Trombosis tardía asociada a dispositivo de cierre percutáneo de orejuela. ¿Es poco frecuente o está infradiagnosticada? / Late thrombosis associated with left atrial appendage closure devices. Is it rare or is it underdiagnosed?

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Knowledge of stroke a study from a sex perspective.

BACKGROUND: Public health is increasingly concerned with recognising factors that lead to sex differences in stroke. We conducted a study to determine the effect of sex on knowledge of stroke risk factors and warning signs, and how both are perceived, in a representative sample of adults. METHODS: A representative sample of the population of Extremadura, Spain was selected using a double randomisation technique. Previously trained medical students carried out face-to-face interviews using a structured questionnaire. RESULTS: 2409 subjects were interviewed [59.9 % women; mean age (SD) 49.0 (18.7) years]. Seventy-three percent of all subjects reported at least one correct warning sign of stroke (OR: 1.01; 95 % CI: 0.84-1.21). The most frequently mentioned warning signs were sudden weakness, dizziness, and headache. There were no sex differences regarding the types of warning symptoms that respondents listed. Women displayed better knowledge of risk factors than men (OR: 1.23; 95 % CI: 1.05-1.46). Women were more likely to name hypertension as a risk factor for stroke whereas men more frequently listed smoking, alcohol consumption and a sedentary lifestyle as risk factors. In response to stroke, women were significantly less likely than men to choose to call an ambulance or to go immediately to hospital (OR: 0.69; 95 % CI: 0.60-0.85). CONCLUSIONS: Stroke knowledge is suboptimal in both men and women. We detected better knowledge of stroke risk factors in women, as well as differences in the type of risk factors listed by men and women. There were significant sex differences regarding response to stroke or to its warning signs.

Detección del shunt intrapulmonar en pacientes con cirrosis hepática mediante doppler transcraneal con contraste. Estudio de prevalencia, caracterización del patrón y validez diagnóstica / Detection of an intrapulmonary shunt in patients with liver cirrhosis through contrast-enhanced transcranial Doppler. A study of prevalence, pattern characterization, and diagnostic validity

INTRODUCCIÓN: Las dilataciones vasculares intrapulmonares (DVIPu) están consideradas una complicación de la cirrosis. La ecocardiografía con contraste (ETTc) es la técnica de elección para su diagnóstico. El objetivo de este estudio es demostrar que el doppler transcraneal con contraste (DTCc) puede servir para el diagnóstico de las DVIPu. MÉTODO: Se incluyeron consecutivamente pacientes evaluados para trasplante hepático. Estudio transversal con enmascaramiento de la prueba de referencia (ETTc) para quien interpreta la prueba a valorar (DTCc). Analizamos la exactitud de la prueba diagnóstica mediante los valores de sensibilidad, especificidad, valor predictivo positivo y negativo, y razón de verosimilitud. RESULTADOS: Por DTCc (n = 43) existía shunt derecha-izquierda en 23 pacientes (62,2%): 4 precoces, 2 indeterminados y 17 tardíos. Diecinueve (51,4%) casos fueron clasificados DVIPu. Con ETTc (n = 37) 10 estudios (27%) fueron negativos para shunt y 27 (73%) positivos, 21 (56,8%) fueron compatibles con DVIPu. Los pacientes con y sin DVIPu no diferían en edad, sexo, etiología, gravedad o índice de MELD, independientemente del método diagnóstico. En el estudio de validez diagnóstica (n = 37) del DTCc frente a la ETTc, el rendimiento diagnóstico fue AUC = 0,813% (IC 95%: 0,666-0,959; p = 0,001), sensibilidad: 76,2% (IC 95%: 54,9-89,4) y especificidad: 90% (IC 95%: 63,9-96,5). Razón de verosimilitud positiva: 6,095. CONCLUSIONES: Demostramos una alta prevalencia de DVIPu en candidatos a trasplante hepático. La probabilidad que tiene el DTCc en detectar DVIPu cuando se observa shunt derecha-izquierda tardío con recirculación es muy elevada, y con pocos falsos positivos. Al ser una técnica previamente no descrita en este contexto, deben llevarse a cabo estudios similares con fin comparativo

INTRODUCTION: Intrapulmonary vascular dilatations (IPVD) are considered a complication of cirrhosis. The technique of choice for their diagnosis is contrast-enhanced echocardiography (CEE). The aim of this study was to determine the usefulness of contrast-enhanced transcranial Doppler (CETD) in the diagnosis of IPVD. METHOD: We consecutively included patients evaluated for liver transplantation. A cross-sectional study was conducted. The investigator interpreting CETD was blind to the results of the gold standard (CEE). The accuracy of the diagnostic test was evaluated through sensitivity, specificity, positive and negative predictive values, and likelihood ratio. RESULTS: CETD (n = 43) showed a right-to-left shunt in 23 patients (62.2%): 4 early, 2 indeterminate and 17 late. Nineteen (51,4%) cases were classified as IPVD. With CEE (n = 37), 10 procedures (27%) were negative for shunt, 27 (73%) were positive, and 21 (56.8%) were compatible with IPVD. Patients with and without IPVD showed no differences in age, sex, etiology, severity, or MELD score, independently of the diagnostic test. In the diagnostic validity study (n = 37) of CETD versus CEE, the AUC for diagnostic yield was 0.813% (95% CI: 0.666-0.959; P = .001), sensitivity was 76.2% (95% CI: 54.9-89.4) and specificity was 90% (95% CI: 63.9-96.5). The positive likelihood ratio was 6.095. CONCLUSIONS: We found a high prevalence of IPVD in candidates for liver transplantation. When a late right-to-left shunt with recirculation is observed, CETD has a high probability of detecting IPVD, with few false-positive results. Because this technique has not previously been described in this indication, similar studies are needed for comparison

[Detection of an intrapulmonary shunt in patients with liver cirrhosis through contrast-enhanced transcranial Doppler. A study of prevalence, pattern characterization, and diagnostic validity]. / Detección del shunt intrapulmonar en pacientes con cirrosis hepática mediante doppler transcraneal con contraste. Estudio de prevalencia, caracterización del patrón y validez diagnóstica.

INTRODUCTION: Intrapulmonary vascular dilatations (IPVD) are considered a complication of cirrhosis. The technique of choice for their diagnosis is contrast-enhanced echocardiography (CEE). The aim of this study was to determine the usefulness of contrast-enhanced transcranial Doppler (CETD) in the diagnosis of IPVD. METHOD: We consecutively included patients evaluated for liver transplantation. A cross-sectional study was conducted. The investigator interpreting CETD was blind to the results of the gold standard (CEE). The accuracy of the diagnostic test was evaluated through sensitivity, specificity, positive and negative predictive values, and likelihood ratio. RESULTS: CETD (n=43) showed a right-to-left shunt in 23 patients (62.2%): 4 early, 2 indeterminate and 17 late. Nineteen (51,4%) cases were classified as IPVD. With CEE (n=37), 10 procedures (27%) were negative for shunt, 27 (73%) were positive, and 21 (56.8%) were compatible with IPVD. Patients with and without IPVD showed no differences in age, sex, etiology, severity, or MELD score, independently of the diagnostic test. In the diagnostic validity study (n=37) of CETD versus CEE, the AUC for diagnostic yield was 0.813% (95%CI: 0.666-0.959; P=.001), sensitivity was 76.2% (95%CI: 54.9-89.4) and specificity was 90% (95%CI: 63.9-96.5). The positive likelihood ratio was 6.095. CONCLUSIONS: We found a high prevalence of IPVD in candidates for liver transplantation. When a late right-to-left shunt with recirculation is observed, CETD has a high probability of detecting IPVD, with few false-positive results. Because this technique has not previously been described in this indication, similar studies are needed for comparison.

Stroke Awareness Is Worse among the Old and Poorly Educated: A Population-Based Survey.

BACKGROUND: This article surveys a representative sample of adults to assess their knowledge of stroke, its vascular risk factors and warning symptoms, illness perception, and attitude toward strokes. METHODS: A representative sample of the region population was selected using a double randomization design. Previously trained medical students carried out face-to-face interviews using a structured questionnaire with open- and closed-ended questions. RESULTS: In all, 2411 subjects were interviewed. Seventy-three percent reported at least 1 correct warning sign of stroke, whereas only 12.2% reported 3. The most frequently mentioned were sudden weakness, dizziness, and headache. Only 59.2% named at least 1 correct risk factor for stroke. Smoking and hypertension were mainly named. Forty percent of the respondents demonstrated adequate knowledge of stroke. Tellingly, prevalence of adequate knowledge was significantly lower in subjects with previous stroke (29.3% [95% confidence interval {CI}, 19.7-40.3], P = .049), hypertension (35.0% [95% CI, 31.1-39.1], P = .009), diabetes (31.9% [95% CI, 25.9-38.3], P = .011), hypercholesterolemia (35.8% [95% CI, 31.8-39.9], P = .03), and obesity (28.2% [95% CI, 23.8-33.0], P < .001). Illness perception was generally correct. In the final logistic regression model, younger age, urban area of residence, higher educational level, higher family income, normal pressure, normal weight, and family history of stroke were associated with adequate knowledge of stroke. CONCLUSIONS: Basic knowledge of stroke is insufficient among the general population of Extremadura. There is a discrepancy between theoretical stroke knowledge and illness perception. These findings have implications for public health initiatives for stroke.