Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain.

BACKGROUND AND PURPOSE: Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS: This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS: A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION: A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.

Inflammation, edema and poor outcome are associated with hyperthermia in hypertensive intracerebral hemorrhages.

BACKGROUND AND PURPOSE: The deleterious effect of hyperthermia on intracerebral hemorrhage (ICH) has been studied. However, the results are not conclusive and new studies are needed to elucidate clinical factors that influence the poor outcome. The aim of this study was to identify the clinical factors (including ICH etiology) that influence the poor outcome associated with hyperthermia and ICH. We also tried to identify potential mechanisms involved in hyperthermia during ICH. METHODS: We conducted a retrospective study enrolling patients with non-traumatic ICH from a prospective registry. We used logistic regression models to analyze the influence of hyperthermia in relation to different inflammatory and endothelial dysfunction markers, hematoma growth and edema volume in hypertensive and non-hypertensive patients with ICH. RESULTS: We included 887 patients with ICH (433 hypertensive, 50 amyloid, 117 by anticoagulants and 287 with other causes). Patients with hypertensive ICH showed the highest body temperature (37.5 ± 0.8°C) as well as the maximum increase in temperature (0.9 ± 0.1°C) within the first 24 h. Patients with ICH of hypertensive etiologic origin, who presented hyperthermia, showed a 5.3-fold higher risk of a poor outcome at 3 months. We found a positive relationship (r = 0.717, P < 0.0001) between edema volume and hyperthermia during the first 24 h but only in patients with ICH of hypertensive etiologic origin. This relationship seems to be mediated by inflammatory markers. CONCLUSION: Our data suggest that hyperthermia, together with inflammation and edema, is associated with poor outcome only in ICH of hypertensive etiology.

Disección triple y progresiva de las arterias cervicales asociada a infección respiratoria del tracto superior / Progressive triple dissection of the cervical arteries in association with upper respiratory tract infection

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Antiinflamatorios no esteroideos y riesgos de toxicidad gastrointestinal: intervención desde una farmacia comunitaria de Vigo / Non-steroidal anti-inflammatory drugs and its gastrointestinal toxicity risk: Intervention from a community drugstore of Vigo

Objetivos: Detectar a los pacientes con factores de riesgo de gastropatía por antiinflamatorios no esteroideos (AINE) que no tengan prescrito ningún tratamiento profiláctico, e intervenir sobre esta situación para prevenir los posibles efectos adversos. Método: Estudio descriptivo transversal. Se registraron todas las prescripciones de AINE efectuadas durante 2 meses. Se realizó una encuesta sobre la presencia de factores de riesgo de gastropatía y el uso o no de gastroprotección. Si el paciente presenta factores de riesgo y no tiene tratamiento preventivo, se realiza una intervención con el médico para que valore la necesidad de gastroprotección. Resultados: Se registraron 91 prescripciones. El AINE más prescrito fue ibuprofeno, seguido de diclofenaco. Entre los factores de riesgo detectados el que más se repite (48,35%) es la edad> 60 años. El 56,04% de los pacientes tenía prescrito un gastroprotector, de los que un 9,89% no presentaba ningún factor de riesgo asociado. A un 10,99% de los pacientes con un factor de riesgo no se le prescribió ningún gastroprotector. Sobre este grupo de pacientes se plantea una posible intervención, y en el 50% de los casos no fue aceptada por el propio paciente. Todas las remitidas al médico fueron aceptadas, y se prescribió un gastroprotector. Conclusión: Una dispensación activa puede detectar a los pacientes con algún factor de riesgo de gastropatía por AINE. La prescripción de un gastroprotector en estos pacientes evita un posible efecto adverso con una simple intervención (AU)

Objectives: To identify patients at risk of NSAIDs related gastrointestinal disease, which are not prescribed with any prophylactic treatment, to intervene on this situation to prevent possibleside-effects. Method: Cross-sectional study using all NSAIDs prescriptions registered during 2 months. A survey was done based on the presence of risk factors for gastropathy, taking into account theuse/not use of a gastro protective agent. If the patient had risk factors and was not on any prophylactic treatment, a consultation with the doctor is done in order to evaluate the possible need of a gastro protective agent. Results: There were a total of 91 medical prescriptions. The most common prescribed NSAIDs were ibuprofen, followed by diclofenac. Among the detected risk factors, the most common was age greater than 60 years old (48.35 %). 56.04 % of the patients were on a gastro protective agent. 9.89 % of them had no associated risk factor. 10.99 % of the patients with associated risk factors were not on any gastro protective agent. On this group a possible intervention was recommended; 50 % of these interventions were refused by the patient. All the interventions sent to the doctor were accepted, with a gastro protective agent being prescribed as a result. Conclusion: The simple act of dispensing can detect patients atrisk of NSAID related gastrolatry. The prescription of a gastroprotective agent on this group could avoid a potential side effect, with just a simple intervention (AU)

Hemoptisis amenazante en el aneurisma de aorta. A propósito de un caso con supervivencia prolongada / Massive hemoptysis in the aortic aneurysm. Review of a case with prolonged survival

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