Progression of carotid near-occlusion to complete occlusion: related factors and clinical implications.

BACKGROUND: The clinical consequences and factors related to the progression from a carotid near-occlusion (CNO) to a complete occlusion are not well established. Our aim is to describe the rate, predictive factors and clinical implications of the progression to complete carotid occlusion (PCCO) in a population of patients with symptomatic CNO. METHODS: We conducted a multicenter, nationwide, prospective study from January 2010 to May 2016. Patients with angiography-confirmed CNO were included. We collected information on demographic data, clinical manifestations, radiological and hemodynamic findings, and treatment modalities. A 24 month carotid-imaging follow-up of the CNO was performed. RESULTS: 141 patients were included in the study, and carotid-imaging follow-up was performed in 122 patients. PCCO occurred in 40 patients (32.8%), and was more frequent in medically-treated patients (34 out of 61; 55.7%) compared with patients treated with revascularization (6 out of 61; 9.8%) (p<0.001). 7 of the 40 patients with PCCO (17.5%) suffered ipsilateral symptoms. Factors independently related with PCCO in the multivariate analysis were: age ≥75 years (OR 2.93, 95% CI 1.05 to 8.13), revascularization (OR 0.07, 95% CI 0.02 to 0.20), and collateral circulation through the ipsilateral ophthalmic artery (OR 3.25, 95% CI 1.01 to 10.48). CONCLUSIONS: PCCO occurred within 24 months in more than half of the patients under medical treatment. Most episodes of PCCO were not associated with ipsilateral symptoms. Revascularization reduces the risk of PCCO.

Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients.

BACKGROUND: In-hospital stroke death rate is an important sanitary issue. Despite advances in the acute phase management of stroke patients, mortality and disability rates remain high. In aging populations and with different mortality between the sexes in general, the study of sex- and age-related differences becomes increasingly relevant for optimization of post-acute clinical care of stroke patients. METHODS: We designed a cohort follow-up study with 13,932 consecutive ischemic stroke (IS) patients from 19 Spanish hospitals. Data was obtained from the Spanish Stroke Registry; transient ischemic attacks and ages <18 years were excluded. Patients were organised by age group and sex. We compared female and male patient cohorts within and across age groups univariately and used multivariable logistic regression to adjust for confounders in differential in-hospital mortality. RESULTS: The median (percentiles 2.5 and 97.5%) age was 78 (41-92) years old for women and 71 (41-92) for men. IS women were more likely to be older, to exhibit cardio-embolic aetiology, and less likely to have been admitted to a stroke unit or to have had a stroke code activated. Both pre-stroke modified Rankin Scale and National Institute of Health Stroke Scale (NIHSS) scores at admission increased significantly with age and were higher in women than those in men. Differences in distributions of common risk factors for IS and of in-hospital outcomes between women and men actually changed with patient's age. It is to be noted here that although there were no statistically significant differences (p > 0.05) between the sexes within any age group, in-hospital mortality appeared significantly higher in women than that in men when analysed overall, due to confounding. Death was more closely related to stroke in women than in men and occurred earlier. Although there were some age-specific sex differences between the predictors for in-hospital mortality, stroke severity measured by NIHSS was the main predictor of in-hospital mortality for both sexes. Topographic classifications - partial anterior circulatory infarct and total anterior circulatory infarct - were significant prognostic factors for men aged <60 years and for those in the 60-69 years range respectively. CONCLUSION: Although most of our findings were consistent with previous studies, it is important to take into account and highlight differences in in-hospital mortality between the sex and age group. Not to account for age-related differences between the sexes can give false results that may mislead management decisions. As most deaths in women were related to stroke, it is important to improve their early management, stroke code activation, access to stroke units and/or revascularisation therapies, especially in the older age groups.

Epidemiología del estridor en la población pediátrica del Hospital Universitario Clínica San Rafael atendida por servicio otorrinolaringología entre los años 2011 a 2014 / Epidemiology of stridor in the pediatric population of the San Rafael Hospital in Bogota during the years 2011-2014

Fue describir las características demográficas de pacientes cuyo síntoma principal fue estridor y que se presentaron en nuestro servicio en un período de 3 años entre enero de 2011 y 2014, valorando variables como sexo, edad, comorbilidades, hallazgos endoscópicos y causa congénita o adquirida para caracterizar estos pacientes y protocolizar su manejo. Se identificaron 34 casos de pacientes que ingresaron por estridor, entre edades de 1 mes y 4 años (media 8 meses). El 55% de los pacientes fueron hombres y el 45% mujeres. La comorbilidad más frecuente fue infección respiratoria inferior en el 52%. A la endoscopia lo más frecuente fue estenosis subglótica, el 100% adquirida; la patología congénita más frecuente fue laringomalacia. El 8% de los pacientes no presentó anormalidades endoscópicas relacionado con menor tiempo de evolución del estridor, es decir, se deben llevar a endoscopia pacientes con estridor persistente. Resultados correlacionados con literatura actual...

To describe the demographic characteristics of patients with stridor like main symptom who was submitted to our service over a period of three years between January 2011 and 2014. Design: Descriptive study. Methods: Variables such as sex, age, comorbidities, endoscopic fi ndings and congenital or acquired etiology, were evaluated to characterize these patients and protocolize their treatment. Results: 34 cases of patients were identifi ed and admitted for stridor, between a age range of 1 month to 4 years (median 8 months). 55% of the patients were male and 45% female. The most frequent comorbidity was the lower respiratory infection in 52%. At endoscopy the most frequent fi nding was subglottic stenosis, acquired in 100%; the most frequent congenital pathology was laryngomalacia. 8% of patients presented no endoscopic abnormalities associated with shorter evolution of stridor. Conclusion: We must take endoscopy patients with persistent stridor, the results relate to that reported in current literature...

Prognostic value of plasma ß-amyloid levels in patients with acute intracerebral hemorrhage.

BACKGROUND AND PURPOSE: It has been proposed that the deposition of the ß-amyloid peptide (Aß) in the brain parenchyma and brain blood vessels has deleterious effects. We tested the hypothesis that the levels of plasma Aß are related to the outcome in patients with intracerebral hemorrhage. METHODS: In a multicenter study, we prospectively included patients with spontaneous intracerebral hemorrhage within the first 24 hours after onset. At admission, we measured plasma Aß40 and Aß42 levels using ELISA techniques. Also, we recorded age, sex, vascular risk factors, National Institutes of Health Stroke Scale score, presence of intraventricular hemorrhage, localization, cause, and volume of the hematoma. We obtained the modified Rankin scale and defined a unfavorable outcome as modified Rankin scale >2 at 3 months. Bivariate and multivariate regression analyses were performed. RESULTS: We studied 160 patients (mean age, 73.8±11.3 years; 59.4% of them were men). A favorable outcome was observed in 64 (40%) of the patients. In the bivariate analyses, unfavorable outcome was associated with high age, female sex, diabetes mellitus, presence of intraventricular hemorrhage, high blood glucose, high National Institutes of Health Stroke Scale score, high volume, and high plasma levels of Aß42 and Aß40. The multivariate analysis showed that increased age (odds ratio, 1.07; 95% confidence interval, 1.035-1.21; P<0.0001), high admission National Institutes of Health Stroke Scale score (odds ratio, 1.29, 95% confidence interval, 1.17-1.42; P<0.0001), presence of diabetes mellitus (odds ratio, 4.15; 95% confidence interval, 1.21-14.1; P=0.02), and Aß42 levels >9.7 pg/mL (odds ratio, 4.11; 95% confidence interval, 1.65-10.1; P=0.02) were independently associated with an increased likelihood of an unfavorable outcome. CONCLUSIONS: High levels of plasma Aß42 in patients with acute intracerebral hemorrhage are associated with a poor functional prognosis.

Microbleed burden and hematoma expansion in acute intracerebral hemorrhage.

BACKGROUND: Intracranial amyloid and hypertensive angiopathy have been related to impaired blood vessel function and the etiology of intracerebral hemorrhage (ICH). Microbleeds (MBs) are surrogate radiological markers that are associated with these underlying angiopathies. We assessed the hypothesis that MBs are associated with hematoma expansion (HE) in patients with hyperacute ICH. METHODS: We studied patients with spontaneous supratentorial ICH within the first 6 h after onset. HE was defined as an increase≥33% in the volume of hematoma on the follow-up CT in comparison with the admission CT. The volume was calculated using the ABC/2 formula. MBs were detected by specific magnetic resonance sequences (gradient-echo). The presence, number and distribution of MBs were analyzed. RESULTS: Our study included 44 patients. Their mean age was 68.9±11.1 years, and 70.5% of them were men. HE was observed in 14 of the patients (31.8%). HE was more prevalent in patients with more than 10 MBs compared with patients with 1-10 MBs (60 vs 12.5%; p=0.03). CONCLUSION: A high burden of MBs is associated with an increased risk of HE in patients with ICH. This is probably a marker of a more severe underlying angiopathy.

Correlacion entre pulsioximetria y saturacion arterial de oxigeno en pacientes en cuidado intensivo / Correlation between pulse oximetry and arterial oxigen saturation in patients in ICU

Objetivo: en pacientes de la unidad de cuidado intensivo es muy importante la cuantificación de saturación periférica de 02 (Sp02) y la saturación arterial de 02 (Sa02); y la correlación de estos registros puede evitar el uso innecesario de estudios y facilitar la toma rápida de decisiones a través de una oximetría. Antecedentes: establecer la concordancia existente entre la saturación periférica de 02 medida por pulsioxímetría y la saturación arterial de 02 determinada por gasimetría arterial. Material y métodos: se tomaron muestras de gases arteriales y simultáneamente se registró el valor de pulsioxímetría. Se recolectaron 301 muestras, de 89 pacientes. Los casos estudiados correspondían a pacientes hospitalizados en la UCI médica de la Fundación Cardio-Infantil, mayores de 18 años y que tuvieran una línea arterial funcionante. La mayoría de los pacientes tenían falla respiratoria y procesos sépticos. El estudio se realizó entre noviembre de 2000 y diciembre de 2001. Las variables que se tuvieron en cuenta fueron: género, edad, raza, tensión arterial media, calidad del pulso radial, inotrópicos, estado de tabaquismo, pH, pC02, p02, saturación de 02 de la muestra arterial, valor de la pulsioxímetría, hemoglobina, pigmentos posibles en el paciente, fenómeno de Raynaud, sedación, ventilación mecánica, PEEP, fracción inspirada de oxígeno (FIO,). Resultados: hubo una excelente concordancia entre la Sp02 y Sa02. (Rho 0,785) Posteriormente se constituyeron dos grupos, el primero conformado por aquellos pacientes con una diferencia entre Sp02 y Sa02 menor o igual a 2 por ciento y el segundo con una diferencia superior a éste, encontrando diferencias estadísticamente significativas en el PEEP, la fracción inspirada de oxígeno, la presión arterial de oxígeno y la sedación. Conclusiones: la pulsioxímetría es una medida confiable y se constituye en un adecuado reemplazo en caso de querer evaluar la oxigenación.