Tiempos de llegada de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad / Arrival times of patients with stroke to a public hospital

Background: Stroke is a time-dependent emergency. Most patients with acute ischemic stroke are excluded from reperfusion therapies due to late consultation. Aims: To estimate the arrival times of patients with stroke to the Emergency Room (ER) of a public hospital. To identify factors associated with early consultation. Material and Methods: A convenience sample, 583 patients aged 71 ± 13 years (55% males) consulting for stroke at an emergency room was analyzed in terms of delay between onset of symptoms and arrival to the ER, demographics and etiology of stroke. Results: The admission diagnoses were ischemic stroke in 76%, intracerebral hemorrhage in 12%, transient ischemic attack in 9% and subarachnoid hemorrhage in 3%. The median time of arrival was 8 hours and 11 minutes after the onset of symptoms. Nineteen percent of consultations for ischemic stroke occurred within 3 hours of symptom onset, and 38% within 6 hours. In the logistic regression analysis, having an address near the hospital and the severity of stroke were associated with early consultation with a combined odds ratio of 5.97 (95% confidence intervals 3.23-11.04). Conclusions: There were significant differences in the arrival times of patients with stroke. Only a low proportion of patients with ischemic stroke consulted within the window for reperfusion therapies. Severe strokes and living near the hospital were associated with early consultation.

Factores asociados a llegada y evaluación precoz de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad / Factors associated with early arrival and evaluation of stroke patients in a regional tertiary hospital

Resumen Antecedentes: El ataque cerebrovascular (ACV) es una urgencia tiempo-dependiente. La mayoría de los pacientes con infarto cerebral quedan excluidos de las terapias de reperfusión por consultar tardíamente. Se desconocen los factores asociados a llegada y evaluación precoz de pacientes con ACV agudo en nuestra población. Objetivos: Identificar los factores asociados, llegada y evaluación precoz de pacientes con ACV agudo. Pacientes y Métodos: Muestra por conveniencia de las consultas por ACV realizadas en el Turno N° 1, del SU del Hospital Dr. Hernán Henríquez de Temuco, entre enero de 2016 y diciembre de 2017. El análisis estadístico se realizó con el software STATA 14.0. Resultados: Se registraron 584 consultas por ACV. La mediana del tiempo de llegada fue de 8 h y 11 min. La mediana del tiempo para la evaluación por neurólogo(a) fue de 66 min. Tener domicilio en Temuco-Padre Las Casas y una mayor severidad del ACV se asociaron a consultar precozmente con un OR = 5,97 (3,23-11,04). Para evaluación dentro de una hora, las variables severidad, llegada en ambulancia y consulta en menos de 3 h, fueron estadísticamente significativas, con un OR combinado de 10,86 (IC 95%: 5,15-22,94). Conclusiones: Los factores más fuertemente asociados a llegada y evaluación precoz incluyen residir en comunas cercanas al hospital y presentar síntomas más severos de ACV. Se sugiere implementar estrategias para aumentar el grado de reconocimiento de síntomas de ACV y para disminuir las barreras de acceso a hospitales que traten a este tipo pacientes.

Introduction: Stroke is a time-dependent emergency. The majority of patients with Acute Ischemic Stroke are excluded from reperfusion therapies due to late consultation. The factors associated with early arrival and evaluation of patients with acute stroke in our population are unknown. The aim of the study was to identify factors associated with early arrival and evaluation of patients with acute stroke. Methods: A convenience sample of the stroke consultations made during shift # 1 at the ER between January 2016 and December 2017, was analyzed. Results: There were 584 stroke consultations in the period. 55.1% were men. The median time of arrival was 8 hours and 11 minutes. The median time for evaluation by neurologist was 66 minutes. Having an address in Temuco-Padre Las Casas and the severity of stroke was associated with early consultation with a combined OR of 5.97 (CI 95% 3.23-11.04). For an evaluation within one hour, in the logistic regression model, the variables severity, arrival in ambulance and consultation in less than 3 hours were statistically significant with a combined OR of 10.86 (CI 95% 5.15-22.94). Conclusions: The factors associated with early consultation and evaluation include residing in communes near the hospital and presenting more severe symptoms of stroke. It is suggested to implement strategies to increase the degree of recognition of stroke symptoms and to reduce barriers to access hospitals that treat patients with stroke.

Tiempos de atención de urgencias neurológicas en un hospital regional de alta complejidad / Waiting times for neurological emergencies in an emergency room

Background: Neurological emergencies constitute 10-15% of medical emergencies. Doctor Hernán Henríquez Aravena Hospital has in house neurologists present permanently at the Emergency Room since July 2013. Aim: To estimate the waiting times for neurological consultations; to compare the waiting times between neurovascular (UV) and non-vascular (UNV) emergencies; and to compare the waiting times of two prioritization (triage) models. Material and Methods: A convenience sample of the consultations made during shift # 1 at the emergency room between January and December 2016, was analyzed. Results: There were 859 consultations in the period, 570 for UNV and 289 for UV. Mean age of consultants was 57 years and 52% were women. The median time for having an evaluation by a neurologist was 106 min (132 and 81 min for UNV and UV respectively). Twenty seven percent of patients were evaluated in less than one hour (23 and 36% of UNV and UV, respectively). The change of the prioritization model decreased the waiting time by 81 and 32 min for UNV and UV, respectively. Conclusions: There were significant differences in waiting times between neurovascular and non-vascular emergencies. Most patients were not evaluated in less than 60 minutes. The change in the initial stratification model was associated with a significant reduction in the waiting times for neurological emergencies.

Evolución del protocolo de trombolisis endovenosa en ataque cerebrovascular isquémico agudo / Intravenous thrombolysis for acute ischemic stroke. A four years’ experience in a Chilean public hospital

Background: Intravenous thrombolysis (IVT) with alteplase (tissue plasminogen activator) is the standard pharmacological treatment in acute ischemic stroke (AIS), reducing disability in patients. Aim: To report the results a thrombolysis protocol during four years in a regional public hospital. Material and Methods: Data from 106 consecutive patients aged 68 ± 13 years (57% men) who were treated with IVT, from May 2012 until April 2016, was analyzed. Results: The median door-to-needle time was 80 minutes (interquartile range = 57-113). The median National Institute of Health Stroke Scale (NIHSS) scores on admission and at discharge were was 11.5 and 5 points respectively. At discharge, 27% of hospitalized patients had a favorable outcome (n = 99), defined as having 0 to 1 points in the modified Rankin scale. Symptomatic intracerebral hemorrhage and mortality rates were 5.7 and 13.1%, respectively. The thrombolysis rate rose from 0.7% in 2012 to 6% in 2016. Conclusions: The implementation of 24/7 neurology shifts in the Emergency Department allowed us to increase the amount and quality of IVT in our hospital, as measured by the rate of thrombolysis and by process indicators such as door-to-needle time.

Análisis de las consultas neurológicas en el Servicio de Urgencia de un hospital terciario / Analysis of the neurologic consultations in the Emergency Deparment at a tertiary hospital

Introducción: Las urgencias neurológicas constituyen el 10-15% de las urgencias médicas. Los principales motivos de consulta son la enfermedad cerebrovascular, crisis epilépticas y cefalea. El Hospital Dr. Hernán Henríquez A. (HHHA) comenzó con neurólogos en el Servicio de Urgencia Adultos (SUA) en horario hábil, en abril de 2011. En julio de 2013 se iniciaron turnos con neurólogo 24/7, presenciales en el SUA. Objetivo: Describir el perfil clínico de las consultas neurológicas en el SUA de nuestro centro. Método: Muestra noprobabilística, por conveniencia, de las consultas realizadas en el Turno N°1, del SUA-HHHA, entre octubre de 2013 y septiembre de 2014. El análisis estadístico se realizó con el software STATA 12.0. Resultados: Se registraron 1.080 consultas en el período. 51,2% fueron mujeres. Promedio de edad = 58 años (DE = 20,2). El 36,7% de las consultas se realizó en horario inhábil. Los diagnósticos más frecuentes fueron infarto cerebral (30,7%), epilepsia (15%) y cefalea (11,3%). El 34,6% de los pacientes fue dado de alta; 25,8% se hospitalizó en el Servicio de Medicina Interna; 21% fue derivado a otros hospitales; 12% fue derivado a otros especialistas y 5,7% ingresó a la Unidad de Paciente Crítico. 0,83% de los pacientes falleció en el SUA. Conclusiones: Los principales motivos de consulta neurológica en nuestro Servicio de Urgencia fueron enfermedades cerebrovasculares, epilepsia y cefalea. Debido a que más de un tercio de las consultas ocurre en horario inhábil, se justifica el sistema de neurología 24/7 presencial en el Servicio de Urgencia.

Introduction: Neurological emergencies constitute 10-15% of medical emergencies. The main reasons for consultation are cerebrovascular disease, seizures and headaches. Dr. Hernan Henriquez Hospital (HHHA) began with neurologists in the Adult Emergency Service in April 2011. In July 2013 24/7 neurology shifts at emergency room were added. Objective: To describe the clinical profile of neurologic consultations at our emergency center. Method: A convenience sample of consultations on shift No. 1, at the Adult Emergency Service HHHA between October 2013 and September 2014. The statistical analysis was performed using STATA 12.0 software. Results: 1,080 consultations were recorded in theperiod. 51.2% were women. Mean age = 58 years (SD = 20.2). 36.7% of consultations are conducted in a non-business hour. The most frequent diagnoses were stroke (30.7%), epilepsy (15%) and headache (11.3%). 34.6% ofpatients were discharged; 25.8% were hospitalized in the Internal Medicine dept; 21% were referred to other hospitals; 12% were referred to other specialists and 5.7% were admitted to Critical Patient Unit. 0.83% of the patients died in the SUA. Conclusions: The main reasons for neurological consultation at our Emergency Service were cerebrovascular disease, epilepsy and headaches. Because more than a third of consultations occur on non-schedule hours, neurology system 24/7 shifts are justified in the Emergency Service.

Beneficios de los ácidos grasos poliinsaturados de cadena larga n-3 en la enfermedad por hígado graso no alcohólico / Benefits of n-3 long-chain polyunsaturated fatty acids in non-alcoholic fatty liver disease

La enfermedad por hígado graso no alcohólico (EHGNA) se asocia comúnmente con las características clínicas del síndrome metabólico como la obesidad, resistencia a la insulina y dislipidemia. La importancia clínica se debe a su elevada prevalencia (30% de la población general) y su amplio espectro de daño histológico que va desde la esteatosis simple generalmente no progresiva, a la esteatohepatitis no alcohólica, que puede conducir a cirrosis, carcinoma hepatocelular, e insuficiencia hepática. En la actualidad, se han caracterizado diferentes factores que conllevan a esta enfermedad hepática, destacándose principalmente el alto contenido de ácidos grasos libres y la resistencia a insulina. El exceso de ácidos grasos libres puede desencadenar lipotoxicidad hepática originada por un alto consumo de ácidos grasos saturados, ácidos grasos trans y carbohidratos, así como por un aumento de los radicales libres y del estrés del retículo endoplásmico. En lo que concierne a los ácidos grasos poliinsaturados de cadena larga n-3 (AGPICL n-3), se han atribuido múltiples beneficios para la salud humana. Los AGPICL n-3 EPA y DHA tienen efectos protectores en la salud cardiovascular y en la funcionalidad e integridad del sistema nervioso central. Actualmente el uso nutricional de ambos ácidos grasos es cada vez más amplio, atribuyendo sus efectos positivos no solamente al tratamiento de las enfermedades cardiovasculares y neurodegenerativas, sino también considerándolos una alternativa eficaz en el manejo de nutricional de la EHGNA. El presente trabajo analiza el uso potencial de los AGPICL n-3 en la prevención y manejo nutricional de la EHGNA.

Nonalcoholic fatty liver disease (NAFLD) is commonly associated with the clinical features of the metabolic syndrome including obesity, insulin resistance and dyslipidemia. NAFLD. Is of clinical relevance because its high prevalence (30% of the general population) and broad spectrum of histological damage, ranging from simple steatosis that is generally non progressive, to nonalcoholic steatohepatitis which can lead to cirrhosis, hepatoce-llular carcinoma, and liver failure. At present, different factors have been identified that lead to this liver disease, highlighting the high content of free fatty acids and insulin resistance. In this regard, excess of free fatty acids caused by a high intake of sa-turated fatty acids, trans fatty acids and of carbohydrates as well the increased formation free radicals that stress the endoplasmic reticulum, can trigger liver lipotoxicity. Regarding fatty acids, n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) have been associated to many benefits for human health. n-3 LCPUFA, such as EPA and DHA, have protective roles in cardiovascular health and in the functionality and integrity of the central nervous system. Currently, the possible therapeutic uses of these fatty acids is expanding, attributing their positive effects not only for the treatment of cardiovascular and neurodegenerative diseases, but also seeing it as an effective alternative in the management of NAFLD. The present review analyzes the potential use of n-3 LCPUFA in the treatment and protection of NAFLD.

Fosfolípidos de origen marino: una nueva alternativa para la suplementación con ácidos grasos omega-3 / Phospholipids from marine origin: a new alternative for supplementing omega-3 fatty acids

Nutritional deficit of omega-3 long-chain polyunsaturated fatty acids (omega-3 LCPUFA), mainly eicosapentaenoic acid and docosahexaenoic acid, in the western population due the low consumption of marine products is actually a matter of concern. The classical alternative is the development of products with fish oil containing triglycerides rich in omega-3 LCPUFA: fish oil as such, encapsulated, microencapsulated or nanoencapsulated. However, independently of such procedures, reversion of taste and odor is always produced, avoiding its consumption. Phospholipids from marine origin are at present a more interesting alternative and of major nutritional impact than triglycerides for supplement omega-3 LCPUFA. These natural products have high concentration of omega-3 LCPUFA, mainly docosahexaenoic acid, are also more stable to oxidation and of higher bioavailability than triglycerides, and in addition provide other nutrients having nutritional benefits. However, at present industrial alternatives to obtain marine phospholipids are limited and probably subjected to future regulations or restrictions. This work analyzes the main advantages of marine phospholipids compared to triglycerides as source of omega-3 LCPUFA, the main sources for these nutrients, such as oils obtained from crustaceous, fish meal or by-products from aquaculture, and the future alternatives to provide the pharmaceutical, nutraceutical and food industry phospholipids from marine origin rich in omega-3 LCPUFA.

El déficit nutricional de ácidos grasos omega-3 de cadena larga (AGPICL omega-3), especialmente de ácido eicosapentaenoico y ácido docosahexaenoico en la población occidental debido al bajo consumo de productos del mar, es motivo actual de preocupación. La alternativa más clásica es el desarrollo de productos que contengan aceite de pescado conteniendo triglicéridos con alto contenido de AGPICL omega-3 en diferentes modalidades; aceite como tal, encapsulado, microencapsulado, o nanoencapsulado. Sin embargo, en cualquiera de estas modalidades, siempre se produce la reversión del olor y sabor, impidiendo así su consumo. Actualmente, los fosfolípidos de origen marino representan una alternativa mucho más interesante y de mayor impacto nutricional para suplementar AGPICL omega-3. Estos productos naturales presentan altas concentraciones de AGPICL omega-3, principalmente de ácido docosahexaenoico, son más estables a la oxidación, de mayor biodisponibilidad que los triglicéridos y además aportan otros nutrientes derivados de su estructura, también beneficiosos para la salud. Sin embargo, las alternativas para la obtención de fosfolípidos marinos a nivel industrial son actualmente pocas y posiblemente sujetas a control o restricción futura. Este trabajo analiza las principales ventajas de los fosfolípidos marinos en relación a los triglicéridos derivados del aceite de pescado como aporte de AGPICL omega-3, las principales fuentes de estos nutrientes, como lo son algunos aceites obtenidos de crustáceos, la harina de pescado o los subproductos de la acuicultura, y las futuras alternativas de desarrollo para proveer a la industria farmacéutica, nutracéutica y de alimentos AGPICL omega-3 a partir de fosfolípidos marinos.

Ácidos grasos poliinsaturados de cadena larga ω-3 y enfermedad cardiovascular / N-3 long chain polyunsaturated fatty acids and cardiovascular disease

ω-3 Long-chain polyunsaturated fatty acids (ω-3 LCPUFA) of marine origin, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) present in fatty fish or blue fish, have different beneficial effects on human health especially at the cardiovascular level. From the late observations in the 1960s, basic, clinic and epidemiological evidence have established significant cardio protective effects for these fatty acids in reducing the morbidity and mortality from the disease. The cardiovascular benefits of ω-3 LCPUFA of marine origin are targeted on various inflammatory and metabolic pathways which are regulated by these fatty acids, particularly in the vascular endothelium, the inflammatory response and cardiac cells activity. EPA and DHA are transformed into a variety of eicosanoids and docosanoids which have strong anti-inflammatory actions antagonizing the proinflammatory actions of ω-6 LCPUFA. The different molecular mechanisms by which these fatty acids exert cardio protective effects and the clinical and epidemiological evidence demonstrating the reduction in the morbidity and mortality from cardiovascular diseases are discussed.

Los ácidos grasos poliinsaturados de cadena larga ω-3 (AGPICL ω-3) de origen marino, principalmente el ácido eicosapentaenoico (EPA) y el ácido docosahexaenoico (DHA), presentes especialmente en pescados grasos o azules, producen diversos efectos saludables en la salud humana, especialmente a nivel cardiovascular. Desde la década de 1960 han surgido múltiples evidencias básico-clínicas y epidemiológicas que establecen que estos ácidos grasos ejercen un significativo efecto cardioprotector, produciendo una disminución de la morbilidad y de la mortalidad por enfermedad cardiovascular. El EPA y el DHA son transformados eicosanoides y docosanoides que tienen poderosos efectos antiinflamatorios y que antagonizan el efecto proinflamatorio de AGPICL ω-6. Los beneficios a nivel cardiovascular atribuidos a los AGPICL ω-3 de origen marino se centran, principalmente, en la regulación de vías metabólicas de la respuesta inflamatoria en el endotelio vascular y en la actividad de las células cardíacas. Esta revisión discute las diferentes evidencias metabólicas, clínicas y epidemiológicas que demuestran como el consumo de AGPICL ω-3 de origen marino puede reducir la morbilidad y mortalidad por enfermedad cardiovascular.

Alimentos funcionales, nutraceúticos y foshu: ¿vamos hacia un nuevo concepto de alimentación? / Functional foods, nutraceuticals and foshu: are we going to a novel food concept?

The increase of economic development and life expectancy of humans has aroused concerns about the health and nutrition in important groups of the population. These modifications have stimulated the development of functional foods (FF), nutraceuticals (NT) and FOSHU (Food with Specific Health Uses) in many countries around the world, mainly in those of greater development. FF are foods to which one or more healthy component has been added without changing its characteristics. The definition of FF is now incorporated into the food normative of many countries. NT is a more complex concept, because it is not referred to a food but to components of a food that can be ingested in amounts greater than those frequently consumed. NT are not pharmaceuticals since they have no therapeutic action although they may have preventive properties. FOSHU is a concept of foods with exclusive medical actions developed in Japan. This review discusses the significance of these new food concepts establishing their origins, potentialities, differences and future projections of these types of foods or food components.

El mayor desarrollo económico y las mayores expectativas de vida de la población, motivan una mayor preocupación por la salud y la alimentación a importantes grupos de la población. Estos cambios han motivado el desarrollo de los llamados alimentos funcionales (AF) y de los nutracéuticos (NT) y de los FOSHU (Food with Specific Health Uses) en varios países del mundo, principalmente en aquellos de mayor desarrollo económico. AF y NT son conceptos diferentes. Los AF son alimentos a los cuales se les ha incrementado o incorporado un componente cuyo consumo representa un beneficio de salud establecido, sin que el producto deje de ser un alimento. La definición de AF está ahora incorporada en la normativa alimentaria de varios países. NT es un concepto más complejo, ya que no se trata de alimentos pero sí de componentes de estos que se pueden consumir en mayores concentraciones que las habituales. Tampoco son medicamentos ya que no se les atribuye propiedades terapéuticas pero sí potencialmente preventivas. FOSHU es un concepto de alimentación con fines medicinales exclusivo de Japón. Este trabajo revisa el significado de estos nuevos conceptos alimentarios estableciendo sus orígenes, potencialidades, diferencias y las futuras proyecciones de este tipo de alimentos o componentes alimentarios.

Factores de riesgo cardiovascular en estudiantes universitarios / Cardiovascular risk factors of college students

College students are in a key life stage for the adoption of lifestyles that will be practiced in the family, society and work. During this period, students gain greater autonomy and take responsibility for their own care. University time becomes a critical step in the development of lifestyles. There is a high prevalence of risk factors for non-communicable diseases in university students such as pre-hypertension especially in men and hypercholesterolemia in women. Other risk factors include smoking, physical inactivity, overweight, obesity, low fruit and vegetable consumption, and high consumption of saturated fats. Some differences of cardiovascular risk factors have been found according to gender, year of career and faculty where students attend. It is recommended to consider these differences when we design and perform educational interventions to achieve greater assertiveness and effectiveness. This article reviews the evidence about cardiovascular risk factors in university students according to gender, year of career and faculty where students attend, following the model proposed by Cecchini et al and according to the Framingham study.

Los estudiantes universitarios se encuentran en una etapa del ciclo vital clave para la adopción de estilos de vida, que practicarán en el ámbito familiar, social y laboral. En este periodo los estudiantes adquieren mayor autonomía y asumen la responsabilidad de su autocuidado, por lo cual se convierte en una etapa crítica para el desarrollo de sus estilos de vida. Existe una alta prevalencia de factores de riesgo de enfermedades crónicas no transmisibles en los universitarios, entre los que destacan pre-hipertensión especialmente en hombres y la hipercolesterolemia en mujeres. También el tabaquismo, sedentarismo, sobrepeso, obesidad, bajo consumo de frutas y verduras, y alto consumo de grasas saturadas. Se encontraron diferencias en los factores de riesgo cardiovascular de acuerdo al género, curso y facultad de los estudiantes. Se recomienda consideran estas diferencias al diseñar y realizar intervenciones educativas para lograr una mayor asertividad y efectividad. El presente artículo revisa la evidencia sobre los factores de riesgo cardiovascular en estudiantes universitarios de acuerdo al género, curso y facultad, según el modelo propuesto por Cecchini y cols. y al estudio de Framingham.

Prevalencia de consumo de drogas en estudiantes universitarios que cursan primer y cuarto año / Prevalence of tabacco, alcohol and marijuana consumption among university students

Background: University students are especially vulnerable towards substance abuse Aim: To describe and compare drug consumption in students of a Chilean university who attended first and fourth year of studies, according to gender and faculty. Material and Methods: A representative, stratified and proportional sample of305 students was randomly chosen by faculty, career, grade and gender during2009. The consumption of alcohol, tobacco and illicit drugs was evaluated using an anonymous survey. Results: Students from health care faculties had the lower prevalence of consumption of tobacco, alcohol, tobacco-alcohol and marijuana, during the first and fourth year. Education area and social sciences faculties had the highest prevalence of consumption. Fourth year students had higher rates of consumption than their first year counterparts. Females had significantly lower rates of alcohol and marijuana consumption. Conclusions: Alcohol, tobacco and marijuana consumption was higher among students from education and social sciences faculties and those attending the fourth year of studies.