[Atrial fibrillation and cognitive impairment: a narrative review]. / Fibrilación auricular y deterioro cognitivo: una revisión narrativa.

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.

Fibrilación auricular y deterioro cognitivo: una revisión narrativa / Atrial fibrillation and cognitive impairment: a narrative review

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.(AU)

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.(AU)

Diferencias de género en la calidad de vida a largo plazo tras un ictus: influencia del estado funcional y el estado de ánimo / Sex differences in long-term quality of life after stroke: Influence of mood and functional status

OBJETIVOS: Valorar la calidad de vida (CV) a largo plazo en pacientes que presentaron un ictus y analizar si existen diferencias entre sexos. MÉTODOS: Estudio descriptivo, observacional, transversal. El estudio fue aprobado por el Comité Ético. Se recogieron datos sociodemográficos, factores de riesgo, datos sobre la CV, el estado de ánimo y el estado funcional mediante escalas validadas. RESULTADOS: La muestra final obtenida fue de 124 pacientes. La edad media fue 71,30 años (DE: 11,99). En el estudio de la CV, las dimensiones que presentaron más problemas en el cuestionario EuroQol-5D fueron las de ansiedad/depresión (66,7%) y dolor/malestar (62,2%). Hubo diferencias significativas entre mujeres y hombres en las dimensiones movilidad y actividades cotidianas (p = 0,016 y p = 0,005). Y en el índice de salud del EQ-5D, también fue peor el resultado en mujeres que en hombres (0,45 ± 0,45 vs. 0,65 ± 0,38; p = 0,013). La CV se relacionó con la dependencia en las actividades básicas de la vida diaria (r = 0,326; p = 0,001) y con el estado de ánimo deprimido (r = -0,514; p < 0,0001). El modelo de predicción, para el índice del cuestionario de CV EQ-5D, estableció que el 72% de la puntuación obtenida en la CV estaría explicada por el estado funcional, la dependencia en las actividades de la vida diaria y el estado de ánimo, mientras que el estar casado aparece como factor protector. CONCLUSIÓN: La CV de los supervivientes a un ictus está afectada negativamente a largo plazo. Son las mujeres las que manifiestan una CV peor, sobre todo en las dimensiones de movilidad y actividades cotidianas

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

Will neurological care change over the next 5 years due to the COVID-19 pandemic? Key informant consensus survey. / ¿Va a cambiar la neurología tras la pandemia de COVID-19 en los próximos 5 años? Estudio de enfoque mediante informadores clave.

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.

Sex differences in long-term quality of life after stroke: Influence of mood and functional status. / Diferencias de género en la calidad de vida a largo plazo tras un ictus: influencia del estado funcional y el estado de ánimo.

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.

[Evaluation of quality of life, social stigma and treatment adherence in patients with epilepsy in the Caceres Healthcare Area: a cross-sectional study]. / Valoracion de la calidad de vida, estigma social y adhesion al tratamiento en pacientes con epilepsia del Area de Salud de Caceres: estudio transversal.

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.

Pompe Disease and Autophagy: Partners in Crime, or Cause and Consequence?

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.

Encefalitis por anticuerpos anti-NMDA secundaria a una infección por virus herpes simple / Anti-NMDA antibody encephalitis secondary to herpes simplex virus infection

No disponible

Un sistema organizado de atención al ictus evita diferencias en la evolución de los pacientes en relación con el momento de su ingreso en una unidad de ictus / A stroke care management system prevents outcome differences related to time of stroke unit admission

Introducción: Existe evidencia de que el ingreso de pacientes con ictus en diferentes periodos laborales influye en su evolución. Analizamos la evolución de los pacientes con relación al momento del ingreso en una unidad de ictus. Métodos: Estudio retrospectivo. Se agrupó a los pacientes considerando los siguientes periodos: a) día de la semana, b) periodo del año y c) turno de trabajo. Analizamos características demográficas, tipo y gravedad del ictus y porcentaje de trombólisis. Determinamos la evolución precoz considerando: la National Institute of Heath Stroke Scale (NIHSS), complicaciones neurológicas (CN) y mortalidad hospitalaria, y situación funcional (SF) a 3 meses mediante la escala modificada de Rankin. Resultados: Se incluyó a 1.250 pacientes. Las CN fueron más frecuentes durante el fin de semana que en los días laborales, sin influir en la mortalidad hospitalaria. Respecto a la SF a 3 meses, el 67,0% de pacientes ingresados en días laborales vs. 60,7% durante el fin de semana (p = 0,096), el 65,5% de los pacientes ingresados durante los meses académicos vs. 63,5% durante las vacaciones de verano (p = 0,803) eran independientes. No identificamos diferencias significativas en la mortalidad a 3 meses según el día o periodo del año; sin embargo, para la variable turno de trabajo, el 13,2% de los pacientes ingresados durante la mañana, el 11,5% por la tarde y el 6,0% durante el turno de noche fallecieron (p = 0,017). Observamos una tendencia a realizar más fibrinólisis en días laborables, turno de la mañana y meses académicos. Conclusiones: El momento del ingreso en la unidad de ictus no influyó en la evolución precoz ni en la situación de independencia a 3 meses

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

A stroke care management system prevents outcome differences related to time of stroke unit admission.

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.

Association between subclinical carotid atherosclerosis, hyperhomocysteinaemia and mild cognitive impairment.

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.

[The impact of neurological and medical complications on the mortality and functional situation of acute stroke patients]. / Impacto de las complicaciones neurologicas y medicas sobre la mortalidad y situacion funcional de pacientes con ictus agudo.

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.

Análisis de recursos asistenciales para el ictus en España en 2012: ¿beneficios de la Estrategia del Ictus del Sistema Nacional de Salud? / Analysis of stroke care resources in Spain in 2012: Have we benefitted from the Spanish Health System’s stroke care strategy?

Introducción: La Estrategia del Ictus del Sistema Nacional de Salud (EISNS) fue un documento de consenso entre las distintas administraciones y sociedades científicas que se desarrolló con el objetivo de mejorar la calidad del proceso asistencial y garantizar la equidad territorial. Nuestro objetivo fue analizar los recursos asistenciales existentes y si se había cumplido el objetivo de la EISNS. Material y métodos: La encuesta sobre los recursos disponibles se realizó por un comité de neurólogos de cada una de las comunidades autónomas (CC.AA), los cuales también realizaron la encuesta de 2008. Los ítems incluidos fueron el número de Unidades de Ictus (UI), su dotación (monitorización, neurólogo 24 h/7 días, ratio enfermería, protocolos), ratio cama UI/100.000 habitantes, recursos diagnósticos (ecografía cardíaca y arterial cerebral, neuroimagen avanzada), realización de trombolisis intravenosa, intervencionismo neurovascular (INV), cirugía del infarto maligno de la arteria cerebral media (ACM) y disponibilidad de la telemedicina. Resultados: Se incluyeron datos de 136 hospitales. Existen 45 UI distribuidas de un modo desigual. La relación cama de UI por habitantes y comunidad autónoma osciló entre 1/74.000 a 1/1.037.000 habitantes, cumpliendo el objetivo solo Cantabria y Navarra. Se realizaron por neurólogos 3.237 trombolisis intravenosas en 83 hospitales, con un porcentaje respecto del total de ictus isquémico entre el 0,3 y el 33,7%. Los hospitales sin UI tenían una disponibilidad variable de recursos. Se realiza INV en todas las CC.AA salvo La Rioja, la disponibilidad del INV 24 h/7 días solo existe en 17 ciudades. Hay 46 centros con cirugía del infarto maligno de la ACM y 5 con telemedicina. Conclusión: La asistencia al ictus ha mejorado en cuanto al incremento de hospitales participantes, la mayor aplicación de trombolisis intravenosa y procedimientos endovasculares, también en la cirugía del infarto maligno de la ACM, pero con insuficiente implantación de UI y de la telemedicina. La disponibilidad de recursos diagnósticos es buena en la mayoría de las UI, e irregular en el resto de hospitales. Las distintas CC.AA deben avanzar para garantizar el mejor tratamiento y equidad territorial, y así conseguir el objetivo de la EISNS

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 24 h/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 24 h/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

How predictors and patterns of stroke recurrence after a TIA differ during the first year of follow-up.

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.

Situación funcional tras un ictus y experiencia acumulada de una unidad de ictus / Functional outcome of stroke and the cumulative experience of a stroke unit

Objetivo: Los pacientes con un ictus tienen más probabilidades de supervivencia e independencia si son atendidos en una unidad de ictus. La información disponible en nuestro entorno acerca de la influencia del aprendizaje sobre estos resultados es escasa. Analizamos la situación funcional y mortalidad en nuestros pacientes en función de la experiencia acumulada en una unidad de ictus. Pacientes y métodos: Estudio de cohortes retrospectivo de pacientes ingresados en una unidad de ictus. Diferenciamos 2 grupos según el año de ingreso: grupo A (julio 2007-diciembre 2009) y grupo B (enero 2010-diciembre 2011), analizando la evolución precoz en función de la puntuación en la escala de ictus del National Institute of Health y la mortalidad al alta y la situación funcional a medio plazo en función de la mortalidad y estado funcional según la escala Rankin a los 3 meses. Resultados: Se incluyó a 1.070 pacientes. No se obtuvo diferencias entre los grupos ni en la evolución favorable (68,3% vs. 63,9), ni en la mortalidad tanto hospitalaria (5,1% vs. 6,6%), como a los 90 días (12,8% vs. 13,1%), siendo mayor el porcentaje de independientes a los 90 días en el grupo B (56,3% vs. 65,5%: p = 0,03). El análisis multivariante ajustado por subtipo de ictus y tratamiento fibrinolítico mantuvo la asociación entre la independencia y el período de ingreso. Conclusiones: La probabilidad de independencia funcional de nuestros pacientes aumentó con la experiencia acumulada de nuestra Unidad de Ictus sin observarse diferencias en la mortalidad

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 salce 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

Parálisis de cuerdas vocales como forma de presentación de miastenia gravis con anticuerpos anti-MuSK / Vocal cord paralysis as a manifestation of myasthenia gravis with anti-MuSK antibodies

No disponible

Analysis of stroke care resources in Spain in 2012: have we benefitted from the Spanish Health System's stroke care strategy?

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.