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Niño , Adulto , Anciano , Humanos , Estado Epiléptico , Factores de Riesgo , Factores de Edad , ElectroencefalografíaRESUMEN
OBJECTIVE: To develop a prognostic model to estimate the probability of patients being independent in ambulation and in activities of daily living (ADL) after six months of stroke. DESIGN: Cohort analytical study. SETTING: Rehabilitation departments of two district general hospitals. SUBJECTS: Ninety-two consecutive stroke patients admitted to a rehabilitation programme. MAIN OUTCOME MEASURES: Independent ambulation was defined as a Functional Ambulation Classification (FAC) > or =4, and the independence in ADL as a Barthel Index (BI) > or =285. All patients were assessed on admission to rehabilitation, and in the first, second, third, fourth and six months after stroke. RESULTS: Prognostic factors were identified by means of a multivariate survival analysis using Cox regression. Three variables were predictors for a FAC > or =4: (1) The patients in the motor (M), motor-sensitive (MS) and motor-sensitive with hemianopsia (MSH) groups (relative risk (RR) 5.43 of M with respect to MSH, and 2.41 of MS to MSH). (2) A Motricity Index >25 (RR 3.19). (3) An age <70 years old (RR 1.99). For a BI > or =85 three predictors were selected: (1) The classification M-MS-MSH (RR 6.02 M to MSH, and 1.52 MS to MSH). (2) An initial BI >20 (RR 3.45); the highest contribution in the achievement of an initial BI >20 was bowel and bladder continence. (3) The antecedent of previous independence (RR 2.68). The predictive models, constructed by means of multiple logistic regression correctly classified 77% and 79% of the patients who obtained FAC > or =4 and a BI > or =85 respectively. CONCLUSIONS: The syndromic classification M, MS and MSH, together with other routinely available data, such as the Motricity Index, BI, the age and the previous functionality, can be used to obtain a patient prognosis level with regard to ambulation and ADL independence.
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Rehabilitación de Accidente Cerebrovascular , Actividades Cotidianas , Anciano , Femenino , Hemiplejía/rehabilitación , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pronóstico , Análisis de Supervivencia , Resultado del Tratamiento , CaminataRESUMEN
Elevated serum calcitonin (SC) levels have been observed in cirrhotic patients although the biological activity of this hormone in such patients is not known. Twenty one patients diagnosed histologically of alcoholic hepatic cirrhosis (AC) and 12 healthy controls were studied evaluating the degree of hepatocellular failure by means of clinical and biological criteria. Serum calcitonin was determined by means of a radioimmuno assay (RIA) and a radioimmunometric assay (IRMA) in which by combining two monoclonal antibodies, mature calcitonin is determined. These levels almost correspond to levels of biologically active calcitonin. The results obtained show a significant increase in SC in patients with AC when compared to controls, both by RIA (280 +/- 197 pg/ml, p less than 0.001) and IRMA (18 +/- 6 pg/ml, p less than 0.01). Control values were 57 +/- 23 pg/ml and 12 +/- 7 pg/ml respectively. Mean SC values in cirrhotic patients obtained by RIA were 4.9 times greater than their controls while the increase in SC in cirrhotics determined by IRMA was 1.5 times the control, thus obtaining a significant direct correlation between SC and severity of hepatic failure. According to our results, the elevated SC found in cirrhotics is mainly due to immature or non active forms directly related with the degree of severity of the hepatic failure and probably to high Molecular Weight molecules. The slight increase in mature SC in this type of patients is probably due to hormonal mechanism of bone regulation, defendants of hepatic osteodystrophy.