Psychopathological and Personality Pro file in Chronic Nononcologic Nociceptive and Neuropathic pain: Cross-sectional Comparative Study.

Introduction: Adaptation to chronic non-oncologic pain is associated with the development of psychopathology and personality disorders, creating severity, chronicity, poorer treatment response, and exacerbations in patients with neuropathy. Objective: To identify the psychopathological and personality profiles of patients with chronic nociceptive and neuropathic pain and their association with pain progression and intensity. Method: A cross-sectional, descriptive and comparative study was conducted in the Pain Treatment Unit of Hospital Universitari Sagrat Cor, with systematic randomized recruitment for 25 months; 115 patients were evaluated using the Hamilton Depression and Anxiety Rating Scale (HAM-D, HAM-A) and the Millon Clinical MultiaxialInventory-III (MCMI-III). Results: The neuropathic group achieved significantly higher scores for pain intensity and depressive and anxiety symptoms. With greater magnitude and frequency, the neuropathic group related pain intensity and progression with depressive/anxiety symptoms, clinical syndromes, and personality patterns. Both groups revealed tendencies towards a compulsive personality pattern, followed by narcissistic, histrionic, and schizoid patterns. Conclusions: When treating chronic pain, the presence of various psychopathological indicators requires an individualized strategy.

Introducción: La adaptación al dolor crónico no oncológico se asocia al desarrollo de psicopatología y afectaciones de la personalidad, generando severidad, cronicidad, menor respuesta al tratamiento y agravándose ante la neuropatía. Objetivo: Identificar perfiles psicopatológicos y de personalidad en pacientes con dolor crónico nociceptivo y neuropático, y su relación con la evolución e intensidad del dolor. Método: Estudio transversal, descriptivo y comparativo, realizado en la Unidad de Tratamiento del Dolor del Hospital Universitari Sagrat Cor, con reclutamiento aleatorio sistemático durante 25 meses; 115 pacientes fueron evaluados mediante la Escala de Hamilton para la Depresión y Ansiedad (HAM-D, HAM-A) y el Inventario Clínico Multiaxialde Millon III (MCMI-III). Resultados: El grupo neuropático obtuvo puntuaciones significativamente mayores en intensidad del dolor, sintomatología depresiva y ansiosa. Con más magnitud y frecuencia, relacionó la intensidad y evolución del dolor con sintomatología depresiva, ansiosa, síndromes clínicos y patrones de la personalidad. Ambos grupos revelaron tendencia al patrón de personalidad compulsiva, seguido del narcisista, histriónico y esquizoide. Conclusiones: En el tratamiento del dolor crónico, la presencia de distintos indicadores psicopatológicos requiere una estrategia individualizada.

Cardioembolic stroke: risk factors, clinical features, and early outcome in 956 consecutive patients

ABSTRACT Background: There is little information about the early clinical features of cardioembolic stroke before complementary examinations. Objective: The aim of this study was to identify risk factors, clinical features, and early outcomes of cardioembolic stroke. Methods: Retrospective study based on prospectively collected data available from a university medical center hospital-based stroke registry. Consecutive patients diagnosed with cardioembolic infarction were selected and compared to those diagnosed with an atherothrombotic stroke. Predictors of cardioembolic infarction were assessed by multivariate analysis. Results: From a cohort of 4597 consecutive patients, we studied 956 patients diagnosed with cardioembolic infarction (80 years [standard deviation (SD) 9.14]; 63% women) and 945 with atherothrombotic infarction (77.01 years [SD 9.75]; 49.8% women). The univariate comparative analysis reported that advanced age (≥ 85 years), female gender, atrial fibrillation (AF), ischemic heart disease, and congestive heart failure were significantly more frequent in the cardioembolic group, whereas hypertension, diabetes, peripheral vascular disease, heavy smoking, hyperlipidemia, and previous transient ischemic attack were significant in the atherothrombotic group. In the logistic regression model, AF (odds ratio [OR] 15.75, 95% confidence interval [CI]: 12.14-20.42), ischemic heart disease (OR 3.12, 95% CI: 2.16-4.5), female gender (OR 1.56, 95% CI: 1.22-2.00), and sudden-onset (OR 1.97, 95% CI: 1.54-2.51), were independent significant predictors of cardioembolic stroke. Conclusions: Potential cardioembolic stroke requires a comprehensive evaluation, since early classification and identification through predictors would improve effective management. (REV INVEST CLIN. 2021;73(1):23-30)

Cardioembolic Stroke: Risk Factors, Clinical Features, and Early Outcome in 956 Consecutive Patients.

BACKGROUND: There is little information about the early clinical features of cardioembolic stroke before complementary examinations. OBJECTIVE: The aim of this study was to identify risk factors, clinical features, and early outcomes of cardioembolic stroke. METHODS: Retrospective study based on prospectively collected data available from a university medical center hospitalbased stroke registry. Consecutive patients diagnosed with cardioembolic infarction were selected and compared to those diagnosed with an atherothrombotic stroke. Predictors of cardioembolic infarction were assessed by multivariate analysis. RESULTS: From a cohort of 4597 consecutive patients, we studied 956 patients diagnosed with cardioembolic infarction (80 years [standard deviation (SD) 9.14]; 63% women) and 945 with atherothrombotic infarction (77.01 years [SD 9.75]; 49.8% women). The univariate comparative analysis reported that advanced age (≥ 85 years), female gender, atrial fibrillation (AF), ischemic heart disease, and congestive heart failure were significantly more frequent in the cardioembolic group, whereas hypertension, diabetes, peripheral vascular disease, heavy smoking, hyperlipidemia, and previous transient ischemic attack were significant in the atherothrombotic group. In the logistic regression model, AF (odds ratio [OR] 15.75, 95% confidence interval [CI]: 12.14-20.42), ischemic heart disease (OR 3.12, 95% CI: 2.16-4.5), female gender (OR 1.56, 95% CI: 1.22-2.00), and sudden-onset (OR 1.97, 95% CI: 1.54-2.51), were independent significant predictors of cardioembolic stroke. CONCLUSIONS: Potential cardioembolic stroke requires a comprehensive evaluation, since early classification and identification through predictors would improve effective management.

Perfil clínico diferencial entre los infartos lacunares y los infartos cerebrales aterotrombóticos / Differential clinical profile of lacunar infarcts compared to atherothrombotic brain infarcts

Aims and objectives: The present study makes a comparative analysis between the clinical profile of lacunar infarcts (LI) and that of atherothrombotic brain infarcts (ABI). Methods: Hospital-based descriptive study of 1809 consecutive patients admitted over a period of 24 years with a diagnosis of lacunar cerebral infarction (n = 864) or atherothrombotic cerebral infarction (n = 945). A comparative analysis of the demographic data, cerebral vascular risk factors, clinical data and hospital evolution between both subtypes of cerebral infarction was performed using a univariate and multivariate statistical methodology. Results: LI accounted for 26.5% and ABI for 28.9% of all cerebral infarctions in the registry. The variables directly and independently associated with ABI were: ischemic heart disease, previous transient ischemic attack, previous cerebral infarction, peripheral vascular disease, anticoagulant therapy, age > 85 years, vegetative symptoms, decreased level of consciousness, sensory deficit, visual deficit, speech disorders, and neurological, respiratory and urinary complications during hospital admission. In contrast, the absence of neurological symptoms at hospital discharge was directly associated with LI. Conclusions: LI and ABI have a distinct clinical profile. The best functional prognosis of LI during the acute phase of the disease is characteristic. In contrast, ICAs have a higher atherosclerotic burden and a worse prognosis.

Fundamentos y objetivo: El objetivo del estudio es efectuar un análisis comparativo entre el perfil clínico de los infartos lacunares (IL) y el perfil de los infartos cerebrales aterotrombóticos (ICA). Métodos: Estudio hospitalario descriptivo de 1809 pacientes consecutivos ingresados durante un período de 24 años con el diagnóstico de infarto cerebral de tipo lacunar (n = 864) o por infarto cerebral aterotrombótico (ICA) (n = 945). Se realizó un análisis comparativo de los datos demográficos, factores de riesgo vascular cerebral, datos clínicos y de evolución hospitalaria utilizando una metodología estadística univariada y, posteriormente, multivariada. Resultados: Los IL representaron el 26.5% y los ICA el 28.9% del total de infartos cerebrales del registro. Las variables asociadas directamente y de forma independiente con los ICA fueron: cardiopatía isquémica, ataque isquémico transitorio previo, infarto cerebral previo, enfermedad vascular periférica, uso de anticoagulantes, edad > 85 años, síntomas vegetativos, disminución del nivel de conciencia, déficit sensitivo, déficit visual, trastornos del habla y complicaciones neurológicas, respiratorias y urinarias durante el ingreso hospitalario. En cambio, la ausencia de sintomatología neurológica al alta se asoció directamente con los IL. Conclusiones: Los IL y los ICA tienen un perfil clínico diferenciado. Es característico el mejor pronóstico funcional de los IL durante la fase aguda de la enfermedad. En cambio, los ICA presentan mayor carga aterosclerótica y peor pronóstico evolutivo.