RESUMEN

INTRODUCTION: Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS: Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS: Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION: In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.

Asunto(s)

Craniectomía Descompresiva , Trombosis de la Vena , Humanos , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Craniectomía Descompresiva/métodos , Estudios Retrospectivos , Pronóstico , Resultado del Tratamiento , Trombosis de la Vena/cirugía , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico

RESUMEN

BACKGROUND: Advanced interatrial block (IAB) is an independent risk factor for ischaemic stroke. This study aimed to analyse whether advanced IAB predicts recurrence of embolic stroke of undetermined source (ESUS). METHODS: 104 patients with a confirmed diagnosis of ESUS were followed up for a median period of 15 months (interquartile range, 10-48). We recorded data on clinical variables, P-wave characteristics, and presence of IAB on the electrocardiogram (ECG). ECG findings were interpreted by a blinded, centralised rater at (XXXX2). ESUS recurrence was the primary outcome variable. RESULTS: Median age was 47 years (range, 19-85); 50% of patients were women. IAB was detected in 36 patients (34.6%); IAB was partial in 29 cases (27.9%) and advanced in 7 (6.7%). Sixteen patients (15.4%) presented stroke recurrence; of these, 5 had partial and 4 had advanced IAB (P = .01; odds ratio [OR] = 9.44; 95% confidence interval [CI], 1.88-47.46; relative risk [RR] = 4.62; 95% CI, 2.01-10.61). Median P-wave duration was longer in patients with stroke recurrence (P = .009). The multivariate logistic regression analysis identified the following independent risk factors for stroke recurrence: advanced IAB (P < .001; OR = 10.86; 95% CI, 3.07-38.46), male sex (P = .028; OR = 4.6; 95% CI, 1.18-17.96), and age older than 50 years (P = .039; OR = 3.84; 95% CI, 1.06-13.88). In the Cox proportional hazards model, the risk variables identified were age older than 50 years (P = .002; hazard ratio, 7.04; 95% CI, 2.06-23.8) and P-wave duration (per ms) (P = .007; hazard ratio, 1.02; 95% CI, 1.01-1.04). CONCLUSIONS: Advanced IAB and age older than 50 years predict ESUS recurrence.

Asunto(s)

Fibrilación Atrial , Isquemia Encefálica , Accidente Cerebrovascular Embólico , Accidente Cerebrovascular , Fibrilación Atrial/diagnóstico , Isquemia Encefálica/diagnóstico , Femenino , Humanos , Bloqueo Interauricular/complicaciones , Bloqueo Interauricular/diagnóstico , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología

RESUMEN

INTRODUCTION: Moyamoya disease (MD) is a progressive, occlusive disease of the arteries of the anterior cerebral circulation that may cause ischaemia or haemorrhage. Patient management aims to prevent new cerebrovascular events through surgical revascularisation and/or pharmacological treatment. MATERIALS AND METHODS: We studied a series of 17 patients with MD (n = 14) or moyamoya syndrome (MS; n = 3), who were evaluated between January 1989 and December 2016; 11 patients were women and 6 were men. Thirteen patients had definitive MD (76%), one had unilateral MD (5.2%), and 3 had MS (18%). The condition manifested as intraparenchymal haemorrhage (in 35.2% of patients), brain ischaemia (29.4%), subarachnoid haemorrhage (17.6%), seizures (11.7%), and headache with no associated haemorrhage (1 patient). RESULTS: Ten patients (58.8%) underwent revascularisation and 7 (41.2%) received pharmacological treatment. All patients were evaluated with the modified Rankin Scale (mRs) at admission and at the last consultation; mRs scores were significantly lower in the group undergoing surgery (P <  .04). During follow-up, none of the patients undergoing revascularisation experienced recurrences, whereas 2 patients receiving pharmacological treatment did experience a new vascular event (one ischaemic and one haemorrhagic) (P <  .05). No significant differences were observed between the treatment outcomes of different revascularisation techniques. CONCLUSIONS: Although our population has different demographic characteristics from those of other non-Asian populations, ours is the largest published series of Hispanic individuals with MD. Our results support the use of revascularisation procedures to improve these patients' neurological status and to prevent new cerebrovascular events.

Asunto(s)

Isquemia Encefálica , Revascularización Cerebral , Enfermedad de Moyamoya , Circulación Cerebrovascular , Femenino , Humanos , Masculino , México/epidemiología , Enfermedad de Moyamoya/epidemiología

RESUMEN

INTRODUCTION: Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS: Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS: Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION: In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.

RESUMEN

BACKGROUND: Cerebral venous thrombosis (CVT) is associated with intracranial hemorrhage. AIM: To identify clinical and imaging features of CVT-associated intracranial hemorrhage. We hypothesized that higher clot burden would be associated with a higher risk of intracranial hemorrhage. METHODS: We performed a retrospective analysis of an international, multicenter cohort of patients with confirmed cerebral venous thrombosis who underwent computed tomography within 2 weeks of symptom onset. Clinical and imaging features were compared between patients with and without intracranial hemorrhage. Clot burden was assessed by counting the number of thrombosed venous sinuses and veins on confirmatory imaging. RESULTS: We enrolled 260 patients from 10 institutions in Europe and Mexico. The mean age was 42 years and 74% were female. Intracranial hemorrhage was found in 102 (39%). Among them parenchymal hemorrhage occurred in 64 (63%), in addition, small juxta-cortical hemorrhage was found in 30 (29%), subarachnoid hemorrhage in 24 (24%) and subdural hemorrhage in 11 (11%). Multiple concomitant types of hemorrhage occurred in 23 (23%). Older age and superior sagittal thrombosis involvement were associated with presence of hemorrhage. The number of thrombosed venous sinuses was not associated with intracranial hemorrhage (median number IQRInterquartile ratio] of sinuses/veins involved with hemorrhage 2 (1-3) vs. 2 (1-3) without hemorrhage, p = 0.4). CONCLUSION: The high rate of intracranial hemorrhage in cerebral venous thrombosis is not explained by widespread involvement of the venous sinuses. Superior sagittal sinus involvement is associated with higher bleeding risk.

Asunto(s)

Venas Cerebrales , Trombosis Intracraneal , Trombosis de la Vena , Adulto , Anciano , Europa (Continente) , Femenino , Humanos , Hemorragias Intracraneales/complicaciones , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/epidemiología , Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/epidemiología , Masculino , México , Estudios Retrospectivos , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/epidemiología

RESUMEN

INTRODUCTION: Moyamoya disease (MD) is a progressive, occlusive disease of the arteries of the anterior cerebral circulation that may cause ischaemia or haemorrhage. Patient management aims to prevent new cerebrovascular events through surgical revascularisation and/or pharmacological treatment. METHODS: We studied a series of 17 patients with MD (n = 14) or moyamoya syndrome (n = 3), who were evaluated between January 1989 and December 2016; 11 patients were women and 6 were men. Thirteen patients had definitive MD (76%), one had unilateral MD (5.2%), and 3 had moyamoya syndrome (18%). The condition manifested as intraparenchymal haemorrhage (in 35.2% of patients), brain ischaemia (29.4%), subarachnoid haemorrhage (17.6%), seizures (11.7%), and headache with no associated haemorrhage (one patient). RESULTS: Ten patients (58.8%) underwent revascularisation and 7 (41.2%) received pharmacological treatment. All patients were evaluated with the modified Rankin Scale (mRs) at admission and at the last consultation; mRs scores were significantly lower in the group undergoing surgery (P < .04). During follow-up, none of the patients undergoing revascularisation experienced recurrences, whereas 2 patients receiving pharmacological treatment did experience a new vascular event (one ischaemic and one haemorrhagic) (P < .05). No significant differences were observed between the treatment outcomes of different revascularisation techniques. CONCLUSIONS: Although our population has different demographic characteristics from those of other non-Asian populations, ours is the largest published series of Hispanic individuals with MD. Our results support the use of revascularisation procedures to improve these patients' neurological status and to prevent new cerebrovascular events.

RESUMEN

Systemic lupus erythematosus (SLE) patients are susceptible to the development of posterior reversible encephalopathy syndrome (PRES). The main theory concerning the physiopathology of PRES suggests that there is brain-blood barrier damage, which is associated with endothelial dysfunction, and characterized by vasogenic oedema. However, current evidence regarding its physiopathogenic mechanisms is quite scant. The aim of this study was to analyse the expression of different serum cytokines, as well as vascular endothelial growth factor (VEGF) and soluble CD40 ligand (sCD40L), in patients with PRES/systemic lupus erythematosus (SLE) and to compare them with levels in SLE patients without PRES and in healthy controls. We performed a transversal study in a tertiary care centre in México City. We included 32 subjects (healthy controls, n = 6; remission SLE, n = 6; active SLE, n = 6 and PRES/SLE patients, n = 14). PRES was defined as reversible neurological manifestations (seizures, visual abnormalities, acute confusional state), associated with compatible changes by magnetic resonance imaging (MRI). Serum samples were obtained during the first 36 h after the PRES episode and were analysed by cytometric bead array, Luminex multiplex assay or enzyme-linked immunosorbent assay (ELISA). Interleukin (IL)-6 and IL-10 levels were significantly higher in PRES/SLE patients (P = 0·013 and 0·025, respectively) when compared to the other groups. Furthermore, IL-6 and IL-10 levels displayed a positive correlation (r = 0·686, P = 0·007). There were no differences among groups regarding other cytokines, sCD40L or VEGF levels. A differential serum cytokine profile was found in PRES/SLE patients, with increased IL-6 and IL-10 levels. Our findings, which are similar to those described in other neurological manifestations of SLE, support the fact that PRES should be considered among the SLE-associated neuropsychiatric syndromes.

Asunto(s)

Citocinas/sangre , Lupus Eritematoso Sistémico/sangre , Síndrome de Leucoencefalopatía Posterior/sangre , Adulto , Ligando de CD40/sangre , Estudios de Casos y Controles , Citocinas/genética , Femenino , Humanos , Separación Inmunomagnética , Interleucina-10/genética , Interleucina-10/inmunología , Interleucina-6/genética , Interleucina-6/inmunología , Lupus Eritematoso Sistémico/complicaciones , Imagen por Resonancia Magnética , Síndrome de Leucoencefalopatía Posterior/complicaciones , Centros de Atención Terciaria , Factor A de Crecimiento Endotelial Vascular/genética , Factor A de Crecimiento Endotelial Vascular/inmunología

RESUMEN

BACKGROUND AND PURPOSE: The study aims to compare lipid profiles among ischemic stroke patients in a predominantly Caribbean-Hispanic population in Miami and a Mestizo Hispanic population in Mexico City. METHODS: We analyzed ischemic stroke Hispanic patients with complete baseline fasting lipid profile enrolled contemporaneously in the prospective registries of two tertiary care teaching hospitals in Mexico City and Miami. Demographic characteristics, risk factors, medications, ischemic stroke subtype, and first fasting lipid profile were compared. Vascular risk factor definitions were standardized. Multiple linear regression analysis was performed to compare lipid fractions. RESULTS: A total of 324 patients from Mexico and 236 from Miami were analyzed. Mexicans were significantly younger (58 · 1 vs. 67 · 4 years), had a lower frequency of hypertension (53 · 4% vs. 79 · 7%), and lower body mass index (27 vs. 28 · 5). There was a trend toward greater prevalence of diabetes in Mexicans (31 · 5 vs. 24 · 6%, P = 0 · 07). Statin use at the time of ischemic stroke was more common in Miami Hispanics (18 · 6 vs. 9 · 4%). Mexicans had lower total cholesterol levels (169 · 9 ± 46 · 1 vs. 179 · 9 ± 48 · 4 mg/dl), lower low-density lipoprotein (92 · 3 ± 37 · 1 vs. 108 · 2 ± 40 · 8 mg/dl), and higher triglyceride levels (166 · 9 ± 123 · 9 vs. 149 · 2 ± 115 · 2 mg/dl). These differences remained significant after adjusting for age, gender, hypertension, diabetes, body mass index, smoking, ischemic stroke subtype, and statin use. CONCLUSION: We found significant differences in lipid fractions in Hispanic ischemic stroke patients, with lower total cholesterol and low-density lipoprotein, and higher triglyceride levels in Mexicans. These findings highlight the heterogeneity of dyslipidemia among the Hispanic race-ethnic group and may lead to different secondary prevention strategies.

Asunto(s)

Isquemia/epidemiología , Trastornos del Metabolismo de los Lípidos/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hispánicos o Latinos , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Isquemia/complicaciones , Metabolismo de los Lípidos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/etiología

RESUMEN

INTRODUCTION: Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations is available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. METHODS: We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. RESULTS: Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 hour) arrival were family history of ischemic heart disease and personal history of migraines; in <3 hours: age 40-69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. CONCLUSIONS: A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis.

Asunto(s)

Isquemia Encefálica/terapia , Accidente Cerebrovascular/terapia , Tiempo de Tratamiento/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/mortalidad , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Pronóstico , Sistema de Registros , Accidente Cerebrovascular/mortalidad , Terapia Trombolítica , Resultado del Tratamiento , Adulto Joven

RESUMEN

BACKGROUND AND PURPOSE: Although pregnancy and postpartum have long been associated with stroke, there is a dearth of information in Latino-American populations. The aim of this study was to describe the cerebrovascular complications occurring during pregnancy/postpartum and compare the characteristics amongst stroke types occurring in this period in Hispanic women. PATIENTS AND METHODS: We studied 240 women with cerebrovascular complications during pregnancy and the first 5 weeks postpartum, from our stroke registry. Patients were classified into three groups: cerebral venous thrombosis (CVT), ischaemic stroke (IS), and intracerebral hemorrhage (ICH). For each group, clinical data, timing of the event, and outcome were analyzed. RESULTS: Of the 240 women, 136 had CVT (56.7%), 64 IS (26.7%), and 40 ICH (16.6%). In 72 women (30%), the event occurred during pregnancy, in 153 (64%) during postpartum, and in 15 (6%) closely related to labor. CVT was more common in the first trimester of pregnancy and in the second and third weeks following delivery; whilst IS and ICH were seen mainly during pregnancy and the first 2 weeks following delivery. Pre-eclampsia/eclampsia was more common in patients with ICH (57.5%) and IS (36%) than in those with CVT (9.6%) (P < 0.001). An excellent recovery (modified Rankin Scale: 0-1) was observed amongst women with CVT (64%) and IS (50%) compared to ICH (32%), (P = 0.004). CONCLUSIONS: Pre-eclampsia/eclampsia is a frequent risk factor in patients with ICH and IS, but not in CVT. Stroke types clustered different within the pregnancy-postpartum period. A good prognosis is observed in patients with CVT.

Asunto(s)

Trastornos Cerebrovasculares/diagnóstico , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Trastornos Puerperales/diagnóstico , Adolescente , Adulto , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/etnología , Comorbilidad/tendencias , Femenino , Hispánicos o Latinos , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/etnología , Pronóstico , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etnología , Sistema de Registros , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etnología , Adulto Joven

RESUMEN

AIMS: The pathogenesis of spontaneous cervical artery dissection remains unknown. We examined the association between different polymorphisms frequently found in young patients with cryptogenic stroke [methylenetetrahydrofolate reductase (MTHFR) C677T, factor II (prothrombin) G20210A, factor V G1691A (Leiden), nitric oxide synthase 3 (NOS3) intron 4 VNTR, and apolipoprotein E (APOE) epsilon4 gene] in patients with a cerebral infarct caused by spontaneous cervical artery dissection. METHODS: Forty-eight patients (27 males) and 96 matching control subjects were recruited. Clinical history, including cardiovascular risk factors, was assessed in all subjects. Genotypes were determined by a polymerase chain reaction with and without a restriction fragment length polymorphism. The genotypes and allele frequencies of the five genetic variants studied were compared between spontaneous cervical artery dissection cases and controls. We also incorporated our data into a meta-analysis of the MTHFR/C677T variant. RESULTS: Of 48 patients with spontaneous cervical artery dissection (28 vertebral and 20 carotid), the mean age of the patients was 36.6 +/- SD 9.9 years. There were no significant associations between the alleles of the five genetic polymorphisms studied and spontaneous cervical artery dissection. In the meta-analysis of the MTHFR/C677T variant, a total of 564 individuals (231 cases and 333 controls) were analysed; no significant association was observed. CONCLUSIONS: The results from this exploratory case-control study show the lack of an association between MTHFR, factor II G20210A, factor V G1691A, NOS3, intron 4 VNTR, and APOE epsilon4 gene polymorphisms and the development of spontaneous cervical artery dissection. Our findings contribute towards a better understanding of the genetic risk factors associated with spontaneous cervical artery dissection.

Asunto(s)

Apolipoproteínas E/genética , Factor V/genética , Predisposición Genética a la Enfermedad , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Óxido Nítrico Sintasa de Tipo III/genética , Polimorfismo Genético , Polimorfismo de Nucleótido Simple , Disección de la Arteria Vertebral/genética , Adulto , Demografía , Femenino , Genotipo , Humanos , Intrones/genética , Masculino , Persona de Mediana Edad , Repeticiones de Minisatélite/genética , Insuficiencia del Tratamiento , Resultado del Tratamiento , Disección de la Arteria Vertebral/enzimología

RESUMEN

INTRODUCTION: Nonaneurysmal subarachnoid hemorrhage (SAH) accounts for 15% to 20% of all the cases of SAH. Its prognosis may vary from complete recovery to different and serious complications. We describe a series of cases with nonaneurysmal SAHs, their clinical and tomographic characteristics and causes as well as long term prognosis. PATIENTS AND METHODS: 50 patients diagnosed of SAH and two negative brain angiographies for aneurysm were followed-up for an average period of 62 months. The demographic data of importance, vascular risk factors, were recorded. They were evaluated during the acute phase with the Hunt and Hess clinical scale and Fisher topographic scale. The distribution of the hemorrhage was listed as absent, perimesencephalic, focal, ventricular or diffuse. Presence of rebleeding, death and the functional course, measured by the Rankin modified scale, were recorded during the follow-up. According to this scale, Rankin of 0 to 2 was considered as a favorable prognosis. RESULTS: This series represents 8.6 of all the SAH cases in our hospital. In 6 cases (12%), there was a causal relationship between the use of sympathicomimetic drugs and the development of SAH. In 80% of them, it was not possible to document the cause of the hemorrhage, while difference causes )cerebral venous thrombosis in 4 [8%], spontaneous dissection of the vertebral artery in 2 [4%], vasculitis secondary to neurocystecerosis in 2 [4%], cavernous angioma in 1 [2%] and spinal arteriovenous malformation in 1) were found. Rebleeding did not occur in any of the cases and only one patient died. In 45 patients (90%), the final functional prognosis was good (Rankin 0-2). We found no significant differences between the tomographic pattern of the hemorrhage, initial clinical condition and long term prognosis. CONCLUSIONS: Our findings show a low frequency of nonaneurysmal SAH in our population and a diversity of causes greater than those reported by other series. The good functional prognosis in these cases was confirmed.

Asunto(s)

Hemorragia Subaracnoidea/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Malformaciones Arteriovenosas/complicaciones , Daño Encefálico Crónico/epidemiología , Daño Encefálico Crónico/etiología , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Hemangioma Cavernoso/complicaciones , Humanos , Hipertensión/complicaciones , Trombosis Intracraneal/complicaciones , Masculino , México/epidemiología , Persona de Mediana Edad , Neurocisticercosis/complicaciones , Pronóstico , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Hemorragia Subaracnoidea/etiología , Simpatomiméticos/efectos adversos , Disección de la Arteria Vertebral/complicaciones

RESUMEN

OBJECTIVE: To offer an educational alternative on diabetes, with the participation of patients with type 2 diabetes, their family members, and health care providers, adapted to local conditions and to these person's felt needs. METHODS: Focused on the primary-care level, this program was carried out in the health area of El Guarco, which is in the province of Cartago, Costa Rica. The first stage of the project included a qualitative study of the knowledge and practices of both patients and health care providers, looking at diabetes prevention and control and the local availability of foods. Based on those results, an educational methodology was developed, educational manuals were written, and courses for health care providers, patients, and patients' families were implemented. Other strategies were developed to make the effort sustainable. RESULTS: We found that patients did not associate family history or obesity with diabetes and that those persons were also confused about the symptoms of diabetes. Patients also received inconsistent nutrition messages from health care providers. Using the diabetes education manual as a base, the providers increased their knowledge of diabetes prevention, treatment, and education by an average of 85%. The diabetic patients who received educational training (mean age, 57.0 years, with a standard deviation of 8.9 years; 92% women) improved their glycemic control. Blood glucose levels decreased from 189 +/- 79 mg/dL (average and standard deviation) to 157 +/- 48 mg/dL (P < 0.05), and glycosylated hemoglobin (HbA1c) went from 11.3% +/- 2.4% to 9.7% +/- 2.3% (P = 0.05). There were no significant changes in body weight or lipid profile, except for triglycerides, which declined (P < 0.05). CONCLUSIONS: This educational program was successfully incorporated into the regular activities of the El Guarco-area health centers. The primary-care level is ideal for carrying out educational programs for diabetes treatment and early detection that are directed at patients, their families, and health care providers.

Asunto(s)

Diabetes Mellitus Tipo 2/prevención & control , Educación en Salud , Adulto , Anciano , Costa Rica , Diabetes Mellitus Tipo 2/dietoterapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Atención Primaria de Salud , Factores de Riesgo

RESUMEN

The present study analyzes the aterogenic factors of the diet of the Costa Rican population in various population and geographic groups. Data utilized was obtained from the Second National Survey on Apparent Food Consumption, 1991. Results found that on the national level consumption of fats, in relation to total caloric intake was higher than recommended levels. Likewise, the percentage of saturated fats exceed the established recommendations for prevention cardiovascular disease, and the intake of polyunsaturated fats was inferior to recommended levels. P/S ratio was 0.3, a value within the range considered to be aterogenic. Cholesterol intake is considered to be adequate. Cholesterol-Saturated-Index (CSI) of the majority of the diets studied was high, as reported in similar situation in other countries where cardiovascular disease is likewise the first cause of death. Dietary fiber was found to be in the lower levels of the daily recommendations. Also, the intake of vitamin C and E shows normal values, while intake of vitamin A is deficient. The principal source of three types of fat in the diet, as well as vitamin E, was shortening made from palm oil, which in spite of no being a rich source of unsaturated fatty acid, the consumption of it is high. Egg is the main source of cholesterol and dietary fiber is primarily obtained from beans. In conclusion, the Costa Rican diet presents a nutritional imbalance which can be considered an atherogenic risk factor for cardiovascular disease.

Asunto(s)

Enfermedades Cardiovasculares , Dieta Aterogénica , Enfermedades Cardiovasculares/prevención & control , Colesterol , Costa Rica , Carbohidratos de la Dieta , Fibras de la Dieta , Ingestión de Energía , Ácidos Grasos , Humanos , Factores de Riesgo , Factores Socioeconómicos , Urbanización , Vitaminas

RESUMEN

We studied the effect of Cisapride (10 mg vo every 8 hours) on the characteristics of the evacuations, orocoecal transit time and motility trough rectoanal manometry in patients diagnosed with chronic constipation. The patients (N = 51) received placebo and/or drug in a controlled, randomized, double blind, crossed study during two treatment phases of 30 days each. The end of each phase was followed by a clinical evaluation, a rectoanal manometry and hydrogen breath test. Cisapride increased the rhythm of ecacuations (5.53 days +/- 3.11 vs 1.59 days +/- 1.15 p < 0.05) improved the frequency of evacuations and diminished the consistency of the feces (p < 0.05), shortened the orocoecal transit time (271.57 min +/- 9.87 vs 201.18 min +/- 29.30 p < 0.05) and improved the parameters of the rectoanal manometry readings such as the pressure of internal anal sphincter (58.14 mmHg 7.33 vs 53.90 mmHg 5.19 p < 0.05), and its relaxation percentage (73.41% +/- 15.30 vs 66.84% +/- 11.83 p < 0.05). Side effects associated with Cisapride were not significant. It is concluded that Cisapride improves intestinal motility in chronic constipation.

Asunto(s)

Estreñimiento/tratamiento farmacológico , Piperidinas/uso terapéutico , Simpatomiméticos/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Cisaprida , Estudios Cruzados , Método Doble Ciego , Femenino , Tránsito Gastrointestinal/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos

RESUMEN

The purpose of this study was to define the dietary pattern of fatty acids, cholesterol, fiber and sucrose in a random sample of 51 families of San José, Costa Rica. Food intake was estimated by using the one-day food weighing method. For food composition values, a single table was created using data taken from others. The results indicated that the level of macronutrient diet composition was in accordance with the United States National Cholesterol Education Program Recommendations. Nevertheless, total dietary fiber (20.3 g/d) intake was below the level suggested by the guidelines, and the percentage of calories from sucrose (12.6%) was above those recommendations. In conclusion, the low P/S ratio, low dietary fiber and high percentage of calories from sucrose in the diet of this urban population group of San José, has several atherogenic features representing one of the important risk factors associated with cardiovascular disease.

Asunto(s)

Enfermedad Coronaria/etiología , Dieta/efectos adversos , Conducta Alimentaria , Adolescente , Adulto , Anciano , Niño , Preescolar , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/prevención & control , Costa Rica , Registros de Dieta , Ácidos Grasos/análisis , Femenino , Análisis de los Alimentos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Factores de Riesgo , Población Urbana

RESUMEN

La hiperlipoproteinemia tipo V, es una alteración en el metabolismo de las lipoproteínas, que se caracteriza por hipertrigliceridemia servera. El presente estudio muestra el efecto de una intervención nutricional sobre las concentraciones séricas de triglicéridos y colesterol en trece pacientes...

Asunto(s)

Humanos , Masculino , Femenino , Colesterol , Colesterol en la Dieta , Lipoproteínas/análisis , Ciencias de la Nutrición , Triglicéridos/análisis , Triglicéridos/efectos adversos , Costa Rica

Asunto(s)

Niño , Humanos , Estatura , Peso Corporal , Población Rural , Costa Rica , Metabolismo Energético , Conducta Alimentaria

Asunto(s)

Embarazo , Adolescente , Adulto , Humanos , Femenino , Anemia Hipocrómica , Hierro , Necesidades Nutricionales , Complicaciones del Embarazo