RESUMO
INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and its incidence and prevalence increase with age, as does cognitive impairment (CI). DEVELOPMENT: Prospective observational studies have shown that AF can significantly increase the risk of stroke, which is an important cause of CI, but it has also been established that the association between the two diseases may be independent of stroke and other shared risk factors. However, the pathophysiological mechanism linking the two entities is still unclear as it is likely to be a multifactorial process (cardioembolic silent strokes, proinflammatory states and cerebral hypoperfusion), with preliminary evidence of a link between atrial cardiomyopathy without AF and cognitive dysfunction. The association between AF and CI raises the possibility that therapeutic interventions aimed at managing this arrhythmia may prevent or delay the onset of CI. Anticoagulation has been shown to significantly reduce the risk of stroke in patients with AF and, with it, the risk of CI, but the effect of other therapeutic interventions such as rhythm and rate control is inconclusive. CONCLUSIONS: AF and CI are an important health problem worldwide and the demographic trend predicts exponential growth of both conditions in the coming years. Therefore, it seems necessary to increase our knowledge of the pathophysiological mechanisms related to them in order to establish effective preventive strategies.
TITLE: Fibrilación auricular y deterioro cognitivo: una revisión narrativa.Introducción. La fibrilación auricular (FA) es la arritmia más común en la práctica clínica y su incidencia y prevalencia aumentan con la edad, como ocurre con el deterioro cognitivo (DC). Desarrollo. Estudios observacionales prospectivos han demostrado que la FA puede aumentar significativamente el riesgo de sufrir un ictus, y éste es una causa importante de DC, pero también se ha establecido que la asociación entre ambas enfermedades puede ser independiente del ictus y otros factores de riesgo compartidos. Sin embargo, el mecanismo fisiopatológico que relaciona ambas entidades todavía no se conoce con exactitud, ya que es probable que se trate de un proceso multifactorial (ictus silentes cardioembólicos, estados proinflamatorios e hipoperfusión cerebral), y existe evidencia preliminar de una relación entre la miocardiopatía auricular sin FA y la disfunción cognitiva. La asociación entre FA y DC plantea la posibilidad de que las intervenciones terapéuticas dirigidas al manejo de esta arritmia puedan prevenir o retrasar la aparición del DC. La anticoagulación ha demostrado reducir de forma significativa el riesgo de ictus en pacientes con FA y, con ello, el riesgo de DC, pero el efecto de otras intervenciones terapéuticas, como el control del ritmo y de la frecuencia, no es concluyente. Conclusiones. La FA y el DC constituyen un importante problema de salud a nivel mundial, y la tendencia demográfica augura el crecimiento exponencial de ambas entidades en los próximos años. Por ello, parece necesario ampliar el conocimiento respecto a los mecanismos fisiopatológicos que las relacionan con el objetivo de establecer estrategias preventivas eficaces.
Assuntos
Fibrilação Atrial , Disfunção Cognitiva , Acidente Vascular Cerebral , Humanos , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Disfunção Cognitiva/psicologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Fatores de Risco , Incidência , Estudos Observacionais como AssuntoRESUMO
INTRODUCTION: The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS: A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS: Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION: The key informant survey identified the foreseeable changes in neurological care after the pandemic.
Assuntos
Infecções por Coronavirus , Pesquisas sobre Atenção à Saúde , Doenças do Sistema Nervoso/terapia , Neurologia/tendências , Pandemias , Pneumonia Viral , Pessoal Administrativo/psicologia , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Ensaios Clínicos como Assunto/métodos , Consenso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Gerenciamento Clínico , Aconselhamento a Distância , Previsões , Departamentos Hospitalares/organização & administração , Humanos , Doenças do Sistema Nervoso/diagnóstico , Exame Neurológico , Neurologia/métodos , Neurologia/organização & administração , Pandemias/prevenção & controle , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Espanha/epidemiologiaRESUMO
OBJECTIVE: To evaluate long-term quality of life (QoL) in patients who have experienced a stroke and to analyse differences in QoL between sexes. METHODS: We conducted a descriptive, cross-sectional, observational study to gather sociodemographic variables and risk factors; data were also obtained on QoL, mood, and functional status using validated scales. The study was approved by our centre's ethics committee. RESULTS: Our final sample included 124 patients; mean age was 71.30±11.99 years. In the QoL study, the EuroQol-5D dimensions in which participants presented most problems were anxiety/depression (66.7%) and pain/discomfort (62.2%). We found significant inter-sex differences in the dimensions of mobility and usual activities (P=.016 and P=.005, respectively). Women also achieved substantially poorer EuroQoL-5D index values than men (0.45±0.45 vs. 0.65±0.38; P=.013). QoL was found to be associated with dependence for the activities of daily living (r=0.326; P=.001) and depressed mood (r=-0.514; P<.0001). According to the predictive model for the EQ-5D index, 72% of the score on QoL items is explained by functional status, dependence for the activities of daily living (basic and instrumental), and depressed mood. Being married, in contrast, seems to be a protective factor. CONCLUSION: Stroke survivors have poor long-term QoL; this is more marked in women than in men, especially in the dimensions of mobility and usual activities.
Assuntos
Caracteres Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Atividades Cotidianas , Adulto , Afeto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Estado Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Epilepsy is a chronic disease with high prevalence. Its impact in the quality of life is influenced by factors like disease characteristics, comorbidities, stigma perception and treatment adherence. AIM: To assess the quality of life, the social stigma and the treatment adherence of patients with epilepsy in our area. PATIENTS AND METHODS: Descriptive, observational and cross-sectional study. Sociodemographic and clinical data were collected. We analyzed data on quality of life (QUOLIE-10), social stigma and treatment adherence through different questionnaires. RESULTS: 40 patients were studied. The mean age was 42.43 ± 17.20 years, and the onset of epilepsy was 25.88 ± 16.81 years. 55% were women. The score in the quality of life questionnaire was 19.28 ± 8.03 points in men and 17.00 ± 7.69 for women, this difference being not significant. There were also no significant differences for social stigma, with a mean of 11.50 ± 13.47 points in men and 6.00 ± 10.36 points for women (p = 0.152). According to the treatment adherence questionnaire (Morisky-Green), 70% of the patients studied were compliant with the treatment. CONCLUSIONS: Patients with epilepsy in our environment have a good quality of life, probably related to good treatment adherence and compliance. There is low perceived social stigma but people with epilepsy still trend to hide their condition.
TITLE: Valoracion de la calidad de vida, estigma social y adhesion al tratamiento en pacientes con epilepsia del Area de Salud de Caceres: estudio transversal.Introduccion. La epilepsia es una enfermedad cronica, con elevada prevalencia. La repercusion de la epilepsia en la calidad de vida de las personas que la padecen se ve influida por factores como las caracteristicas de la enfermedad, la presencia de comorbilidad, la percepcion de estigma social y la adhesion al tratamiento. Objetivo. Valorar la calidad de vida, el estigma social y la adhesion al tratamiento de pacientes con epilepsia de nuestra area. Pacientes y metodos. Estudio descriptivo, observacional y transversal. Se recogieron datos sociodemograficos y clinicos. Analizamos datos sobre la calidad de vida (Quality of Life in Epilepsy-10), el estigma social y la adhesion al tratamiento a traves de diferentes cuestionarios. Resultados. Se estudio a 40 pacientes, con una media de edad de 42,43 ± 17,2 años y una media de edad de inicio de la epilepsia de 25,88 ± 16,81 años. El 55% fueron mujeres. La puntuacion en el cuestionario sobre calidad de vida fue de 19,28 ± 8,03 puntos para los hombres y 17,00 ± 7,69 para las mujeres, y esta diferencia no fue significativa. Tampoco se observaron diferencias significativas para el estigma social: media de 11,50 ± 13,47 puntos para los hombres y 6,00 ± 10,36 para las mujeres (p = 0,152). Segun el cuestionario de adhesion terapeutica (Morisky-Green), el 70% de los pacientes fue cumplidor del tratamiento. Conclusiones. Los pacientes con epilepsia tienen una buena calidad de vida, que creemos atribuible a la buena adhesion y el cumplimiento del tratamiento. Se detecta una baja percepcion de estigma social, pero los pacientes tienden a ocultar el diagnostico.
Assuntos
Epilepsia/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Qualidade de Vida , Estigma Social , Adulto , Área Programática de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Autorrelato , EspanhaRESUMO
Pompe disease or glycogen storage disease type II (OMIM: 232300) is a lysosomal storage disorder resulting from a partial or total lack of acid alphaglucosidase, which may produce muscle weakness, gait abnormalities, or even death by respiratory failure. In the last decade, autophagy has been proposed as a mechanism involved in the severity of symptoms related to this disorder and as a potential therapeutic target to alleviate disease progression. This review summarizes the relationship between autophagy and Pompe disease, including what information has been recently discovered and what remains unclear.
Assuntos
Autofagia , Doença de Depósito de Glicogênio Tipo II/patologia , Animais , Modelos Animais de Doenças , Terapia de Reposição de Enzimas , Doença de Depósito de Glicogênio Tipo II/metabolismo , Doença de Depósito de Glicogênio Tipo II/terapia , Humanos , Proteínas Associadas aos Microtúbulos/metabolismo , Mitocôndrias/metabolismo , Músculo Esquelético/metabolismo , alfa-Glucosidases/genética , alfa-Glucosidases/metabolismoRESUMO
INTRODUCTION: Evidence supports that admitting patients with stroke during different hospital work periods is related to distinct outcomes. We aimed to analyse outcomes in patients according to the period and time of admission to the stroke unit. METHODS: Retrospective study. For purposes of data analysis, patients were grouped according to the following time periods: a) day of the week, b) period of the year, c) shift. We analysed demographic characteristics, stroke type and severity, and the percentage undergoing thrombolysis in each group. The measures used to evaluate early outcomes were the National Institutes of Health Stroke Scale (NIHSS), neurological complications (NC), and in-hospital mortality. Functional outcome at 3 months was determined using the modified Rankin scale. RESULTS: The stroke unit admitted 1250 patients. We found NC to be slightly more frequent for weekend admissions than for weekday admissions, but this trend does not seem to have influenced in-hospital mortality. Regarding functional outcome at 3 months, 67.0% of weekday vs. 60.7% of weekend admissions were independent (P=.096), as were 65.5% of patients admitted during the academic months vs. 63.5% of those admitted during summer holidays (P=.803). We identified no significant differences in 3-month mortality linked to the day or period of admission; however, for the variable 'shift', 13.2% of the patients died during the morning shift, 11.5% during the afternoon shift, and 6.0% during the night shift (P=.017). We identified a trend toward higher rates of thrombolysis administration on weekdays, during the morning shift, and during the academic months. CONCLUSIONS: Time of admission to the stroke unit did not affect early outcomes or functional independence at 3 months.
Assuntos
Gerenciamento Clínico , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Unidades Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: Evidence suggests that intima-media thickness (IMT) and plasma homocysteine (Hcy) levels are associated with one another, and both appear to be related to cognitive dysfunction. However, no connection between both factors taken together and mild cognitive impairment (MCI) has been established. This study analysed potential relationships between IMT, Hcy and MCI. METHODS: We included 105 patients with MCI and 76 controls with no history of vascular disease. All participants underwent laboratory analyses, a carotid ultrasound, and clinical and neuropsychological assessment. We used the Mantel-Haenszel test (MHT), ANCOVA and multiple linear regression models (MLRM) to examine any associations between IMT, Hcy and cognitive state. RESULTS: The MHT revealed a significant association between IMT and risk of MCI (z = 4.285, P < 0.0001). The OR for the upper quartile vs the lower quartile was 5.12 (95% CI: 2.12-12.36). MHT also showed a clear association between Hcy levels and risk of MCI (z = 3.01, P = 0.003). OR for the upper vs the lower quartile was 3.39 (95% CI: 1.41-8.12). Additionally, we found a correlation between IMT and Hcy (r = 0.162, P = 0.032). CONCLUSIONS: Our results suggest that there is a connection between IMT, Hcy levels and presence of amnestic MCI in a population with no history of clinically manifest atherosclerosis. Furthermore, there is also a connection between the IMT and Hcy levels themselves.
Assuntos
Doenças das Artérias Carótidas/epidemiologia , Espessura Intima-Media Carotídea , Disfunção Cognitiva/epidemiologia , Homocisteína/sangue , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/patologia , Estudos de Casos e Controles , Disfunção Cognitiva/sangue , Disfunção Cognitiva/patologia , Feminino , Humanos , MasculinoRESUMO
INTRODUCTION: Stroke patients have a high risk of presenting complications, the appearance of which can condition the prognosis of the stroke. We studied the frequency and impact of the onset of several different complications on the early and mid-term prognosis of these patients. PATIENTS AND METHODS: We conducted an observation-based study of the patients admitted to a stroke unit. The complications that occurred while hospitalised were recorded, a distinction being drawn between neurological and medical complications. The study examined their influence, according to the subtype of stroke, on intra-hospital mortality and that at 90 days, as well as on the functional situation at 90 days, by analysing the clinical factors that are predictive for the appearance of complications. RESULTS: The sample consisted of 847 patients. Altogether, 29.5% of the patients presented complications, which were more frequent in haemorrhagic stroke (50.5% versus 26.6%; p < 0.0001). The most usual complications were of a neurological nature (21%). For both subtypes, the presence of complications was associated with a higher rate of mortality both in hospital (2.1% versus 12.6%; p < 0.0001) and at 90 days (5.7% versus 29.6%; p < 0.0001), and a lower probability of independence at 90 days (72.9% versus 30.4%; p < 0.0001). The severity of the stroke on admission revealed itself as the most powerful predictor of the onset of any type of complication. CONCLUSIONS: The appearance of complications during the acute phase of the stroke has an adverse influence on mortality and on the functional prognosis. The identification of predictive factors could reduce the impact upon the progress of acute stroke patients.
TITLE: Impacto de las complicaciones neurologicas y medicas sobre la mortalidad y situacion funcional de pacientes con ictus agudo.Introduccion. Los pacientes con ictus presentan un elevado riesgo de presentar complicaciones. Su aparicion puede condicionar el pronostico del ictus. Estudiamos la frecuencia y el impacto de la aparicion de diversas complicaciones en el pronostico precoz y a medio plazo en estos pacientes. Pacientes y metodos. Estudio observacional de los pacientes ingresados en una unidad de ictus. Se registraron las complicaciones durante su estancia, distinguiendose entre complicaciones neurologicas y medicas. Se estudio la influencia de estas segun subtipo de ictus en la mortalidad intrahospitalaria y a los 90 dias, y en la situacion funcional a los 90 dias, analizandose los factores clinicos predictores para la aparicion de complicaciones. Resultados. Muestra de 847 pacientes. Un 29,5% de los pacientes presento complicaciones, que fueron mas frecuentes en el ictus hemorragico (50,5% frente a 26,6%; p < 0,0001). Las complicaciones mas habituales fueron las neurologicas (21%). Para ambos subtipos, la presencia de complicaciones se asocio a mayor mortalidad intrahospitalaria (2,1% frente a 12,6%; p < 0,0001) y a 90 dias (5,7% frente a 29,6%; p < 0,0001), y menor probabilidad de independencia a 90 dias (72,9% frente a 30,4%; p < 0,0001). La gravedad del ictus al ingreso se mostro como el predictor mas potente en la aparicion de cualquier tipo de complicacion. Conclusiones. La aparicion de complicaciones durante la fase aguda del ictus influye de forma adversa en la mortalidad y en el pronostico funcional. La identificacion de factores predictores podria disminuir el impacto sobre la evolucion del paciente con un ictus agudo.
Assuntos
Isquemia Encefálica/complicações , Hemorragia Cerebral/complicações , Mortalidade Hospitalar , Doença Aguda , Adulto , Idoso , Doenças Cardiovasculares/complicações , Complicações do Diabetes , Feminino , Unidades Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Prognóstico , Transtornos Respiratórios/complicações , Estudos Retrospectivos , Fatores de RiscoRESUMO
The highest risk of subsequent stroke after a TIA occurs within the first week after the index event. However, the risk of stroke recurrence (SR) remains high during the first year of follow-up. We studied the temporal pattern and predictors of SR (at 7 days and from 7 days to 1-year follow-up). Between April 2008 and December 2009, we included 1,255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). We determined the short-term (at 7 days) and long-term (from 8 days to 1 year) risk of SR. Patients who underwent short-term recurrence and long-term recurrence were compared with regard to clinical findings, vascular territories, and etiology. Enough information (clinical variables and extracranial vascular imaging) was assessed in 1,137 (90.6 %) patients. The 7-day stroke risk was 2.6 %. 32 (3.0 %) patients had an SR after 7-day follow-up. Multiple TIA (HR 3.50, 1.67-7.35, p = 0.001) and large artery atherosclerosis (HR 2.51, 1.17-5.37, p = 0.018) were independent predictors of early SR, whereas previous stroke (HR 1.40, 1.03-1.92, p = 0.034) and coronary heart disease (2.65, 1.28-5.50, p = 0.009) were independent predictors of late SR. Notoriously, 80 % of SR happened in the same territory of the index TIA at 7-day follow-up, whereas only 38 % during the long-term follow-up (p < 0.001). Different predictors of SR were identified throughout the follow-up period. Moreover, the ischemic mechanism differed in early and late stroke recurrences.
Assuntos
Ataque Isquêmico Transitório/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neuroimagem , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: Patients with acute stroke are more likely to survive and achieve independence if they are treated in a stroke unit. Available information in our setting is scarce. We analyse the outcomes of our patients on the basis of cumulative experience in a stroke unit. PATIENTS AND METHODS: A retrospective cohort study of patients admitted to a stroke unit. We differentiate between two groups according to the year of admission: group A (July 2007-December 2009) and group B (January 2010-December 2011), analysing early outcome based on the score on the National Institute of Health stroke scale and mortality at discharge, and medium-term outcome in terms of mortality and functional status according to the modified Rankin scale at three months. RESULTS: A total 1070 patients were included. There were no differences between groups with respect to favourable outcome (68.3% vs 63.9), hospital mortality (5.1% vs 6.6%), or 90-day mortality (12.8% vs 13.1%). The percentage of patients who were independent at 90 days was greater in group B (56.3% vs 65.5%, P=.03). In the multivariate analysis adjusted for stroke subtype and fibrinolytic therapy, the association between patient independence and admission period remained present. CONCLUSIONS: The probability of functional independence in our patients increased alongside accumulated experience in our stroke unit with no differences in mortality.
Assuntos
Acidente Vascular Cerebral , Idoso , Feminino , Mortalidade Hospitalar , Unidades Hospitalares/organização & administração , Humanos , Masculino , Análise Multivariada , Neurologia/organização & administração , Estudos Retrospectivos , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Terapia Trombolítica/métodos , Resultado do TratamentoRESUMO
INTRODUCTION: The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. MATERIAL AND METHODS: The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24h/7d, nurse ratio, protocols), SU bed ratio/100,000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. RESULTS: We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. CONCLUSION: Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives.
Assuntos
Recursos em Saúde/provisão & distribuição , Disparidades em Assistência à Saúde/organização & administração , Acidente Vascular Cerebral/terapia , Procedimentos Endovasculares/métodos , Hospitais , Humanos , Neurologia , Qualidade da Assistência à Saúde , Espanha , Inquéritos e Questionários , Terapia Trombolítica/métodos , Recursos HumanosAssuntos
Malformação de Arnold-Chiari/complicações , Riso/fisiologia , Transtornos de Enxaqueca/etiologia , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Encéfalo/patologia , Humanos , Ibuprofeno/uso terapêutico , Pressão Intracraniana/fisiologia , Imageamento por Ressonância Magnética , Masculino , Dor/etiologiaRESUMO
INTRODUCTION: Patients with stroke associated with non-valvular atrial fibrillation (NVAF) are a specific group, and their disease has a considerable social and economic impact. The primary objective of the CONOCES study, the protocol of which is presented here, is to compare the costs of stroke in NVAF patients to those of patients without NVAF in Spanish stroke units from a societal perspective. MATERIALS AND METHODS: CONOCES is an epidemiological, observational, naturalistic, prospective, multicentre study of the cost of the illness in a sample of patients who have suffered a stroke and were admitted to a Spanish stroke unit. During a 12-month follow-up period, we record sociodemographic and clinical variables, score on the NIH stroke scale, level of disability, degree of functional dependency according to the modified Rankin scale, and use of healthcare resources (hospitalisation at the time of the first episode, readmissions, outpatient rehabilitation, orthotic and/or prosthetic material, medication for secondary prevention, medical check-ups, nursing care and formal social care services). Estimated monthly income, lost work productivity and health-related quality of life measured with the generic EQ-5D questionnaire are also recorded. We also administer a direct interview to the caregiver to determine loss of productivity, informal care, and caregiver burden. RESULTS AND CONCLUSIONS: The CONOCES study will provide more in-depth information about the economic and clinical impact of stroke according to whether or not it is associated with NVAF.
Assuntos
Fibrilação Atrial/complicações , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/etiologia , Efeitos Psicossociais da Doença , Humanos , Estudos Prospectivos , EspanhaRESUMO
INTRODUCTION: Type 1 neurofibromatosis is the most common neurocutaneous syndrome. Most published case series study the paediatric population. MATERIAL AND METHODS: Cross-sectional study of cases of type 1 neurofibromatosis from neurology departments that were recorded in a database. We analysed the different clinical variables providing the diagnosis as well as demographic and neuroradiological variables. RESULTS: We found a total of 31 patients with type 1 neurofibromatosis. The mean age was 28.9 years and 58.4% were women. Subjects with unidentified bright objects (UBOs) were younger than those without them (22.45±8.22 years vs. 32.5±10.64; P=.011). In contrast, subjects with neurofibromas were older than those without them (30.56±10.68 years vs. 18.25±4.34; P=.032). No sex differences were found in the presentation of clinical or radiological variables. Seven patients (22.6%) had tumours; 3 were optic pathway gliomas (1 bilateral), 3 were plexiform neurofibromas, and 1 was a pilocytic astrocytoma in the brainstem. CONCLUSIONS: Patients with type 1 neurofibromatosis presented both peripheral neurofibromas and tumorous lesions of the central nervous system. Subjects with neurofibromas were older than those who did not present them, while subjects with UBOs were younger than those without such lesions.
Assuntos
Neurofibromatose 1/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Neurofibromatose 1/diagnóstico por imagem , Neurorradiografia , Adulto JovemRESUMO
INTRODUCTION: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. MATERIAL AND METHODS: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. RESULTS: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7 days a week in 2009). There were 3 hospitals offering clinical telemedicine services. CONCLUSIONS: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS.