Castro” en Villa Clara, Cuba. El universo lo constituyeron todos los pacientes que ingresaron con diagnóstico de Infarto Cerebral en la sala de Neurología del Hospital, en el año 2019. Mediante un muestreo aleatorio simple se seleccionaron 153 pacientes. La información fue almacenada y procesada en SPSS v.21. Se realizó el análisis estadístico descriptivo para cada variable de estudio, en una distribución de frecuencias; se aplicó un análisis bivariado de grupos, comparando variables epidemiológicas y clínicas. Finalmente, como modelo predictor de mortalidad en estos pacientes, se creó una red neuronal Perceptrón Multicapa. Resultados. El 65,6% de los pacientes egresaron vivos del Hospital. Hubo un total de 48 fallecidos (31,4%); de estos, la totalidad tenían algún defecto motor al momento del ingreso, y en la mayoría existían trastornos del lenguaje y del estado de conciencia. Estas variables se asociaron muy significativamente desde el punto de vista estadístico con la mortalidad de los pacientes (p=0,000). El modelo predictor de mortalidad creado, mostró una precisión promedio ± desviación estándar de 89 ± 6%. Conclusión. La edad avanzada, el defecto motor al ingreso, los trastornos del lenguaje, el deterioro del nivel de conciencia, así como las complicaciones neurológicas y no neurológicas, constituyen factores de mal pronóstico y determinan una mayor mortalidad en la fase aguda del Ictus Isquémico. Abstract Objective. To determine factors of bad prognosis in patients with Cerebral Infarction, at the Arnaldo Milián Castro Hospital, Villa Clara, in 2019. Methods. Observational, analytical, transversal study, during January-December 2019, at "Arnaldo Milián Castro" Hospital in Villa Clara, Cuba. The universe was made up of all the patients who were admitted with a diagnosis of Cerebral Infarction in the Neurology ward of the Hospital, in 2019. Through simple random sampling, 153 patients were selected. The information was stored and processed in SPSS v.21. Descriptive statistical analysis was performed for each study variable, in a frequency distribution; A bivariate analysis of groups was applied, comparing epidemiological and clinical variables. Finally, as a mortality predictor model in these patients, a Multilayer Perceptron neural network was created. Results. 65.6% of the patients were discharged alive from the Hospital. There was a total of 48 deaths (31.4%); Of these, all had some motor defect at the time of admission, and in most of them there were disorders of language and state of consciousness. These variables were highly significantly associated from the statistical point of view with patient mortality (p=0.000). The mortality predictor model created showed an average accuracy ± standard deviation of 89 ± 6%. Conclusion. Advanced age, motor defect on admission, language disorders, impaired level of consciousness, as well as neurological and non-neurological complications, are poor prognostic factors and determine higher mortality in the acute phase of ischemic stroke