[Systolic blood pressure reduction in patients with intracranial hemorrhage and functional prognosis]. / Reducción de la presión arterial sistólica en pacientes con hemorragia intracraneal y pronóstico funcional.

Background: Acute intracerebral hemorrhage affects annually more than 1 million people worldwide. Chronic systemic arterial hypertension is the most important modifiable risk factor for spontaneous intracerebral hemorrhage. Objective: To determine the relationship between the decrease in systolic blood pressure (SBP) in patients with intracranial hemorrhage and their short-term functional prognosis. Material and methods: Observational, longitudinal, prospective study in patients with intraparenchymal hemorrhage secondary to hypertensive dyscontrol, older than 18 years, of both sexes. Blood pressure was recorded at admission, every hour during the first 6 hours and every two hours from 8 to 24 hours after admission. Functionality was assessed using the modified Rankin scale at admission, at 6 and 24 hours after admission. Results: 58 patients were included, in whom the reduction of systolic blood pressure at admission was 17.04% and at 24 hours was 31.3 mm Hg; the mean systolic blood pressure was 183.62 mm Hg as opposed to 152.3 mm Hg at discharge (p < 0.001). Conclusions: In the first 6 hours, reduction in ASR is significantly associated with hospital outcome in patients with intracranial hemorrhage. A linear association was observed with improvement and favorable functional prognosis as measured by the modified Rankin scale.

Introducción: la hemorragia intracerebral aguda afecta anualmente a más de un millón de personas en todo el mundo. La hipertensión arterial sistémica crónica es el factor de riesgo modificable más importante para la hemorragia intracerebral espontánea. Objetivo: determinar la relación entre la disminución de la presión arterial sistólica (TAS) en pacientes con hemorragia intracraneal y su pronóstico funcional a corto plazo. Métodos: estudio observacional, longitudinal, prospectivo, en pacientes con hemorragia intraparenquimatosa secundaria a descontrol hipertensivo, mayores de 18 años, de ambos sexos. Se realizaron registros de presión arterial al ingreso, cada hora durante las primeras seis horas y cada dos horas desde las ocho a las 24 horas posterior al ingreso. Se evaluó funcionalidad mediante escala de Rankin modificada al ingreso, a las seis y a las 24 horas después del ingreso. Resultados: se incluyeron 58 pacientes, en quienes la reducción de la TAS al ingreso fue de 17.04% y a las 24 horas fue de 31.3 mm Hg de la presión arterial sistólica; la media de la TAS fue de 183.62 mm Hg a diferencia de la registrada al egreso, que fue de 152.3 mm Hg (p < 0.001). Conclusiones: en las primeras seis horas, la reducción de la TAS está significativamente asociada con el resultado hospitalario en pacientes con hemorragia intracraneal. Se observó una asociación lineal con la mejoría y un pronóstico funcional favorable, medido por la escala de Rankin modificada.

Tendencia de egresos hospitalarios con diagnóstico de accidente cerebrovascular agudo entre los años 2018-2021 en Chile: análisis descriptivo / Hospital discharge trend with diagnosis of acute stroke between the years 2018 and 2021 in Chile: descriptive analysis

Introducción: El accidente cerebrovascular (ACV) es una afección con alta morbimortalidad, producida por la interrupción de la perfusión cerebral. Este artículo tiene como objetivo analizar la tendencia de egresos hospitalarios por ACV agudo en el periodo 2018-2021 en Chile. Metodología: Estudio descriptivo observacional, que incluyó egresos hospitalarios con diagnóstico de ACV agudo en el periodo 2018-2021, en Chile (n=19.274), según datos del Departamento de Estadísticas e Información de Salud de Chile. Se calculó la tasa de egreso hospitalario (TEH) según variable, utilizando datos del censo chileno 2017. No requirió comité de ética. Resultados: El 2018 tuvo la mayor TEH por ACV agudo (28,99) y el 2021 la menor (26,39). El grupo de "80 años y más" presenta la mayor TEH, mientras que el de "5-9 años" la menor. La mayor y menor TEH las tienen las regiones de Ñuble (263,00) y Tarapacá (10,29), respectivamente. Discusión: La disminución de TEH durante dicho periodo podría deberse al fortalecimiento de la Ley de Urgencia, al Programa Nacional de Telesalud y el impacto de la reciente pandemia. A mayor edad, aumenta la prevalencia y gravedad de las comorbilidades, lo cual explicaría la mayor TEH en el grupo más longevo. La mayor TEH masculina podría ser porque los hombres presentan mayor cantidad y severidad de factores de riesgo. La mayor TEH en la región del Ñuble posiblemente sea por los elevados niveles de pobreza y ruralidad, y la menor TEH en Tarapacá podría relacionarse con la presencia de una población nacional más joven.

Introduction: Stroke (CVA) is a condition with high morbidity and mortality, produced by the interruption of cerebral perfusion. This article aims to analyze the trend of hospital discharges for acute stroke in the period 2018-2021 in Chile. Methodology: Descriptive observational study, which included hospital discharges with a diagnosis of acute stroke in the period 2018-2021, in Chile (n=19,274), according to data from the Chilean Department of Health Statistics and Information. The hospital discharge rate (HTE) was calculated according to variable, using data from the 2017 Chilean census. No ethics committee was required. Results: 2018 had the highest HTE for acute stroke (28.99) and 2021 the lowest (26.39). The group aged "80 years and older" had the highest TEH, while the group aged "5-9 years" had the lowest TEH. The regions of Ñuble (263.00) and Tarapacá (10.29) have the highest and lowest HTE, respectively. Discussion: The decrease in HTE during this period could be due to the strengthening of the emergency law, the National Telehealth Program and the impact of the recent pandemic. The higher the age, the higher the prevalence and severity of comorbidities, which would explain the higher HTE in the older group. The higher male HTE may be due to the fact that men have a greater number and severity of risk factors. The higher HTE in the Ñuble region is possibly due to the high levels of poverty and rurality, and the lower HTE in Tarapacá would be related to having a younger national population.

Predictive Mortality Factors after Decompressive Craniectomy in Ischemic Stroke / Fatores preditivos de mortalidade após craniectomia descompressiva em acidentes vasculares cerebrais isquêmicos

Background Decompressive craniectomy is a consolidated method for the treatment of malignant ischemic stroke (iS) in the territory of the middle cerebral artery. Thus, factors contributing to mortality constitute an important area of investigation. Objective To evaluate the epidemiological clinical profile and predictors of mortality in a single-center population of patients undergoing decompressive craniectomy for the treatment of malignant iS. Methods A single-center retrospective study was performed in 87 patients with malignant iS subjected to emergency decompressive craniectomy from January 2014 to December 2017. Age, gender, laterality, aphasia, time interval between disease onset and treatment, and clinical and neurological outcomes using the Glasgow coma scale were assessed. The patients were stratified by age: a group of participants 60 years old or younger, and a group of participants older than 60 years old for assessment of survival and mortality by the Kaplan-Meier test and log-rank comparison. The intensity of the association between demographic and clinical variables was evaluated by multivariate Cox regression. Results Ischemic stroke was prevalent in patients with hypertension (63.29%). Seventy seven (84%) patients had some type of postoperative complication, mostly pneumonia (42.8%). The risk of death was 2.71 (p » 0.0041) and 1.93 (p » 0.0411) times higher in patients older than 60 and with less than 8 points on the Glasgow coma scale, respectively. Conclusion Malignant iS has a significant mortality rate. Age above 60 years and Glasgow coma scale values below 8 were statistically correlated with unfavorable prognosis.

Contexto A craniectomia descompressiva é um método consolidado para o tratamento do acidente vascular cerebral isquêmico (AVCI) maligno no território da artéria cerebral média. No entanto, os fatores envolvidos na mortalidade constituem objeto de investigação. Objetivo Avaliar o perfil clínico epidemiológico e os preditores de mortalidade em uma população unicêntrica de pacientes submetidos à craniectomia descompressiva para tratamento de acidente vascular isquêmico maligno. Métodos Um estudo retrospectivo unicêntrico foi realizado com 87 pacientes com AVCI maligno submetidos à craniectomia descompressiva de emergência de janeiro de 2014 a dezembro de 2017. Idade, gênero, lateralidade, afasia, intervalo de tempo entre o início da doença e o tratamento, e escala de coma de Glasgow foram avaliados. Os pacientes foram estratificados por idade: um grupo com participantes com 60 anos de idade ou menos, e outro com participantes com mais de 60 anos para avaliação de sobrevida e mortalidade pelo teste de Kaplan-Meier e comparação log-rank. A intensidade da associação entre variáveis demográficas e clínicas foi avaliada por regressão multivariada de Cox. Resultados Houve prevalência de hipertensos (63,29%). Setenta e sete (84%) dos pacientes tiveram algum tipo de complicação pós-operatória, com predomínio de pneumonia (42,8%). O risco de morte foi 2,71 e 1,93 maior em pacientes com mais de 60 anos e com menos de 8 pontos na escala de coma de Glasgow, respectivamente. Conclusão O AVCI maligno ainda tem uma taxa de mortalidade significativa. Idade acima de 60 anos e valores da escala de coma de Glasgow abaixo de 8 foram estatisticamente correlacionados com um prognóstico desfavorável.

Estudio Transversal: Riesgo Cardiovascular en Diabetes Mellitus II según Score UKPDS en pacientes del Hospital José Carrasco Arteaga / Cross-Sectional Study: Cardiovascular Risk in Diabetes Mellitus II using UKPDS Score in Hospital José Carrasco Arteaga patients

INTRODUCCIÓN: La Diabetes Mellitus Tipo 2 (DM2) es una enfermedad de gran impacto sanitarionitario y socioeconómico. Las complicaciones cardiovasculares son su principal causa de muerte, por este motivo es de gran importancia la aplicación de estrategias de prevención. El objetivo de este estudio fue determinar el Riesgo Cardiovascular según el Score UKPDS en pacientes con Diabetes Mellitus Tipo 2 atendidos en del Hospital José Carrasco Arteaga de Cuenca-Ecuador, durante el periodo noviembre 2018 a agosto 2019. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo, de corte transversal, con una muestra de 118 pacientes con diagnóstico de DM2 atendidos en el Hospital José Carrasco Arteaga, entre noviembre 2018 a agosto 2019. Se revisaron los registros clínicos, se recopilo la información en un formulario con todas las variables del Score UKPDS. La estimación del Riesgo Cardiovascular (RCV) se llevó a cabo con ayuda de la Calculadora Risk Engine versión 2.0 del Score UKPDS. RESULTADOS: En la población de estudio predominó el sexo femenino. La edad se encontró en un rango de 32 a 95 años, el grupo etario de mayor frecuencia fue el de 55 a 59 años con el 16.1%. En el 40% de la muestra la duración de la enfermedad fue de >10 años. El 42.4% (n=50) presentó valores ≥130mmHg de PAS. El 75.4% de la muestra tenían un mal control glucémico, con hemoglobina glicosilada mayor al rango normal para el grupo de edad. El RCV estimado a 5 años se mantuvo dentro de "Riesgo Bajo" para la mayoría de la muestra; mientras que a los 10 años se encontró que aumenta el riesgo sobre todo para ECV no Fatal (Riesgo alto: 21.25%) y para IAM Fatal (6.8%) y no Fatal (6.8%). CONCLUSIÓN: La mayoría de pacientes tenían más de 10 años de evolución de DMII. Más de la mitad de la muestra tenían un control glicémico inadecuado. El riesgo cardiovascular a los 5 años fue "bajo" para la mayoría de la población, tanto para IAM como para ECV. El riesgo cardiovascular a los 10 años fue ligeramente mayor para todas las entidades, sobre todo aumenta para ECV no fatal, a "riesgo muy alto" del 21.2%, el riesgo de IAM también aumenta a riesgo muy alto del 6.8%.

BACKGROUND: Type 2 Diabetes Mellitus (DM2) is a disease of great health and socioeconomic impact. Cardiovascular complications are the main cause of death in diabetic patients, for this reason the application of prevention strategies is important. The aim of the research was to determine the cardiovascular risk according to UKPDS Score in patients diagnosed with DM2, treated at Hospital José Carrasco Arteaga, Cuenca-Ecuador, from November 2918 to August 2019. METHODS: A descriptive, cross-sectional study was conducted with a sample of 118 patients diagnosed with DM2, treated at Hospital José Carrasco Arteaga, between November 2018 and August 2019. Clinical records were reviewed, information was collected on a form with all the variables of the UKPDS Score. Cardiovascular Risk Estimation (RCV) was carried out with the Risk Engine Calculator version 2.0 of the UKPDS Score. RESULTS: The female sex predominated in the study population. The age range went from 32 to 95 years old, the most frequent range of age was 55 to 59 years old (16.1%). The disease duration in 40% of the population was higher than 10 years. 42.4 %(n=50) presented SBP values ≥130mmHg. 75.4% of the sample had poor glycemic control, with glycosylated hemoglobin levels higher than the normal range for each age group. The estimated 5-year CVR was low for most of the sample; while the 10 year CVR increased, especially for non-fatal CVD(high risk:21.25%) and for fatal (6.8%) and non-fatal(6.8%) AMI. CONCLUSION: Most of the patients had more than 10 years with DMII diagnosis. More than half of the sample had inadequate glycemic control. The CVR at 5 years was "low" for the majority of the population, both for AMI and CVD. The cardiovascular risk at 10 years was slightly higher for all entities, especially it increases for non-fatal CVD, to a "very high risk" of 21.2%, and the risk of AMI also increases to a "very high risk" of 6.8%.

Cerebrovascular Accidents Related to Snakebites in the Amazon-Two Case Reports.

The objective of this case series was to describe 2 patients presenting with subarachnoid hemorrhage with hydrocephalus and hemoventricle after a snakebite caused by presumed Bothrops ssp. Both cases occurred in the municipality of Guajará (Amazonas state), Western Brazilian Amazon. Both cases featured delay in administration of serum therapy, which may have contributed to the emergence of complications such as stroke. Patient 1 was admitted to hospital 16 h after the snakebite occurred. Before receiving antivenom, testing showed the patient as having unclottable blood. She developed hemorrhagic stroke (a subarachnoid hemorrhage with hydrocephalus and hemoventricle). On the seventh day, she was discharged from hospital. Patient 2 arrived at the hospital 3 d after the snakebite occurred and presented with unclottable blood. He had a stroke (right frontoparietal hemorrhage, intraparenchymal hemorrhage already open to the ventricle) and died on the eighth day after the snakebite. Delay in seeking health care after snake envenomation can result in worse outcome.