Influencia del ingreso en una Unidad de Monitorización vídeo-EEG prolongada en función del tiempo de evolución de epilèpsia

Se desconoce si existe un tiempo de evolución límite a partir del cual ingresar en una UMVEEG* no suponga una mejoría del pronóstico del paciente epiléptico. El estudio analiza el efecto del ingreso en la UMVEEG sobre una serie de variables pronósticas (FC**, NFAE***, CVP****) en función del tiempo de evolución desde el diagnóstico. Analizamos epilépticos diagnosticados con certeza y pacientes con crisis psicógenas. Se estudiaron 135 pacientes(Edad:39+13,5años,Sexo(55,6%mujeres).Se obtuvo una mejoría significativa de FC**(p 0,001)y CVP****(p 0,005)en los grupos estudiados independientemente del tiempo de evolución.El tiempo de evolución determinó una respuesta diferencial sobre la reducción del NFAE***excepto para crisis psicógenas,en que hubo una reducción significativa(p=0,004)independientemente del tiempo de evolución.Actualment es desconeix si existeix un temps límit d'evolució a partir del qual l'ingrés a una UMVEEG*no millori el pronòstic del pacient epilèptic.L'estudi analitza l'efecte ingrés a UMVEEG* sobre una sèrie de variables pronòstic(FC**,NFAE***,QVP****)segons el temps d'evolució des del diagnòstic.Es van analitzar pacients epilèptics confirmats i pacients amb crisis psicògenes. Es van estudiar 135 pacients(Edat:39+13,5anys,Sexe(55,6%dones).Es va obtenir una milloria significativa de FC**(p 0,001)i CVP****(p 0,005)a tots els grups estudiats independentment del temps d'evolució.El temps d'evolució va determinar una resposta diferencial sobre la reducció del NFAE***amb l'excepció de crisis psicògenes,que varen reduir significativament(p=0,004)el NFAE***independentment del temps d'evolució

Automated scoring of collaterals, blood pressure, and clinical outcome after endovascular treatment in patients with acute ischemic stroke and large-vessel occlusion

Altres ajuts: Ministerio de Ciencia e Innovación; Fondo Europeo de Desarrollo Regional (FEDER).Introduction: We aimed to determine whether the degree of collateral circulation is associated with blood pressure at admission in acute ischemic stroke patients treated with endovascular treatment and to determine its prognostic value. Methods: We evaluated patients with anterior large vessel occlusion treated with endovascular treatment in a single-center prospective registry. We collected clinical and radiological data. Automated and validated software (Brainomix Ltd., Oxford, UK) was used to generate the collateral score (CS) from the baseline single-phase CT angiography: 0, filling of ≤10% of the occluded MCA territory; 1, 11-50%; 2, 51-90%; 3, >90%. When dichotomized, we considered that CS was good (CS = 2-3), or poor (CS = 0-1). We performed bivariate and multivariable ordinal logistic regression analysis to predict CS categories in our population. The secondary outcome was to determine the influence of automated CS on functional outcome at 3 months. We defined favorable functional outcomes as mRS 0-2 at 3 months. Results: We included 101 patients with a mean age of 72.1 ± 13.1 years and 57 (56.4%) of them were women. We classified patients into 4 groups according to the CS: 7 patients (6.9%) as CS = 0, 15 (14.9%) as CS = 1, 43 (42.6%) as CS = 2 and 36 (35.6%) as CS = 3. Admission systolic blood pressure [aOR per 10 mmHg increase 0.79 (95% CI 0.68-0.92)] and higher baseline NIHSS [aOR 0.90 (95% CI, 0.84-0.96)] were associated with a worse CS. The OR of improving 1 point on the 3-month mRS was 1.63 (95% CI, 1.10-2.44) favoring a better CS (p = 0.016). Conclusion: In acute ischemic stroke patients with anterior large vessel occlusion treated with endovascular treatment, admission systolic blood pressure was inversely associated with the automated scoring of CS on baseline CT angiography. Moreover, a good CS was associated with a favorable outcome

Clinical and radiological characteristics and outcome of wake-up intracerebral hemorrhage

There is little information on the characteristics of patients with wake-up intracerebral hemorrhage (WU-ICH). We aimed to evaluate frequency and relevant differences between WU-ICH and while-awake (WA) ICH patients. This is a retrospective study of a prospective database of consecutive patients with spontaneous ICH, who were classified as WU-ICH, WA-ICH or UO-ICH (unclear onset). We collected demographic, clinical and radiological data, prognostic and therapeutic variables, and outcome [(neurological deterioration, mortality, functional outcome (favorable when modified Rankin scale score 0-2)]. From a total of 466 patients, 98 (25.8%) were classified as UO-ICH according to the type of onset and therefore excluded. We studied 368 patients (mean age 73.9 ± 13.8, 51.4% men), and compared 95 (25.8%) WU-ICH with 273 (74.2%) WA-ICH. Patients from the WU-ICH group were significantly older than WA-ICH (76.9 ± 14.3 vs 72.8 ± 13.6, p = 0.01) but the vascular risk factors were similar. Compared to the WA-ICH group, patients from the WU-ICH group had a lower GCS score or a higher NIHSS score and a higher ICH score, and were less often admitted to a stroke unit or intensive care unit. There were no differences between groups in location, volume, rate of hematoma growth, frequency of intraventricular hemorrhage and outcome. One in five patients with spontaneous ICH are WU-ICH patients. Other than age, there are no relevant differences between WU and WA groups. Although WU-ICH is associated with worse prognostic markers vital and functional outcome is similar to WA-ICH patients

The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage

Background and Purpose There are no generally accepted criteria for the etiologic classification of intracerebral hemorrhage (ICH). For this reason, we have developed a set of etiologic criteria and have applied them to a large number of patients to determine their utility. Methods The H-ATOMIC classification includes 7 etiologic categories: Hypertension, cerebral Amyloid angiopathy, Tumour, Oral anticoagulants, vascular Malformation, Infrequent causes and Cryptogenic. For each category, the etiology is scored with three degrees of certainty: Possible(3), Probable(2) and Definite(1). Our aim was to perform a basic study consisting of neuroimaging, blood tests, and CT-angio when a numerical score (SICH) suggested an underlying structural abnormality. Combinations of >1 etiologic category for an individual patient were acceptable. The criteria were evaluated in a multicenter and prospective study of consecutive patients with spontaneous ICH. Results Our study included 439 patients (age 70.8 ± 14.5 years; 61.3% were men). A definite etiology was achieved in 176 (40.1% of the patients: Hypertension 28.2%, cerebral Amyloid angiopathy 0.2%, Tumour 0.2%, Oral anticoagulants 2.2%, vascular Malformation 4.5%, Infrequent causes 4.5%). A total of 7 patients (1.6%) were cryptogenic. In the remaining 58.3% of the patients, ICH was attributable to a single (n = 56, 12.7%) or the combination of 2 (n = 200, 45.5%) possible/probable etiologies. The most frequent combinations of etiologies involved possible hypertension with possible CAA (H3A3, n = 38) or with probable CAA (H3A2, n = 29), and probable hypertension with probable OA (H2O2, n = 27). The most frequent category with any degree of certainty was hypertension (H1+2+3 = 80.6%) followed by cerebral amyloid angiopathy (A1+2+3 = 30.9%). Conclusions According to our etiologic criteria, only about 40% patients received a definite diagnosis, while in the remaining patients ICH was attributable to a single possible/probable etiology or to more than one possible/probable etiology. The use of these criteria would likely help in the management of patients with ICH.This work was supported by Ministery of Health-Instituto de Salud Carlos III: RETICS (Redes temáticas de Investigación Cooperativa) INVICTUS RD012/0014 (JM-F, PC-R, AM-D, LP-S, RD-M), FEDER (Fondo Europeo de Desarrollo Regional)

Correlation between clinical parameters characterising peri-implant and periodontal health : a practice-based research in Spain in a series of patients with implants installed 4-5 years ago

Objectives: To explore peri-implant health (and relation with periodontal status) 4-5 years after implant insertion. Study D esign: A practice-based dental research network multicentre study was performed in 11 Spanish centres. The first patient/month with implant insertion in 2004 was considered. Per patient four teeth (one per quadrant) showing the highest bone loss in the 2004 panoramic X-ray were selected for periodontal status assessment. Bone losses in implants were calculated as the differences between 2004 and 2009 bone levels in radiographs. Results: A total of 117 patients were included. Of the 408 teeth considered, 73 (17.9%) were lost in 2009 (losing risk: >50% for bone losses ?7mm). A total of 295 implants were reviewed. Eight of 117 (6.8%) patients had lost implants (13 of 295 implants installed; 4.4%). Implant loss rate (quadrant status) was 1.4% (edentulous), 3.6% (preserved teeth), and 11.1% (lost teeth) (p=0.037). The percentage of implant loss significantly (p<0.001) increased when the medial/distal bone loss was ?3 mm. The highest (p?0.001) pocket depths were found in teeth with ?5mm and implants with ?3mm bone losses, with similar mean values (?4mm), associated with higher rates of plaque index and bleeding by probing. Conclusions: The significant bi-directional relation between plaque and bone loss, and between each of these two parameters/signs and pocket depths or bleeding (both in teeth and implants, and between them) together with the higher percentage of implants lost when the bone loss of the associated teeth was ?3 mm suggest that the patient?s periodontal status is a critical issue in predicting implant health/lesion

Vocabulario de la sociedad civil, la ruralidad y los movimientos sociales en América Latina

El Vocabulario de la Sociedad Civil, la Ruralidad y los Movimientos Sociales en América Latina tiene como objetivo desarrollar vocablos relacionados con temas de gran trascendencia para la vida colectiva de la población Latinoamericana; pretende introducir a estudiantes, personas del ámbito académico y activistas en la comprensión de estas categorías de análisis. A través de la mirada de 70 especialistas que participaron en este vocabulario, es posible comprender muchos de los términos que se utilizan dentro de la investigación social y áreas relacionadas con las ciencias políticas, ambientales y rurales, a partir de una mayor explicación y detalle. Es por ello que se inserta este trabajo desde una mirada colectiva y amplia de los conceptos que se exponen. En este libro podrá encontrar las ideas de varios autores y autoras de distintas universidades, con una visión multi, inter y transdisciplinaria. El esfuerzo que se realizó para conjuntar varios términos y analizar su compleja red de interpretaciones, permitirá que este manuscrito pueda ser consultado por estudiantes, personas del ámbito científico-académico, y ciudadanía; porque contiene el estado del arte, la historia del paulatino avance de múltiples conceptos y su vigencia en el contexto actual

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Influencia del ingreso en una Unidad de Monitorización vídeo-EEG prolongada en función del tiempo de evolución de epilèpsia

Se desconoce si existe un tiempo de evolución límite a partir del cual ingresar en una UMVEEG* no suponga una mejoría del pronóstico del paciente epiléptico. El estudio analiza el efecto del ingreso en la UMVEEG sobre una serie de variables pronósticas (FC**, NFAE***, CVP****) en función del tiempo de evolución desde el diagnóstico. Analizamos epilépticos diagnosticados con certeza y pacientes con crisis psicógenas. Se estudiaron 135 pacientes(Edad:39+13,5años,Sexo(55,6%mujeres).Se obtuvo una mejoría significativa de FC**(p<0,001)y CVP****(p<0,005)en los grupos estudiados independientemente del tiempo de evolución.El tiempo de evolución determinó una respuesta diferencial sobre la reducción del NFAE***excepto para crisis psicógenas,en que hubo una reducción significativa(p=0,004)independientemente del tiempo de evolución.Actualment es desconeix si existeix un temps límit d´evolució a partir del qual l´ingrés a una UMVEEG*no millori el pronòstic del pacient epilèptic.L´estudi analitza l´efecte ingrés a UMVEEG* sobre una sèrie de variables pronòstic(FC**,NFAE***,QVP****)segons el temps d´evolució des del diagnòstic.Es van analitzar pacients epilèptics confirmats i pacients amb crisis psicògenes. Es van estudiar 135 pacients(Edat:39+13,5anys,Sexe(55,6%dones).Es va obtenir una milloria significativa de FC**(p<0,001)i CVP****(p<0,005)a tots els grups estudiats independentment del temps d’evolució.El temps d´evolució va determinar una resposta diferencial sobre la reducció del NFAE***amb l´excepció de crisis psicògenes,que varen reduir significativament(p=0,004)el NFAE***independentment del temps d´evolució

Hemorragia remota secundaria al tratamiento fibrinolítico endovenoso en el ictus isquémico: frecuencia, factores de riesgo y pronóstico

L'hemorràgia remota (RPH) és una complicació infreqüent i poc coneguda secundària al tractament amb fibrinòlisi endovenosa en pacients amb ictus isquèmic. Les principals hipòtesis relacionen la RPH amb l'angiopatia amiloide cerebral, i l'associen amb un mal pronòstic funcional i vital. L'objectiu va ser determinar la freqüència, característiques radiològiques, factors de risc i pronòstic de la RPH. Considerant la infreqüència de l'hemorràgia remota es va dissenyar un estudi multicèntric de pacients consecutius amb ictus isquèmic que van ser tractats amb fibrinòlisi endovenosa. La majoria de variables es van recollir de forma prospectiva des de l'any 2011 a través d'una base de dades online d'ictus agut de resposta obligatòria a Catalunya (registre d'el Sistema Online d'Informació de l'Ictus Agut). Es van incloure un total de 992 pacients, dels quals 34 (3.4%) pacients tenien RPH. Els principals factors de risc de les RPH van ser els marcadors indirectes per ressonància magnètica cerebral d'angiopatia amiloide cerebral (presència, càrrega i localització lobular de microsagnats, i la siderosis superficial) i les lesions isquèmiques silents. Els factors de risc de la RPH van variar segons la localització del sagnat. Les RPH de localització lobular es van associar al número, càrrega i localització lobular dels microsagnats, major grau de leucoaraiosi i la siderosis superficial. Les RPH profundes es van associar a crisis hipertensives (> 185 / 105mmHg) durant les 24 hores següents al tractament fibrinolític endovenós. En comparació a pacients sense transformació hemorràgica parenquimatosa, els pacients amb RPH van tenir major proporció de dependència funcional i major mortalitat als 90 dies de seguiment. En conclusió, el nostre estudi suggereix que les troballes de la ressonància magnètica cerebral poden ajudar a identificar aquells pacients amb ictus isquèmic agut i amb alt risc de RPH després de rebre fibrinòlisi endovenosa. El nostre estudi pot ajudar a una millor selecció de pacients candidats a rebre tractament amb fibrinòlisi endovenosa i pot obrir futures línies d'investigació amb la finalitat d'augmentar la seguretat del tractament fibrinolític.La hemorragia remota (rPH) es una complicación infrecuente y poco conocida secundaria al tratamiento con fibrinólisis endovenosa en pacientes con ictus isquémico. Las principales hipótesis relacionan la rPH con la angiopatía amiloide cerebral, y la asocian con un mal pronóstico funcional y vital. El objetivo fue determinar la frecuencia, características radiológicas, factores de riesgo y pronóstico de la rPH. Debido a la infrecuencia de la hemorragia remota se diseñó un estudio multicéntrico de pacientes consecutivos con ictus isquémico que fueron tratados con fibrinólisis endovenosa. La mayoría de variables se recogieron de forma prospectiva desde el año 2011 a través de una base de datos online de ictus agudo de cumplimentación obligatoria en Cataluña (registre del Sistema Online d'Informació de l'Ictus Agut). En el estudio se incluyeron un total de 992 pacientes. En total encontramos 34 (3.4%) pacientes con rPH. Los principales factores de riesgo de las rPH fueron los marcadores indirectos por resonancia magnética cerebral de angiopatía amiloide cerebral (presencia, carga y localización lobular de microsangrados; y la siderosis superficial) y las lesiones isquémicas silentes. Los factores de riesgo de la rPH variaron según la localización del sangrado. Las rPH de localización lobular se asociaron al número, carga y localización lobular de los microsangrados, mayor grado de leucoaraiosis y la siderosis superficial. Las rPH profundas se asociaron a crisis hipertensivas (>185/105mmHg) durante las 24 horas siguientes al tratamiento fibrinolítico endovenoso. En comparación a pacientes sin transformación hemorrágica parenquimatosa, los pacientes con rPH tuvieron mayor proporción de dependencia funcional y mayor mortalidad a los 90 días de seguimiento. En conclusión, nuestro estudio sugiere que los hallazgos de la resonancia magnética cerebral pueden ayudar a identificar aquellos pacientes con ictus isquémico agudo y con alto riesgo de rPH tras recibir fibrinólisis endovenosa. Nuestro estudio poadría ayudar a una mejor selección de pacientes candidatos a recibir tratamiento con fibrinólisis endovenosa y abre futuras líneas de investigación con la finalidad de aumentar la seguridad del tratamiento fibrinolítico.Remote hemorrhage (rPH) is an uncommon complication of intravenous thrombolysis in patients with acute ischemic stroke. Risk factors and outcome of rPH are unknown. Some authors suggest that rPH is associated with cerebral amyloid angiopathy, poor functional outcome and death. We aimed to investigate the frequency, radiological features, risk factors and outcome of rPH. Considering the low frequency of rPH, we designed a multicenter study of consecutive patients with acute ischemic stroke who were treated with intravenous thrombolysis. Most variables were collected prospectively from 2011 in a mandatory online database in Catalonia (registre del Sistema Online d'Informació de l'Ictus Agut). We included 992 patients and 34 of them (3.4%) had a rPH. The main risk factors for rPH were magnetic resonance imaging markers of cerebral amyloid angiopathy (presence, number and lobar localization of cerebral microbleeds; and superficial siderosis) and silent ischemic lesions. Risk factors of rPH were different according to the bleeding localization. Lobar rPH were associated with presence, number and lobar localization of cerebral microbleeds, superficial siderosis and higher degree of white matter disease. Deep rPH were associated with hypertensive episodes (>185/105mmHg) within the following 24 hours after intravenous thrombolysis. Compared to patients without any parenchymal hemorrhage, patients with rPH had worse functional outcome and higher mortality at 90 days of follow-up. In conclusion, our study suggests that magnetic resonance imaging findings may help to identify those patients with acute ischemic stroke and high risk of rPH after intravenous thrombolysis. In addition, our results can be useful for selecting patients for further studies to improve the safety of this therapy