Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 33-39, feb. 2020. tab, graf
Artigo em Espanhol | LILACS-Express | ID: ibc-ET2-3434

RESUMO

Objetivo. Identificar los factores asociados con una respuesta inicial inmediata a los síntomas en los pacientes que han padecido un ictus isquémico. Método. Estudio observacional transversal en el que se incluyeron a todos los pacientes con ictus isquémico ingresados de forma consecutiva en el Hospital Universitario de Burgos (España) durante 1 año. Se recogieron parámetros sociodemográficos, clínicos, conductuales, cognitivos y contextuales, y se estudió su posible relación con el tiempo de reacción del paciente (TR) mediante análisis univariante y multivariante. Resultados. Se incluyeron 425 pacientes (mediana del TR de 140 minutos). El TR supuso un 72,6% del tiempo prehospitalario total (TPH), con una respuesta inmediata si el paciente se encontraba acompañado (OR 9,57; IC95% 3,89-23,52), si los síntomas se iniciaban durante el día (OR 8,77; 3,40-22,63), si el paciente sabía cómo actuar ante un posible ictus (OR 3,84; 2,77-7,09), si el primer contacto médico era con el servicio de emergencias médicas (SEM) (OR 3,03; 1,62-5,68), si el paciente percibía la situación como grave o muy grave (OR 2,38; 1,17-4,83) o si el ictus ocurría en el ámbito urbano (OR 2,17; 1,16-4,06). Conclusión. El intervalo de tiempo entre el inicio de los síntomas y la respuesta inicial del paciente se relaciona con factores conductuales, cognitivos y contextuales, los cuales deberían ser considerados en la planificación de futuras campañas educacionales


Objective. To identify factors related to a rapid response to the onset of symptoms and a call for help for patients with ischemic stroke. Methods. Observational cross-sectional study of all patients with ischemic stroke admitted consecutively to Hospital Universitario de Burgos in Spain during 1 year. We collected sociodemographic, clinical, behavioral, cognitive, and contextual data for all patients and applied uni- and multivariate analysis to explore possible associations with the patient's response time. Results. A total of 425 patients were included. The mean patient response time was 140.00 minutes. Patient delay accounted for 72.6% of the total prehospital response time. Factors associated with a rapid call for help were the presence of an accompanying person (OR, 9.57; 95% CI, 3.89–23.52), daytime onset of symptoms (OR, 8.77; 3.40-22.63), patient knowledge of how to act in case of stroke symptoms (OR, 3.84; 2.77-7.09), first medical contact through the public health system's emergency medical service (OR, 3.03; 1.62-5.68), patient perception of symptoms as severe or very severe (OR, 2.38; 1.17-4.83), and stroke onset in an urban area (OR, 2.17; 1.16-4.06). Conclusions. The patient's response time between onset of symptoms is related to behavioral, cognitive and contextual factors that should be taken into account when planning future patient education campaigns

2.
Emergencias ; 32(1): 33-39, 2020 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31909910

RESUMO

OBJECTIVES: To identify factors related to a rapid response to the onset of symptoms and a call for help for patients with ischemic stroke. MATERIAL AND METHODS: Observational cross-sectional study of all patients with ischemic stroke admitted consecutively to Hospital Universitario de Burgos in Spain during 1 year. We collected sociodemographic, clinical, behavioral, cognitive, and contextual data for all patients and applied uni- and multivariate analysis to explore possible associations with the patient's response time. RESULTS: A total of 425 patients were included. The mean patient response time was 140.00 minutes. Patient delay accounted for 72.6% of the total prehospital response time. Factors associated with a rapid call for help were the presence of an accompanying person (OR, 9.57; 95% CI, 3.89-23.52), daytime onset of symptoms (OR, 8.77; 3.40- 22.63), patient knowledge of how to act in case of stroke symptoms (OR, 3.84; 2.77-7.09), first medical contact through the public health system's emergency medical service (OR, 3.03; 1.62-5.68), patient perception of symptoms as severe or very severe (OR, 2.38; 1.17-4.83), and stroke onset in an urban area (OR, 2.17; 1.16-4.06). CONCLUSION: The patient's response time between onset of symptoms is related to behavioral, cognitive and contextual factors that should be taken into account when planning future patient education campaigns.

3.
J Clin Med ; 8(10)2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31627368

RESUMO

BACKGROUND: Despite recent advances in acute stroke care, only 1-8% of patients can receive reperfusion therapies, mainly because of prehospital delay (PHD). OBJECTIVE: This study aimed to identify factors associated with PHD from the onset of acute stroke symptoms until arrival at the hospital. METHODS: A cross-sectional study was conducted including all patients consecutively admitted with stroke symptoms to Burgos University Hospital (Burgos, Spain). Socio-demographic, clinical, behavioral, cognitive, and contextualized characteristics were recorded, and their possible associations with PHD were studied using univariate and multivariable regression analyses. RESULTS: The median PHD of 322 patients was 138.50 min. The following factors decreased the PHD and time until reperfusion treatment where applicable: asking for help immediately after the onset of symptoms (OR 10.36; 95% confidence interval (CI) 4.47-23.99), onset of stroke during the daytime (OR 7.73; 95% CI 3.09-19.34) and the weekend (OR 2.64; 95% CI 1.19-5.85), occurrence of stroke outside the home (OR 7.09; 95% CI 1.97-25.55), using a prenotification system (OR 6.46; 95% CI 1.71-8.39), patient's perception of being unable to control symptoms without assistance (OR 5.14; 95% CI 2.60-10.16), previous knowledge of stroke as a medical emergency (OR 3.20; 95% CI 1.38-7.40), call to emergency medical services as the first medical contact (OR 2.77; 95% CI 1.32-5.88), speech/language difficulties experienced by the patient (OR 2.21; 95% CI 1.16-4.36), and the identification of stroke symptoms by the patient (OR 1.98; 95% CI 1.03-3.82). CONCLUSIONS: The interval between the onset of symptoms and arrival at the hospital depends on certain contextual, cognitive, and behavioral factors, all of which should be considered when planning future public awareness campaigns.

4.
Emergencias ; 31(2): 86-90, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30963735

RESUMO

OBJECTIVES: To identify factors associated with activation of emergency medical services (EMS) in stroke. MATERIAL AND METHODS: Cross-sectional study of all patients admitted with stroke to Hospital Universitario de Burgos in Spain between September 1, 2015, and August 31, 2016. We recorded sociodemographic, clinical, behavioral, cognitive, and context information and explored possible associations with calls for EMS units. RESULTS: Three hundred eleven patients were included. EMS units were activated in 171 cases (55%) associated with an assessment that the patient was unable to manage the health situation from the onset of symptoms (adjusted odds ratio [OR], 6.95; 95% CI, 3.64-13.26), a witness's call for help (rather than the patient's) (OR, 5.68; 95% CI, 2.99-10.83), serious neurological deficit defined by a score over 16 on the National Institute of Health Stroke Scale (OR, 4.51; 95% CI, 1.10-18.46), a patient's awareness of serious symptoms leading to a call for help (OR, 4.03; 95% CI, 1.42-11.42), and a patient's history of high blood pressure (OR, 2.38; 95% CI, 1.25-4.54). CONCLUSION: Calls for EMS attendance from either a patient or a witness are associated with objective signs of severe stroke and subjective perception of severity.

5.
Emergencias (Sant Vicenç dels Horts) ; 31(2): 86-90, abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182524

RESUMO

Objetivo: Identificar los factores asociados con la activación del servicio de emergencias médicas (SEM) en pacientes que han padecido un ictus. Método: Estudio transversal en el que se incluyeron a todos los pacientes con ictus ingresados en el Hospital Universitario de Burgos (España) entre el 01/09/2015 y el 31/08/2016. Se recogieron datos sociodemográficos, clínicos, conductuales, cognitivos y contextuales, y se estudió su posible relación con el uso del SEM. Resultados: Se incluyeron 311 pacientes. El uso del SEM (n = 171; 55%) se asoció con el pensamiento del paciente de no ser capaz de manejar la situación en el momento de inicio de los síntomas con OR (ajustada) 6,95 (IC 95%: 3,64-13,26), con ser los testigos y no el paciente quienes solicitaran ayuda con OR 5,68 (IC 95%: 2,99-10,83), con presentar un déficit neurológico grave (NIHSS > 16) con OR 4,51 (IC 95%: 1,10-18,46), cuando el paciente solicitó ayuda atendiendo a la gravedad de los síntomas con OR 4,03 (IC 95%: 1,42-11,42) o cuando tenía antecedentes personales de hipertensión arterial OR 2,38 (IC 95%: 1,25-4,54). Conclusión: La solicitud de asistencia al SEM por parte del paciente o testigos se relaciona con factores objetivos de gravedad del ictus y con la percepción subjetiva de gravedad


Objective: To identify factors associated with activation of emergency medical services (EMS) in stroke. Methods: Cross-sectional study of all patients admitted with stroke to Hospital Universitario de Burgos in Spain between September 1, 2015, and August 31, 2016. We recorded sociodemographic, clinical, behavioral, cognitive, and context information and explored possible associations with calls for EMS units. Results: Three hundred eleven patients were included. EMS units were activated in 171 cases (55%) associated with an assessment that the patient was unable to manage the health situation from the onset of symptoms (adjusted odds ratio [OR], 6.95; 95% CI, 3.64-13.26), a witness's call for help (rather than the patient's) (OR, 5.68; 95% CI, 2.99-10.83), serious neurological deficit defined by a score over 16 on the National Institute of Health Stroke Scale (OR, 4.51; 95% CI, 1.10-18.46), a patient's awareness of serious symptoms leading to a call for help (OR, 4.03; 95% CI, 1.42-11.42), and a patient's history of high blood pressure (OR, 2.38; 95% CI, 1.25-4.54). Conclusion: Calls for EMS attendance from either a patient or a witness are associated with objective signs of severe stroke and subjective perception of severity


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Serviço Hospitalar de Emergência , Estudos Transversais , Cuidados Críticos , Ambulâncias , Transferência de Pacientes , Epidemiologia Descritiva
6.
Crit Care Med ; 45(8): e865-e866, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28422776

RESUMO

OBJECTIVE: To communicate a complication of prone-position ventilation. DATA SOURCES: Case history. STUDY SELECTION: Case report. DATA EXTRACTION AND DATA SYNTHESIS: Clinical information from medical record. CONCLUSIONS: This is a very infrequent cause of dysphagia following prone-position ventilation.


Assuntos
Doenças dos Nervos Cranianos/etiologia , Paralisia/etiologia , Decúbito Ventral , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Doenças do Nervo Glossofaríngeo/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
7.
J Neuroeng Rehabil ; 13(1): 79, 2016 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-27590188

RESUMO

BACKGROUND: Hemineglect is frequent after right hemisphere stroke and prevents functional independence, but effective rehabilitation interventions are lacking. Our objective was to determine if a visual-acoustic alarm in the hemineglect arm activated by a certain discrepancy in movement of both hands can enhance neglect arm use in five tasks of daily living. METHODS: In this pre-post intervention study 9 stroke patients with residual hemineglect of the arm were trained for 7 days in five bimanual tasks of daily living: carrying a tray, button fastening, cutting food with knife and fork, washing the face with both hands and arm sway while walking. This was done through motion sensors mounted in bracelets on both wrists that compared movement between them. When the neglect-hand movement was less than a limit established by two fuzzy logic based classifiers, a visual-acoustic alarm in the neglect-hand bracelet was activated to encourage its use in the task. RESULTS: Both motion and function of the neglect hand improved during the seven days of training when visual-acoustic alarms were active but a worsening to baseline values occurred on day 8 and day 30 when alarms where switched off. Improvement was limited to vision-dependent tasks. CONCLUSIONS: Neglect-hand improvement with this approach is limited to bimanual activities in which an object is manipulated under vision control, but no short or long term learning happens.


Assuntos
Reabilitação do Acidente Vascular Cerebral/instrumentação , Atividades Cotidianas , Idoso , Braço/fisiopatologia , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Acidente Vascular Cerebral/fisiopatologia
8.
J Inherit Metab Dis ; 39(1): 115-24, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26025547

RESUMO

BACKGROUND: Severe methylenetetrahydrofolate reductase (MTHFR) deficiency is a rare inborn defect disturbing the remethylation of homocysteine to methionine (<200 reported cases). This retrospective study evaluates clinical, biochemical genetic and in vitro enzymatic data in a cohort of 33 patients. METHODS: Clinical, biochemical and treatment data was obtained from physicians by using a questionnaire. MTHFR activity was measured in primary fibroblasts; genomic DNA was extracted from cultured fibroblasts. RESULTS: Thirty-three patients (mean age at follow-up 11.4 years; four deceased; median age at first presentation 5 weeks; 17 females) were included. Patients with very low (<1.5%) mean control values of enzyme activity (n = 14) presented earlier and with a pattern of feeding problems, encephalopathy, muscular hypotonia, neurocognitive impairment, apnoea, hydrocephalus, microcephaly and epilepsy. Patients with higher (>1.7-34.8%) residual enzyme activity had mainly psychiatric symptoms, mental retardation, myelopathy, ataxia and spasticity. Treatment with various combinations of betaine, methionine, folate and cobalamin improved the biochemical and clinical phenotype. During the disease course, patients with very low enzyme activity showed a progression of feeding problems, neurological symptoms, mental retardation, and psychiatric disease while in patients with higher residual enzyme activity, myelopathy, ataxia and spasticity increased. All other symptoms remained stable or improved in both groups upon treatment as did brain imaging in some cases. No clear genotype-phenotype correlation was obvious. DISCUSSION: MTHFR deficiency is a severe disease primarily affecting the central nervous system. Age at presentation and clinical pattern are correlated with residual enzyme activity. Treatment alleviates biochemical abnormalities and clinical symptoms partially.


Assuntos
Homocistinúria/enzimologia , Homocistinúria/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/deficiência , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Espasticidade Muscular/enzimologia , Espasticidade Muscular/genética , Ataxia/genética , Betaína/uso terapêutico , Criança , Feminino , Ácido Fólico/uso terapêutico , Estudos de Associação Genética/métodos , Homocistinúria/tratamento farmacológico , Humanos , Deficiência Intelectual/genética , Masculino , Metionina/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Mutação/genética , Fenótipo , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/enzimologia , Transtornos Psicóticos/genética , Estudos Retrospectivos , Doenças da Medula Espinal/genética , Vitamina B 12/uso terapêutico
9.
Int J Neural Syst ; 25(4): 1450036, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25684369

RESUMO

The development of efficient stroke-detection methods is of significant importance in today's society due to the effects and impact of stroke on health and economy worldwide. This study focuses on Human Activity Recognition (HAR), which is a key component in developing an early stroke-diagnosis tool. An overview of the proposed global approach able to discriminate normal resting from stroke-related paralysis is detailed. The main contributions include an extension of the Genetic Fuzzy Finite State Machine (GFFSM) method and a new hybrid feature selection (FS) algorithm involving Principal Component Analysis (PCA) and a voting scheme putting the cross-validation results together. Experimental results show that the proposed approach is a well-performing HAR tool that can be successfully embedded in devices.


Assuntos
Atividades Cotidianas , Diagnóstico Precoce , Atividade Motora/fisiologia , Reconhecimento Automatizado de Padrão/métodos , Acidente Vascular Cerebral/diagnóstico , Algoritmos , Inteligência Artificial , Lógica Fuzzy , Humanos , Acidente Vascular Cerebral/fisiopatologia
13.
Metab Brain Dis ; 28(1): 21-4, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23160835

RESUMO

Biochemical and metabolic analysis of ischemic cerebral tissue is central in stroke investigation and is usually performed in animal stroke models, such as the permanent occlusion of the middle cerebral artery (MCAO) in the rat that we have used. To be sure that the sample is from infarct tissue, it is differentiated from the surrounding normal tissue by staining, usually with 2,3,5-triphenyltetrazolium chloride (TTC), but staining can hamper biochemical colorimetric analysis. We performed this study to avoid this obstacle. A cerebral infarct was provoked in a sample of 10 rats and the brain was cut in coronal sections that were stained with TTC so that the unstained, infarct areas could be delineated in a template of each section in which areas with infarct in all animals were delineated. We calculated infarct coordinates and depth so that the infarct tissue can be sampled without staining. For more precision, the ischemic cortex can be delimited staining its surface before sectioning and cortical tissue into which TTC diffuses can be afterwards discarded, as we had previously measured the TTC diffusion depth in rat brains.


Assuntos
Infarto da Artéria Cerebral Média/diagnóstico , Sais de Tetrazólio , Animais , Modelos Animais de Doenças , Masculino , Ratos , Ratos Sprague-Dawley , Coloração e Rotulagem
14.
Neurochem Res ; 37(5): 1085-90, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22297726

RESUMO

Although coffee has antioxidant capacity, it is not known which of its bioactive compounds is responsible for it, nor has it been analyzed in experimental cerebral infarction. We studied the effect one of its compounds, 3-caffeoylquinic acid (3-CQA), at doses of 4, 25 and 100 µg on plasma antioxidant capacity and plasma polyphenol content, measuring the differences before and after inducing a cerebral infarction in an experimental rat model. We compared them with 3-caffeoylquinic-free controls. The increase in total antioxidant capacity was only higher than in controls in 3-CQA treated animals with the highest dose. This increase in antioxidant capacity was not due to an increase in polyphenols. No differences between the experimental and control group were found regarding polyphenol content and cerebral infarction volume. In conclusion, this increase in antioxidant capacity in the group that received the highest dose of 3-CQA was not able to reduce experimental cerebral infarction.


Assuntos
Antioxidantes/metabolismo , Infarto Cerebral/metabolismo , Ácido Clorogênico/farmacologia , Café/química , Polifenóis/metabolismo , Animais , Masculino , Ratos , Ratos Sprague-Dawley
15.
Neuroepidemiology ; 37(2): 90-5, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21894047

RESUMO

BACKGROUND: Mild hand tremor occurs in most normal adults. There are no surveys of the prevalence or clinical correlates of such tremor among children. METHODS: A cross-sectional study of tics, tremor and other neurological disorders was conducted in Spanish children; thus, 819 schoolchildren in Burgos, Spain, drew Archimedes spirals with each hand. Tremor in spirals was rated (0-2) by a blinded neurologist and an overall tremor rating (0-4) was assigned. RESULTS: The mean age was 10.9 ± 3.1 years. A tremor rating of 1 (mild tremor) was present in either hand in 424 (51.7%) children, and in both hands in 88 (10.7%) children. Higher tremor ratings were very uncommon. The overall tremor rating was higher in boys than girls (1.31 ± 0.41 vs. 1.22 ± 0.34, p = 0.002) and correlated weakly yet significantly with age (ρ = 0.09, p = 0.01). Within subjects, the left hand spiral rating was greater than the right (p < 0.001). CONCLUSIONS: In this cross-sectional study of 819 Spanish schoolchildren, mild tremor was commonly observed. As in adults, males had more tremor than females, tremor scores increased with age, and tremor scores were higher in the left than right arm, demonstrating that these clinical correlations seem to be more broadly generalizable to children. The functional significance of tremor in children, particularly as it relates to handwriting proficiency, deserves additional scrutiny.


Assuntos
Instituições Acadêmicas , Tremor/diagnóstico , Tremor/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Espanha/epidemiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA