[Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?] / Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?

Objective: To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design: Cohort, prospective and observational study. Setting: Post-intensive care multidisciplinary program. Patients or participants: Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions: Inclusion in the post-ICU multidisciplinary program. Main variables of interest: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results: One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Alcohol overuse and intracerebral hemorrhage: characteristics and long-term outcome.

BACKGROUND AND PURPOSE: Alcohol overuse (AOu) is considered an important risk factor for spontaneous intracerebral hemorrhage (ICH). The clinical and outcome characteristics of these patients (AOu-ICH) are not well known. METHODS: All patients with ICH admitted to a single university tertiary stroke center were prospectively studied from May 2005 to May 2015. Demographic profiles, radiologic characteristics and clinical outcomes of patients with acute ICH and previous AOu (>40 g/day or >300 g/week) were analyzed. RESULTS: During the study period, 555 patients with spontaneous primary ICH met the inclusion criteria. A total of 81 patients (14.6%) reported AOu (24.3% of men vs. 3.1% of women; P < 0.0001; mean age, 63 years old for AOu vs. 74 years old for non-AOu; P < 0.0001). Of the classic cardiovascular risk factors, only smoking was associated with AOu (63% vs. 12.2% of non-AOu; P < 0.0001). Initial severity and hematoma volume were similar in both groups, with no observed differences in stroke care or in-hospital medical complications. Patients with AOu had worse outcome (modified Rankin Scale score, 3-6 points) than patients without AOu at 3 months [odds ratio (OR), 2.50; 95% confidence interval (CI), 1.32-4.75; P = 0.005] and 12 months (OR, 2.47; 95% CI, 1.23-5.00; P = 0.011). A similar trend was observed at 5 years (OR, 2.48; 95% CI, 0.96-6.39; P = 0.059). CONCLUSIONS: Alcohol overuse was present in 14.6% of patients with ICH, who were predominantly male, smokers and a mean of 11 years younger than the non-AOu group. Despite a lack of differences in initial clinical severity, stroke care and early medical complications, patients with AOu had worse short- and long-term outcomes.

Sex-related differences in abdominal obesity impact on ischemic stroke risk.

BACKGROUND AND PURPOSE: The objective of our study was to evaluate sex differences in the impact of weight and abdominal obesity on the risk of ischemic stroke. METHODS: We included 388 patients with ischemic stroke (aged <75 years) assessed consecutively in our hospital and 732 controls matched by age and sex. Vascular risk factors and anthropometric data (waist circumference, weight and height) were recorded. The impact of three anthropometric variables [body mass index (BMI), waist circumference and waist to height ratio] on ischemic stroke risk was calculated. These variables were divided into quartiles for a comprehensive comparison between cases and controls, stratified by sex and adjusted in logistic regression by age and vascular risk factors. Further logistic regression using dummy variables was performed to evaluate the association between BMI-adjusted abdominal obesity and stroke risk. RESULTS: Increased BMI was not associated with increased stroke risk overall or in women, but was a protective factor in men [P = 0.03; odds ratio (OR), 0.59 (0.37-0.94)]. Abdominal obesity was a risk factor for stroke in women, in both waist circumference [P < 0.001; OR, 5.79 (3.10-10.85)] and waist to height ratio [P < 0.001; OR, 3.61 (1.99-6.54)] analyses, but was not significant in men. When considered independently of BMI, abdominal obesity was a risk factor in both sexes, but the strength of the association was significantly higher in women. CONCLUSIONS: Increased BMI was related to a lower risk of stroke in men. Abdominal obesity was associated with ischemic stroke in women. The impact of abdominal obesity on stroke risk differs by sex.

People with epilepsy receive more statins than the general population but have no higher cardiovascular risk: results from a cross-sectional study.

BACKGROUND AND PURPOSE: Epilepsy has been associated with cardiovascular comorbidity. Risk prediction equations are the standard tools in primary prevention of cardiovascular disease. Our aim was to compare the prevalence of cardiovascular risk factors (CVRFs), cardiovascular risk and statin use in people with epilepsy (PWE) and the general population. METHODS: The CVRFs and cardiovascular risk score were compared between 815 PWE from an outpatient register and 5336 participants from a general population cohort. RESULTS: People with epilepsy had less hypertension (43.3% vs. 50.4%), less diabetes (15.8% vs. 19.2%), more dyslipidemia (40.2% vs. 34.6%) and lower cardiovascular risk than the general population (P < 0.01). No etiology was associated with a worse CVRF profile or higher cardiovascular risk. Patients taking enzyme-inducing antiepileptic drugs (EIAEDs) had more dyslipidemia than the general population (41.6% vs. 34.6%) but similar cardiovascular risk. Independently of risk or CVRFs, PWE had 60% more probability of receiving statins than the general population. CONCLUSIONS: People with epilepsy had more dyslipidemia, related to EIAEDs, and lower cardiovascular risk but still took more statins than the general population. Physicians should use clinical judgement to decide on further treatment of CVRFs in PWE who are below the recommended risk threshold for treatment and should consider lipid abnormalities a potential side-effect of EIAEDs. Other therapy options may need to be evaluated before starting lipid-lowering treatment.

Comparison of mathematical models applied to f1 dairy sheep lactations in organic farm and environmental factors affecting lactation curve parameter.

THE OBJECTIVE OF THIS STUDY WAS TO COMPARE THE GOODNESS OF FIT OF FOUR LACTATION CURVE MODELS: Wood's Gamma model (WD), Wilmink (WL), and Pollott's multiplicative two (POL2) and three parameters (POL3) and to determine the environmental factors affecting the complete lactation curve of F1 dairy sheep under organic management. A total of 5,382 weekly milk yields records from 150 ewes, under organic management were used. Residual mean square (RMS), determination coefficients (R(2)), and correlation (r) analysis were used as an indicator of goodness of fit for each model. WL model best fitted the lactation curves as indicated by the lower RMS values (0.019), followed by WD (0.023), POL2 (0.025) and POL3 (0.029). The four models provided total milk yield (TMY) estimations that were highly correlated (0.93 to 0.97) with observed TMY (89.9 kg). The four models under estimated peak yield (PY), whereas POL2 and POL3 gave nearer peak time lactation estimations. Ewes lambing in autumn had higher TMY and showed a typical curve shape. Higher TMY were recorded in second and third lambing. Season of lambing, number of lambing and type of lambing had a great influenced over TMY shaping the complete lactation curve of F1 dairy sheep. In general terms WL model showed the best fit to the F1 dairy sheep lactation curve under organic management.

Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

OBJECTIVE: To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN: Cohort, prospective and observational study. SETTING: Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS: Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS: 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

[Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients]. / Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior.

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.

Description of stroke mimics after complete neurovascular assessment. / Estudio descriptivo de los stroke mimics después de un estudio neurovascular completo.

INTRODUCTION: A considerable percentage of events initially diagnosed as ischaemic stroke have non-cerebrovascular causes; these are called stroke mimics (SM). Currently available evidence about these events is heterogeneous and comes from studies with small samples. OBJECTIVE: The purpose of our study is to identify conditions that may present as SM, define their epidemiological and clinical characteristics, and determine the percentage of cases of SM treated with intravenous fibrinolysis. METHODS: Prospective study including all patients admitted to a tertiary university hospital between June 2005 and April 2015 with a diagnosis of acute stroke. We analysed demographic data, cardiovascular risk factors, time from code stroke activation to admission, stroke severity (NIHSS), final destination after discharge, degree of disability (mRS), and treatment. We compared SM and ischaemic strokes. We ruled out patients with intracranial haemorrhage, subarachnoid haemorrhage, or other causes of SM that may be detected on the baseline CT scan. RESULTS: Four hundred four of the 4,570 included patients (8.8%) were found to have SM. Patients with SM were younger (70.3 vs. 74, P<.0001), less likely to exhibit cardiovascular risk factors and atrial fibrillation (13 vs. 34%, P<.0001), scored lower on the NIHSS at baseline (2 vs. 4, P<.0001), and included fewer cases of aphasia (9.4 vs. 19.6%, P<.02) and dysphagia (1.2 vs. 17%, P<.0001) than patients with stroke. SM caused fewer code stroke activations (28 vs. 40%, P<.0001). Patients with SM required shorter hospital stays (4.9 vs. 7.8 days, P<.0001), were less frequently admitted to the stroke unit (47 vs. 60%, P<.0001) and more frequently discharged home (95 vs. 62%, P<.0001), and had better outcomes (mRS scores 0-2; 76 vs. 54%, P<.0001). Intravenous fibrinolysis was administered to 4.7% of these patients. Epileptic seizures were the most frequent cause of SM (26%). CONCLUSIONS: In our sample, 8.8% of all diagnoses of ischaemic stroke were SM. These events have different demographic, clinical, and prognostic characteristics; epilepsy is the most common aetiology. Despite receiving specialised emergency care, 19 patients with SM (4.7%) were treated with intravenous fibrinolysis.

Resultados preliminares del impacto del ejercicio físico sobre los trastornos respiratorios durante el sueño y metabolismo de la glucosa. Ensayo clínico aleatorizado / Preliminary results for the impact of physical exercise on sleep-related breathing disorders and glucose metabolism. Randomized clinical trial

OBJETIVO: Valorar en pacientes con síndrome de apnea obstructiva del sueño (SAOS) el efecto del ejercicio sobre la gravedad del mismo y el perfil del metabolismo de la glucosa. Análisis preliminar de los resultados del ensayo clínico. PACIENTES Y MÉTODOS: Ensayo clínico aleatorizado con grupos paralelos. Fueron incluidos 38 sujetos sedentarios con un SAOS moderado o grave, si había rechazo de tratamiento con CPAP. Los pacientes fueron aleatorizados al grupo de intervención (programa aeróbico de ejercicio físico) o a un grupo control (medidas habituales) En ambos grupos la actividad física fue medida mediante un podómetro. El diagnóstico se efectuó mediante poligrafía tras la cual se determinó en ayunas el perfil glucémico. Estas medidas se repitieron tras 6 meses de seguimiento. RESULTADOS: Los enfermos que finalizaron el protocolo, 16 en el grupo intervención y 19 en el grupo control, no mostraron diferencias en las características basales. Tras los 6 meses de evolución se observó en el grupo intervención una disminución en el índice de masa corporal y perímetro de cuello (p <0,05). En el grupo intervención disminuyó el índice de apneas-hipopneas/hora (24,9 vs 19,1; p = 0,244), aunque fue significativamente mayor en el índice de desaturaciones >3% (33,2/h vs 18,7/h, p = 0,044), en las cifras de glucemia (101,5 vs 90 mg/dL; p = 0,002) y con tendencia estadística en la insulinemia (12,55 vs 9,30 μU/mL; p = 0,079)CONCLUSIONES: En pacientes con SAOS moderado-grave un programa de ejercicio aeróbico muestra una mejoría clínicamente relevante en la gravedad del SAOS y un efecto positivo en el metabolismo de la glucosa

OBJECTIVE: To evaluate the effect of exercise on the severity of obstructive sleep apnea syndrome (OSAS) as well as the glucose metabolism profile in patients with OSAS. Preliminary analysis of the results of the clinical trial. PATIENTS AND METHODS: Randomized clinical trial with parallel groups. 38 sedentary subjects with moderate or severe OSAS were included if they had refused CPAP treatment. The patients were randomly assigned to the intervention group (aerobic physical exercise program) or a control group (normal measures). Physical activity was measured with a pedometer in both groups. The diagnosis was made using polygraphy after which the glucose profile was determined while fasting. These measurements were repeated after 6 months of follow-up. RESULTS: Patients who completed the protocol, 16 in the intervention group and 19 in the control group, did not show differences in baseline characteristics. After six months of follow-up, a decrease in body mass index and neck perimeter were observed in the intervention group (p <0.05). The apnea-hypopnea/hour index decreased in the intervention group (24.9 vs 19.1; p = 0.244), although the desaturation index >3% (33.2/h vs 18.7/h, p = 0.044) and blood glucose levels (101.5 vs 90 mg/dL; p = 0.002) were significantly higher and there was a statistical insulinemia trend (12.55 vs 9.30 μU/mL; p = 0.079). CONCLUSIONS: In patients with moderate-severe OSAS, an aerobic exercise program shows a clinically relevant improvement in OSAS severity and a positive effect on glucose metabolism

Preliminary results from the Mexican national telemedicine network.

A national telemedicine network was established in Mexico, based on satellite transmission. Six remote hospitals were connected during the first phase in 1997. The network applications included distance learning and administration. In addition, 476 clinical consultations were carried out in the first six months (to March 1998). Clinical problems were solved in the teleconsultation in 159 cases (33%). The patient was transferred in 217 cases (46%). The 16 most common specialties at the six remote sites accounted for 274 teleconsultations, and cardiology and orthopaedics accounted for just over half of all teleconsultations. One of the six remote sites accounted for 41% of the teleconsultations.

[Development of a canine model of chronic progressive right ventricular hypertension]. / Desarrollo de un modelo canino de hipertensión ventricular derecha crónica progresiva.

INTRODUCTION: Several animal models of right ventricle hypertension (RVH) have been produced through pulmonary artery banding with linen, tygon or teflon. Nevertheless few devices attempting a progressive, step by step graduated chronic development of RVH have been reported. The present study describes the results in our animal model of chronic RVH. MATERIAL AND METHODS: We designed a software programmed to obtain hemodynamic data and installed a small occlusive hydraulic device (OHD) at the pulmonary artery trunk producing a raise in the right ventricular systolic pressure (RVSP); this pressure can be modified externally through the OHD. We studied 12 healthy mongrel dogs (18 to 28 kg of weight) in the course of 6 months. Hemodynamic measurements were performed at different RVSP at two months intervals; (Baseline, 40 mmHg and 60 mmHg). RESULTS: The software was useful to analyze several hemodynamic variables at each RVSP. At 60 mmHg, the end diastolic pressure of the right ventricle (RVEDP) increased from 4.2 +/- 0.4 mmHg to 13.2 +/- 1.1 mmHg, p < 0.000, accompanied with a fall in cardiac output adjusted to the dogs weight from 0.16 +/- 0.03 L/min/kg to 0.09 +/- 0.01 L/min/kg, p > 0.000. Also an increase of the end diastolic pressure of the left ventricle (LVEDP) from 7.4 +/- 0.8 mmHg to 16.3 +/- 2.8 mmHg, p < 0.000, was observed. RVSP was maintained in chronic condition and the intraclass correlation coefficient was 0.83, P < 0.005. CONCLUSIONS: Right ventricular chronic hypertension is created. The device is useful and reliable to maintain chronic increments of RVSP. The software permits a versatile analysis.

Impact of an outpatient cardiac rehabilitation program on clinical and analytical variables in cardiovascular disease.

PURPOSE: The aim of the study was to determine the effect of lifestyle changes in patients participating in a cardiac rehabilitation program. METHODS: Patients with cardiovascular disease (N = 59) were enrolled in cardiac rehabilitation, which included nutritional and exercise interventions. All patients completed the program, but only 44 attended the reassessment after 12 months because of work reasons or lack of time or interest. RESULTS: Ergometry before and after cardiac rehabilitation showed significant differences in exercise tolerance time (5.2 ± 1.8 minutes vs 7.1 ± 2.1 minutes; P< .001), metabolic equivalents (6.5 ± 1.8 vs 8.8 ± 2.2; P< .001), and the Börg rating of perceived exertion scale (12 ± 1.8 points vs 13.7 ± 1.6 points; P= .005). At the end of the intervention program, significant improvements were seen in body weight (82.6 ± 15.2 kg vs 80.8 ± 14.3 kg; P< .001), waist circumference (100.3 ± 12.4 cm vs 98.0 ± 11.0 cm; P= .002), and levels of fasting glucose (126.5 ± 44.6 mmol/L vs 109.6 ± 24.8 mmol/L; P< .001), low-density lipoprotein cholesterol (2.7 ± 0.9 mmol/L vs 2.5 ± 0.8 mmol/L; P= .033), and C-reactive protein (5.1 ± 8.7 µg/mL vs 4.1 ± 2.6 µg/mL; P= .008), as well as in adherence to a healthy diet as estimated by the Trichopoulou questionnaire score (7.9 ± 2.3 vs 10.6 ± 1.5; P< .001). Twelve months later, however, many of these benefits had either remained stable or worsened. CONCLUSIONS: Cardiac rehabilitation is an appropriate program for the improvement of clinical and analytical variables, such as functional capacity, carbohydrate and lipid metabolism, anthropometric measures, and diet. However, 12 months later, many of these benefits either remained stable or worsened.

Estudio descriptivo de los stroke mimics después de un estudio neurovascular completo / Description of stroke mimics after complete neurovascular assessment

Introducción: Un porcentaje de casos diagnosticados inicialmente como infartos isquémicos son de causa no cerebrovascular o stroke mimics (SM). Los datos publicados al respecto son heterogéneos y, generalmente, con cohortes pequeñas. Objetivo: Nuestro objetivo es establecer qué enfermedades cursan como SM, definir sus características epidemiológicas y clínicas e identificar el porcentaje de casos tratados con fibrinólisis. Métodos: Registro prospectivo de los eventos considerados cerebrovasculares desde junio del 2005 a abril del 2015, analizando datos demográficos, factores de riesgo cardiovascular, activación de Código Ictus e ingreso, severidad (NIHSS), destino al alta, morbilidad (mRS) y tratamiento recibido. Se han comparado los ictus isquémicos con los SM. Se excluyeron las hemorragias intracraneales, subaracnoideas y las causas de SM detectables en la TC inicial. Resultados: Sobre 4.570 casos, 404 (8,8%) son SM. Los pacientes con SM son más jóvenes (70,3 vs. 74 años, p < 0,0001), tienen menos factores de riesgo cardiovascular y fibrilación auricular (13 vs. 34%, p < 0,0001), una menor puntuación en NIHSS (2 vs. 4, p < 0,0001) y menos afasia (9,4 vs. 19,6%, p < 0,02) y disfagia (1,2 vs. 17%, p < 0,0001). En los SM se activan menos códigos ictus (28 vs. 40%, p < 0,0001) y requieren menos días de ingreso (4,9 vs. 7,8; p<0,0001) y menos ingresos en la unidad de ictus (47 vs. 60%, p < 0,0001). Los SM son dados de alta a domicilio con mayor frecuencia (95 vs. 62%, p < 0,0001) y con menor discapacidad (mRS 0-2; 76 vs. 54%, p < 0,0001). Un 4,7% de los SM recibieron fibrinólisis. La primera causa de SM fueron las crisis epilépticas (26%). Conclusiones: Los SM supusieron el 8,8% de los ingresos con diagnóstico inicial de ictus isquémico. Los SM tienen características demográficas, clínicas y pronósticas diferentes, siendo la epilepsia la etiología más frecuente. Pese a recibir atención urgente especializada, 19 pacientes (4,7%) fueron trataron con fibrinólisis

Introduction: A considerable percentage of events initially diagnosed as ischaemic stroke have non-cerebrovascular causes; these are called stroke mimics (SM). Currently available evidence about these events is heterogeneous and comes from studies with small samples. Objective:The purpose of our study is to identify conditions that may present as SM, define their epidemiological and clinical characteristics, and determine the percentage of cases of SM treated with intravenous fibrinolysis. Methods: Prospective study including all patients admitted to a tertiary university hospital between June 2005 and April 2015 with a diagnosis of acute stroke. We analysed demographic data, cardiovascular risk factors, time from code stroke activation to admission, stroke severity (NIHSS), final destination after discharge, degree of disability (mRS), and treatment. We compared SM and ischaemic strokes. We ruled out patients with intracranial haemorrhage, subarachnoid haemorrhage, or other causes of SM that may be detected on the baseline CT scan. Results: Four hundred four of the 4,570 included patients (8.8%) were found to have SM. Patients with SM were younger (70.3 vs. 74, P <. 0001), less likely to exhibit cardiovascular risk factors and atrial fibrillation (13 vs. 34%, P < .0001), scored lower on the NIHSS at baseline (2 vs. 4, P<.0001), and included fewer cases of aphasia (9.4 vs. 19.6%, P < .02) and dysphagia (1.2 vs. 17%, P < .0001) than patients with stroke. SM caused fewer code stroke activations (28 vs. 40%, P < .0001). Patients with SM required shorter hospital stays (4.9 vs. 7.8 days, P < .0001), were less frequently admitted to the stroke unit (47 vs. 60%, P < .0001) and more frequently discharged home (95 vs. 62%, P < .0001), and had better outcomes (mRS scores 0-2; 76 vs. 54%, P <. 0001). Intravenous fibrinolysis was administered to 4.7% of these patients. Epileptic seizures were the most frequent cause of SM (26%). Conclusions: In our sample, 8.8% of all diagnoses of ischaemic stroke were SM. These events have different demographic, clinical, and prognostic characteristics; epilepsy is the most common aetiology. Despite receiving specialised emergency care, 19 patients with SM (4.7%) were treated with intravenous fibrinolysis

Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos? / Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

Objetivo Describir las secuelas al mes del alta hospitalaria en pacientes que precisaron ingreso en Cuidados Intensivos por neumonía grave COVID-19 y analizar las diferencias entre los que recibieron terapia exclusivamente con oxigenoterapia con alto flujo con respecto a los que precisaron ventilación mecánica invasiva (VMI). Diseño Estudio de cohorte, prospectivo y observacional. Ámbito Consulta multidisciplinar pos Cuidados Intensivos. Pacientes o participantes Pacientes que superaron el ingreso en la Unidad de Cuidados Intensivos (UCI) por neumonía grave COVID-19 desde abril 2020 hasta octubre 2021. Intervenciones Inclusión en el programa multidisciplinar pos UCI. Variables de interés principales Secuelas motoras, sensitivas, psicológicas/psiquiátricas, respiratorias y nutricionales tras el ingreso hospitalario. Resultados Se incluyeron 104 pacientes. 48 pacientes recibieron oxigenoterapia nasal de alto flujo (ONAF) y 56 VMI. Las principales secuelas encontradas fueron la neuropatía distal (33,9% VMI vs. 10,4% ONAF); plexopatía braquial (10,7% VMI vs. 0% ONAF); disminución de fuerza de agarre: mano derecha 20,67 kg (± 8,27) en VMI vs. 31,8 kg (± 11,59) en ONAF y mano izquierda 19,39 kg (± 8,45) en VMI vs. 30,26 kg (± 12,74) en ONAF; y balance muscular limitado en miembros inferiores (28,6% VMI vs. 8,6% ONAF). Las diferencias observadas entre ambos grupos no alcanzaron significación estadística en el estudio multivariable. Conclusiones Los resultados obtenidos tras el estudio multivariable sugieren no existir diferencias en cuanto a las secuelas físicas percibidas al mes del alta hospitalaria en función de la terapia respiratoria empleada, ya fuera ONAF o ventilación mecánica prolongada, si bien son precisos más estudios para poder obtener conclusiones al respecto (AU)

Objective To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design Cohort, prospective and observational study. Setting Post-intensive care multidisciplinary program. Patients or participants Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions Inclusion in the post-ICU multidisciplinary program. Main variables of interest Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions (AU)

Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior / Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients

El perfil del paciente que más frecuentemente sufre amputaciones de miembro inferior suele ser uno de edad avanzada y alta comorbilidad. Los médicos rehabilitadores precisamos en la valoración de estos pacientes de herramientas objetivas que predigan los resultados de los programas de protetización para aumentar la seguridad del paciente y eficiencia de los programas de rehabilitación protésica. Dada la necesidad de actualizar el conocimiento científico en este campo hemos realizado una revisión de la literatura con el objetivo de definir una propuesta de herramientas que faciliten la toma de decisiones en la indicación de rehabilitación protésica en estos pacientes. Para la realización de este trabajo se ha realizado una estrategia de búsqueda bibliográfica utilizando las bases de datos científicas PubMed, Web of Science, Scopus y Cochrane Library. La calidad de los artículos seleccionados se ha valorado según las herramientas propuestas por CASPe.(AU)

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.(AU)

Recomendaciones sobre rehabilitación cardíaca en la cardiopatía isquémica de la Sociedad de Rehabilitación Cardio-Respiratoria (SORECAR) / Recommendations of the Cardio-Respiratory Rehabilitation Society (SORECAR) on cardiac rehabilitation in ischemic heart disease

La cardiopatía isquémica supone la mayor causa de muerte en España y en el mundo occidental. El programa de rehabilitación cardíaca engloba todas las medidas para realizar prevención secundaria en estos pacientes y mejorar la morbimortalidad. Es un programa eficaz, pero su implementación es escasa y variable, siendo inferior al 5% en España, por lo que se debería priorizar estrategias para facilitar la realización de estos programas. Un grupo de expertos fue nombrado por la Sociedad Española de Rehabilitación Cardio-Respiratoria (SORECAR) para realizar una revisión de todas las evidencias disponibles en rehabilitación cardíaca y elaborar un documento aplicándolo a la práctica clínica. El resultado ha sido la elaboración final de un protocolo de actuación en rehabilitación cardíaca, con instrucciones o recomendaciones a modo de resumen. Contiene aspectos sobre rehabilitación cardíaca para disminuir la variabilidad entre dichas Unidades y crear las bases para una adecuada acreditación de Unidades de Rehabilitación Cardíaca (AU)

Ischemic heart disease is the largest cause of death in Spain and the Western world. Cardiac rehabilitation programs encompass all the measures necessary for secondary prevention in these patients and to improve morbidity and mortality. These programs are effective, but their implementation is low and variable, being less than 5% in Spain. Consequently, priority should be given to strategies that facilitate the implementation of these programs. A group of experts was appointed by the Cardio-Respiratory Rehabilitation Society (SORECAR) to review all the available evidence on cardiac rehabilitation and apply it to develop a clinical practice document. The end result was the development of a protocol for cardiac rehabilitation, with instructions or summarized recommendations. The document discusses aspects of cardiac rehabilitation that reduce variation among these units and provides a basis for proper accreditation of cardiac rehabilitation units (AU)

Infarto-reinfarto: estudio comparativo clínico-funcional en un programa de rehabilitación cardiaca / Infarction-reinfarction: A clinical-functional comparative study within a cardiac rehabilitation program

Introducción: Los pacientes con reinfarto de miocardio pertenecen al grupo de alto riesgo en los programas de rehabilitación cardiaca (PRC). Objetivos: Evaluar si existen diferencias basales entre pacientes infartados y reinfartados que acuden a un PRC. Analizar su respuesta tras el programa. Métodos: Estudio longitudinal retrospectivo tipo casos controles en pacientes con reinfarto de miocardio frente a pacientes con un único infarto. Muestra: 152 pacientes (76 casos y 76 controles). Periodo de estudio: del 1 de enero del 2005 al 31 de octubre del 2012. Intervención PRC en Hospital Virgen de la Victoria, Málaga. Variables: factores de riesgo cardiovascular, nivel de estrés, situación emocional, profesión, hábito de ejercicio, tipo de personalidad, percepción de salud, ergometría y ecocardiografía. Análisis estadístico: programa SPSS-15.0. Resultados: Basalmente, se observan diferencias estadísticamente significativas en casos frente a controles en: hábito de ejercicio (OR = 1,31 [1,01-1,69]), percepción de salud buena (15,2%/64%), ansiedad (66,7%/38%) depresión (46%/25%) y perímetro abdominal > 102 cm (OR = 1,8 [1,16-2,78]). Tras el programa, los pacientes re-IAM mejoran de forma significativa en el hábito de ejercicio (p = 0,00), percepción de salud buena (p = 0,00), estrés laboral (p = 0,00), ansiedad (p = 0,00), depresión (p = 0,00) y perímetro abdominal (p = 0,00). En cuanto a la cardiopatía, mejoran la función ventricular (p = 0,00) y la ergometría (0,9 METS p = 0,00; tiempo: 32,79 s, p = 0,00). Conclusiones: Los pacientes con reinfarto parten de peor hábito de ejercicio, peor percepción de salud, mayor ansiedad-depresión y obesidad central. La respuesta al programa de rehabilitación es positiva en ambos grupos, con cambios más favorables en pacientes reinfartados en cuanto a aspectos funcionales y psicológicos (AU)

Introduction: Patients with myocardial infarction recurrence belong to the group of patients at high risk in cardiac rehabilitation programs (CRP). Objectives: To assess whether there are baseline differences between single myocardial infarction patients and recurrent infarction patients. To analyze changes after a CRP. Methods: A longitudinal, retrospective, case-control study was conducted in patients with a single event of myocardial infarction compared to patients with recurrent infarction. Sample: The sample was made up of 76 cases and 76 controls. Study period: 1 January 2005 to 31 October 2012. Intervention: CRP at Virgen de la Victoria Hospital from Malaga. Study variables were cardiovascular risk factors, stress level, emotional status, profession, exercise habit, personality type, perceived health, exercise test, echocardiography. Statistical analysis was done using the SPSS-15.0. Results: At baseline statistically significant differences were observed in cases versus controls: exercise habit [OR 1.31 (1.01-1.69)], good health perception (15.2%/64%), anxiety (66,7%/38%) depression (46%/25%), abdominal circumference > 102 cm (OR: 1.8 [1.16-2.78]). After CRP, patients with infarction recurrence improved significantly in exercise habit (P=.00), health perception (P=0.00) work stress perception (P=0.00), anxiety (P=00), depression (P=00) and abdominal circumference (P=0.00), systolic function improves (P=.00) and ergometry (0.9 METS P=0.00 and 32.79 seconds P=0.00). Conclusions: Patients with recurrent myocardial infarction started the program with worse exercise habit, worse perceived health, central obesity, increased anxiety and depression. Changes after rehabilitation program were positive in both groups, with more favorable changes in recurrent infarction patients regarding functional and psychological aspects (AU)

[Pulmonary function in chronic ischemic cardiopathy]. / Estudio de la función pulmonar en la cardiopatía isquémica crónica.

Twenty patients with heart disease were prospectively studied. Seven of them had an old myocardial infarction and thirteen, ischemic symptoms without infarction. Pulmonary function was studied focusing on small airway disease and gas exchange abnormalities. Our results showed that a mild degree of abnormality exists as reflected by bronchial obstruction with origin in small airways, V/Q disturbed and hypoxemia. In 88% these seem to be related to left ventricular disfunction. Twenty four hours after pulmonary function test all patients underwent left heart catheterization with coronarography and ventriculography.

[Alveolar-arterial oxygen gradient in cardiopulmonary patients breathing ambient air at rest and during exercise]. / Estudio del gradiente A-a de oxígeno en pacientes cardiopulmonares, respirando aire ambiente, en reposo y en ejercicio.

The alveolar to arterial difference of oxygen [(A-a)DO2] depends on variables such as ventilation, cardiac output, respiratory exchange ratio and arterial PO2. The arterial PO2 itself depends on the ventilation to perfusion ratio (V/Q) pulmonary shunt, (a-v) O2 difference, and the metabolic status of the patient. When the alveolar-ventilation is normal, the (A-a)DO2 reflects gas exchange abnormalities and when the alveolar-ventilation is increased, the (A-a)DO2 can increase because of a decrease in PaCO2. The factors capable of altering the alveolar to arterial oxygen difference were investigated in ninety patients with pulmonary disease: (pulmonary embolism, lung fibrosis and chronic obstructive lung disease), both at rest and during exercise. At rest when alveolar ventilation was increased, the (A-a)DO2 broadened due to the decrease in PaCO2. During exercise the (A-a)DO2 also increased and the PaCO2 was not significantly modified, therefore admixture it is the result of an increase in the proportion of venous. The difference between the mixed venous and arterial PO2 decreased due to alveolar hypoventilation reducing in consequence the (A-a)DO2. We conclude that in the group studied the increase in the (A-a)DO2 is mainly due to V/Q imbalance at rest and during exercise.

[Continuous spectrophotometry as a method to study pulmonary edema in isolated canine pulmonary lobe]. / Espectrofotometría continua como método para el estudio del edema pulmonar en una preparación de lóbulo pulmonar canino aislado.

The aim of this paper is to introduce the spectrophotometric method to the study of pulmonary edema in isolated ex-vivo canine pulmonary lobe preparation. This spectrophotometric method is based on the on-line measure of light transmission in a column of blood, that is proportional to hematocrit. A second light is used to follow Evans blue dyed proteins. With this method we were able to measure the amount of edema in 10 isolated canine lobes. Both the filtration and reflection coefficient of the membrane as well as the characteristics of the filtrate could be calculated. The filtration coefficient was 0.6 +/- 0.4 ml/min (1.3 +/- 0.9 ml/min/100 g pulmonary, tissue) at maximum capillary pressure and the reflection coefficient was 0.53 +/- 0.07. With the spectrophotometric method we have the capability to study different aspects of lung edema formation. This method has the advantage of being exact and independent from pressure and volume induced vascular changes. It also allows the measurement of solute transport.