Drip and ship and mothership models of mechanical thrombectomy result in similar outcomes in acute ischemic stroke of the anterior circulation.

BACKGROUND: Stroke therapy has been transformed in recent years due to the availability of thrombolysis and mechanical thrombectomy (MT). Whether transferring the patient directly to a comprehensive stroke center (CSC, mothership model) is better than taking them to a primary stroke center (PSC) and then to a CSC for MT (drip and ship) is unclear but has important implications. We compared the performance of both models in a district of the Basque country, Spain. METHODS: This is a retrospective analysis of prospectively collected data of all acute ischemic stroke patients consecutively admitted to the Neurology Department of two institutions and eligible for MT over a 36-month period with anterior circulation large vessel occlusion (LVO). One center applied the mothership model and the other the drip-and-ship. The two models were compared in terms of mortality and functional status assessed by modified Rankin (mRS) scale at 90 days. As a surrogate of the effectiveness of the two models, all times pertinent to stroke therapy were recorded. RESULTS: A total of 187 patients were evaluated subjected to MT with the drip-and-ship model and 188 with mothership, with a median NIHSS of 15. Prior to MT, 17% of the drip-and-ship patients received thrombolysis and 26% in the mothership. Neither mortality rate nor mRS showed statistically significant differences 90 days after stroke. The time lapse from stroke to MT was optimal in both models; albeit being 10 minutes longer in the drip-and-ship model, it had no impact on patients' outcomes. CONCLUSIONS: Drip-and-ship and mothership models can provide optimal and similar results in acute stroke patients in terms of mortality and functional status at 90 days. Their coexistence may alleviate the burden of CSC thus facilitating the access of more stroke patients to advanced therapies in an equitable manner.

Factores asociados al consumo de riesgo y abusivo de alcohol en estudiantes de primero de Medicina de la Universidad del País Vasco / Factors associated with the risk of consumption and alcohol abuse in first year medical students at theBasque Country University

OBJETIVO: Identificar factores asociados al consumo de riesgo y abusivo de alcohol en estudiantes de primero de medicina de la Universidad del País Vasco. MATERIALES Y MÉTODO: Estudio observacional, descriptivo y transversal realizado en una muestra de 225 estudiantes (77,8% mujeres) mediante un cuestionario anónimo autoadministrado. Se ha realizado un análisis bivariado y se han construido modelos de regresión logística con tres variables dependientes: borracheras, consumos intensivos (CIA) y consumos de riesgo (CR) de alcohol en el último mes. RESULTADOS: El 46,0% de los estudiantes se había emborrachado en el último mes, el 48,3% era bebedor de riesgo y el 67,2% había realizado consumos intensivos de alcohol. En el modelo final son factores de protección: iniciarse en el consumo de alcohol a los 16 años o más tarde (borracheras OR = 0,409, CIA OR = 0,307, CR OR = 0,233) y vivir con los padres u otros familiares para emborracharse en el último mes (OR = 0,336). Son factores de riesgo: que el mejor amigo/a se haya emborrachado en el mes previo (borracheras OR=6,245, CIA OR=4,438, CR OR = 4,616); ser hombre para las borracheras (OR=2,884) y el CIA (OR = 3,588) y ser mujer para el CR (OR = 4,047); unas altas expectativas para el CIA (OR = 2,660) y el CR (OR = 4,572) y que todos o la mayoría de los amigos/as y compañeros/as se hayan emborrachado (OR = 2,367) o que el mejor amigo/a haya consumido alcohol en el último mes (OR = 10,287) para las borracheras en el mes previo. CONCLUSIONES: Los CR y CIA en el último mes son frecuentes. Las expectativas positivas asociadas al alcohol son moderadamente elevadas y se relacionan fundamentalmente con el estado emocional. Retrasar la edad de inicio es el principal factor de protección, mientras que las borracheras recientes del mejor amigo/a y las altas expectativas positivas asociadas al alcohol son los principales y más consistentes factores de riesgo

OBJECTIVE: To identify factors associated with the risk of abuse of alcohol consumption in first year medical students at the Basque Country University. MATERIALS AND METHOD: An observational, descriptive and cross-sectional study was carried out in a sample of 225 students (77.8% women) using a self-administered anonymous questionnaire. A bivariate analysis was carried out and logistic regression models were constructed with three dependent variables: drunkenness, binge drinking (BD) and risk of consumption (RC) of alcohol in the last month. RESULTS: 46.0% of the students had got drunk in the last month, 48.3% were risk drinkers and 67.2% had been binge drinking. In the final model the protective factors were: start drinking alcohol at 16 years or later (drunkenness OR = 0.409, BD OR = 0.307, RC OR = 0.233) and live with the parents or other relatives for drunkenness in the last month (OR = 0.336). The following are risk factors: that the best friend has got drunk in the previous month (drunkenness OR = 6.245, BD OR=4.438, CR OR = 4.616); being male for drunkenness (OR = 2,884) and CIA (OR = 3,588) and being woman for the CR (OR = 4,047); high expectations for the CIA (OR = 2,660) and the CR (OR = 4,572) and that all or most of the friends and peers have got drunk (OR=2.367) or that the best friend has consumed alcohol in the last month (OR = 10.287) for drunkenness in the previous month. CONCLUSIONS: CR and CIA in the last month are frequent. The positive expectations associated with alcohol are moderately high and are fundamentally related with the emotional state. Delaying the age of onset is the main protective factor, while recent drunkenness of the best friend and the high positive expectations associated with alcohol are the main and most consistent risk factors

Neurological reasons for consultation and hospitalization during the COVID-19 pandemic.

BACKGROUND: COVID-19 disease affects the nervous system and led to an increase in neurological consults for patients at admission and through the period of hospitalization during the peak of the pandemic. METHODS: Patients with clinical and laboratory diagnosis of COVID-19 that required a neurologic consultation or those who presented with neurological problems on admission that led to a diagnosis of SARS-CoV-2 infection during a 2-month period at the peak of the pandemic were included in this study. Demographic and clinical variables were analyzed. RESULTS: Thirty-five patients were included. The presenting neurologic manifestations on admission led to the diagnosis of COVID-19 in 14 patients (40%). The most common reasons for consultation during the hospitalization period were stroke (11), encephalopathy (7), seizures (6), and neuropathies (5) followed by a miscellaneous of syncope (2), migraine (1), anosmia (1), critical illness myopathy (1), and exacerbation of residual dysarthria (1). The most common neurological disturbances were associated with severe disease except for neuropathies. Patients with encephalopathies and seizures had markedly increased D-dimer and ferritin values, even higher than stroke patients. RT-PCR was performed in 8 CSF samples and was negative in all of them. CONCLUSION: Neurological disturbances represent a significant and severe burden in COVID-19 patients, and they can be the presenting condition that leads to the diagnosis of the viral infection in a high percentage of patients. Evidence of direct viral mechanisms was scarce, but the pathogenesis of the diverse manifestations remains enigmatic.

Consumo de alcohol y tabaco en estudiantes de primero de Medicina de la Universidad del País Vasco / Alcohol and tobacco consumption in first-year students of Medicine at the Universidad del País Vasco

Objetivo: Conocer la prevalencia y los patrones de consumo de alcohol y tabaco en función del género de los estudiantes de primero de medicina de la Universidad del País Vasco. Materiales y método: Estudio observacional, descriptivo y transversal mediante cuestionario anónimo autoadministrado basado en la encuesta ESTUDES y en el que se incluye el test AUDIT C y el Índice de dureza de fumar (HSI). Resultados: Muestra de 225 estudiantes (77,8% mujeres), media de edad 18,9 años. El 8,0% nunca ha consumido alcohol, el 80,0% ha consumido bebidas alcohólicas en el último mes y el 46,0% se ha emborrachado en los últimos 30 días. Entre los consumidores en el último mes, el 9,4% bebe todos los fines de semana, el 48,3% es bebedor de riesgo y el 67,2% ha realizado consumos intensivos de alcohol. Por lo que se refiere al tabaco, el 80,9% nunca ha fumado, el 2,2% fuma semanalmente y el 1,8% fuma a diario. No se observan diferencias significativas en función del género, excepto una mayor prevalencia de borracheras en el último año y consumos intensivos de alcohol en los hombres y de consumos de riesgo en las mujeres. Conclusiones: La prevalencia de fumadores es muy baja y muy inferior a la de otros universitarios de España. Por el contrario, las prevalencias de consumo de alcohol son elevadas y similares a las de otros jóvenes de la misma edad, sean o no estudiantes universitarios. Son necesarios programas específicos de prevención del consumo de alcohol y de otras drogas en estudiantes universitarios y particularmente en titulaciones que desempeñan un papel modélico para la población general

Objective. To find out the prevalence and patterns of alcohol and tobacco consumption based on gender among first-year students of medicine at the Universidad del País Vasco. Materials and method. An observational, descriptive and cross-sectional study using an anonymous, self-administered questionnaire based on the ESTUDES survey and including AUDIT C test and the Heaviness of Smoking Index (HSI). Results. Sample of 225 students (77.8% female), mean age 18.9 years. 8.0% have never consumed alcohol, 80.0% have consumed alcohol in the last month and 46.0% have been drunk in the last 30 days. Among consumers in the last month, 9.4% drink every weekend, 48.3% are risk drinkers and 67.2% have been binge drinking. As far as tobacco is concerned, 80.9% had never smoked, 2.2% smoke every week and 1.8% smoke daily. There were no significant gender differences, except for a higher prevalence of drunkenness in the last year and binge drinking in the males and risk drinking in females. Conclusions. The prevalence of smoking is very low and much lower than that of other university students in Spain. On the other hand, the prevalence of alcohol consumption is high and similar to that of other young people of the same age, whether university students or not. Specific programmes are required for prevention of the consumption of alcohol and other drugs among college students and particularly in those taking degree subjects that represent a role model for the general population