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Objetivo: Evaluar si clasificadores de aprendizaje supervisado no lineales basados en radiómica de la TC cerebral sin contraste (TCCSC) pueden predecir el pronóstico funcional al alta en pacientes con hematoma intracerebral espontáneo (HIE). Material y método: Análisis observacional retrospectivo y unicéntrico de pacientes con diagnóstico de HIE confirmado por TCCSC entre enero de 2016 y abril de 2018. Se incluyeron pacientes con HIE >18años y con TCCSC realizado dentro de las primeras 24horas del inicio de los síntomas. Se excluyeron los HIE secundarios y en los que no se disponía de las variables de radiómica. Se recogieron datos clínicos, demográficos y variables al ingreso. Los pacientes se clasificaron según la Escala Modificada de Rankin (mRS) al alta en buen (mRS0-2) y mal pronóstico (mRS3-6). Tras la segmentación manual de la TCCSC de cada HIE se obtuvieron las variables de radiómica. La muestra se dividió en una cohorte de entrenamiento y prueba y otra cohorte de validación (70-30%, respectivamente). Se usaron diferentes métodos de selección de variables y reducción de dimensionalidad, así como diferentes algoritmos para la construcción del modelo. Se realizaron 10 iteraciones de validación cruzada estratificada en la cohorte de entrenamiento y prueba y se calculó la media de los valores de área bajo la curva (AUC). Una vez entrenados los modelos, se calculó la sensibilidad de cada uno para predecir el pronóstico funcional al alta en la cohorte de validación. Resultados: Se analizaron 105 pacientes con HIE. Se evaluaron 105 variables de radiómica de cada paciente. Los algoritmos P-SVM, KNN-E y RF-10, en combinación con el método de selección de variables ANOVA, fueron los clasificadores con mejor rendimiento en la cohorte de entrenamiento y prueba (AUC: 0,798, 0,752 y 0,742, respectivamente)...(AU)

Purpose: To evaluate if nonlinear supervised learning classifiers based on non-contrast cerebral CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma (HIE). Methods: Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE >18years and with non-contrast CT performed within the first 24hours of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS0-2) and poor prognosis (mRS3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30%, respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. Results: 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC: 0.798, 0.752 and 0.742, respectively)...(AU)

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PURPOSE: To evaluate if nonlinear supervised learning classifiers based on non-contrast CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma. METHODS: Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE > 18 years and with TCCSC performed within the first 24 h of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS 0-2) and poor prognosis (mRS 3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30% respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. RESULTS: 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC 0.798, 0.752 and 0.742 respectively). The predictions of these models, in the validation cohort, had a sensitivity of 0.897 (0.778-1;95%CI), with a false-negative rate of 0% for predicting poor functional prognosis at discharge. CONCLUSION: The use of radiomics-based nonlinear supervised learning classifiers are a promising diagnostic tool for predicting functional outcome at discharge in HIE patients, with a low false negative rate, although larger and balanced samples are still needed to develop and improve their performance.

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Objetivos: Comparar el proceso asistencial prehospitalario y los resultados hospitalarios de los pacientes categorizados como Código Ictus (CI) en función del tipo de ambulancia que realiza la primera valoración, y analizar los factores asociados con un buen resultado funcional y la mortalidad a los 3 meses. Método: Estudio observacional de cohortes prospectivo multicéntrico. Incluyó todos los CI atendidos por un sistema de emergencias prehospitalario desde enero del 2016 a abril del 2022. Se recogieron variables prehospitalarias y hospitalarias. La variable de clasificación fue el tipo de ambulancia que asiste el CI: unidad de soporte vital básico (USVB) o avanzado (USVA). Las variables de resultado principal fueron la mortalidad y el estado funcional de los ictus isquémicos sometidos a tratamiento de reperfusión a los 90 días del episodio. Resultados: Se incluyeron 22.968 pacientes, de los cuales 12.467 (54,3%) presentaron un ictus isquémico con un buen estado funcional previo. El 93,1% fueron asistidos por USVB y se solicitó una USVA en el 1,6% de los casos. A pesar de presentar diferencias en el perfil clínico del paciente atendido y en los tiempos del proceso CI prehospitalario, el tipo de unidad no mostró una asociación independiente con la mortalidad (OR ajustada 1,1; IC 95%: 0,77-1,59) ni con el estado funcional a los 3 meses (OR ajustada 1,05; IC 95%: 0,72-1,47). Conclusiones: El porcentaje de complicaciones de los pacientes con CI atendidos por USVB es bajo. El tipo de unidad que asistió al paciente inicialmente no se asoció ni con el resultado funcional ni con la mortalidad a los 3 meses. (AU)

Objectives: To study prehospital care process in relation to hospital outcomes in stroke-code cases first attended by 2 different levels of ambulance. To analyze factors associated with a satisfactory functional outcome at 3 months. Methods: Prospective multicenter observational cohort study. All stroke-code cases attended by prehospital emergency services from January 2016 to April 2022 were included. Prehospital and hospital variables were collected. The classificatory variable was type of ambulance attending (basic vs advanced life support). The main outcome variables were mortality and functional status after ischemic strokes in patients who underwent reperfusion treatment 90 days after the ischemic episode. Results: Out of 22 968 stroke-code activations, ischemic stroke was diagnosed in 12 467 patients (54.3%) whose functional status was good before the episode. Basic ambulances attended 93.1%; an advanced ambulance was ordered in 1.6% of the patients. Even though there were differences in patient and clinical characteristics recorded during the prehospital process, type of ambulance was not independently associated with mortality (adjusted odds ratio [aOR], 1.1; 95% CI, 0.77-1.59) or functional status at 3 months (aOR, 1.05; 95% CI, 0,72-1,47). Conclusions: The percentage of patient complications in stroke-code cases attended by basic ambulance teams is low. Type of ambulance responding was not associated with either mortality or functional outcome at 3 months in this study. (AU)

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OBJECTIVES: To study prehospital care process in relation to hospital outcomes in stroke-code cases first attended by 2 different levels of ambulance. To analyze factors associated with a satisfactory functional outcome at 3 months. MATERIAL AND METHODS: Prospective multicenter observational cohort study. All stroke-code cases attended by prehospital emergency services from January 2016 to April 2022 were included. Prehospital and hospital variables were collected. The classificatory variable was type of ambulance attending (basic vs advanced life support). The main outcome variables were mortality and functional status after ischemic strokes in patients who underwent reperfusion treatment 90 days after the ischemic episode. RESULTS: Out of 22 968 stroke-code activations, ischemic stroke was diagnosed in 12 467 patients (54.3%) whose functional status was good before the episode. Basic ambulances attended 93.1%; an advanced ambulance was ordered in 1.6% of the patients. Even though there were differences in patient and clinical characteristics recorded during the prehospital process, type of ambulance was not independently associated with mortality (adjusted odds ratio [aOR], 1.1; 95% CI, 0.77-1.59) or functional status at 3 months (aOR, 1.05; 95% CI, 0,72-1,47). CONCLUSION: The percentage of patient complications in stroke-code cases attended by basic ambulance teams is low. Type of ambulance responding was not associated with either mortality or functional outcome at 3 months in this study.

OBJETIVO: Comparar el proceso asistencial prehospitalario y los resultados hospitalarios de los pacientes categorizados como Código Ictus (CI) en función del tipo de ambulancia que realiza la primera valoración, y analizar los factores asociados con un buen resultado funcional y la mortalidad a los 3 meses. METODO: Estudio observacional de cohortes prospectivo multicéntrico. Incluyó todos los CI atendidos por un sistema de emergencias prehospitalario desde enero del 2016 a abril del 2022. Se recogieron variables prehospitalarias y hospitalarias. La variable de clasificación fue el tipo de ambulancia que asiste el CI: unidad de soporte vital básico (USVB) o avanzado (USVA). Las variables de resultado principal fueron la mortalidad y el estado funcional de los ictus isquémicos sometidos a tratamiento de reperfusión a los 90 días del episodio. RESULTADOS: Se incluyeron 22.968 pacientes, de los cuales 12.467 (54,3%) presentaron un ictus isquémico con un buen estado funcional previo. El 93,1% fueron asistidos por USVB y se solicitó una USVA en el 1,6% de los casos. A pesar de presentar diferencias en el perfil clínico del paciente atendido y en los tiempos del proceso CI prehospitalario, el tipo de unidad no mostró una asociación independiente con la mortalidad (OR ajustada 1,1; IC 95%: 0,77- 1,59) ni con el estado funcional a los 3 meses (OR ajustada 1,05; IC 95%: 0,72-1,47). CONCLUSIONES: El porcentaje de complicaciones de los pacientes con CI atendidos por USVB es bajo. El tipo de unidad que asistió al paciente inicialmente no se asoció ni con el resultado funcional ni con la mortalidad a los 3 meses.

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Introducción: El accidente cerebrovascular (ACV) es una afección con alta morbimortalidad, producida por la interrupción de la perfusión cerebral. Este artículo tiene como objetivo analizar la tendencia de egresos hospitalarios por ACV agudo en el periodo 2018-2021 en Chile. Metodología: Estudio descriptivo observacional, que incluyó egresos hospitalarios con diagnóstico de ACV agudo en el periodo 2018-2021, en Chile (n=19.274), según datos del Departamento de Estadísticas e Información de Salud de Chile. Se calculó la tasa de egreso hospitalario (TEH) según variable, utilizando datos del censo chileno 2017. No requirió comité de ética. Resultados: El 2018 tuvo la mayor TEH por ACV agudo (28,99) y el 2021 la menor (26,39). El grupo de "80 años y más" presenta la mayor TEH, mientras que el de "5-9 años" la menor. La mayor y menor TEH las tienen las regiones de Ñuble (263,00) y Tarapacá (10,29), respectivamente. Discusión: La disminución de TEH durante dicho periodo podría deberse al fortalecimiento de la Ley de Urgencia, al Programa Nacional de Telesalud y el impacto de la reciente pandemia. A mayor edad, aumenta la prevalencia y gravedad de las comorbilidades, lo cual explicaría la mayor TEH en el grupo más longevo. La mayor TEH masculina podría ser porque los hombres presentan mayor cantidad y severidad de factores de riesgo. La mayor TEH en la región del Ñuble posiblemente sea por los elevados niveles de pobreza y ruralidad, y la menor TEH en Tarapacá podría relacionarse con la presencia de una población nacional más joven.

Introduction: Stroke (CVA) is a condition with high morbidity and mortality, produced by the interruption of cerebral perfusion. This article aims to analyze the trend of hospital discharges for acute stroke in the period 2018-2021 in Chile. Methodology: Descriptive observational study, which included hospital discharges with a diagnosis of acute stroke in the period 2018-2021, in Chile (n=19,274), according to data from the Chilean Department of Health Statistics and Information. The hospital discharge rate (HTE) was calculated according to variable, using data from the 2017 Chilean census. No ethics committee was required. Results: 2018 had the highest HTE for acute stroke (28.99) and 2021 the lowest (26.39). The group aged "80 years and older" had the highest TEH, while the group aged "5-9 years" had the lowest TEH. The regions of Ñuble (263.00) and Tarapacá (10.29) have the highest and lowest HTE, respectively. Discussion: The decrease in HTE during this period could be due to the strengthening of the emergency law, the National Telehealth Program and the impact of the recent pandemic. The higher the age, the higher the prevalence and severity of comorbidities, which would explain the higher HTE in the older group. The higher male HTE may be due to the fact that men have a greater number and severity of risk factors. The higher HTE in the Ñuble region is possibly due to the high levels of poverty and rurality, and the lower HTE in Tarapacá would be related to having a younger national population.

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Purpose:The early identification of oropharyngeal dysphagia (OD) in patients after an acute stroke using non-invasive and easily administered instruments can minimize its consequences and reduce comorbidity and mortality. The Volume-Viscosity Swallow Test (V-VST) is a screening test that makes it possible. The goal of this study is to contribute to the validation of the V-VST European Portuguese (V-VST: EP) version and study the prevalence of safety and efficacy signs in acute stroke patients. Method: The V-VST: EP, its instructions manual and algorithm, was presented to a panel of experts, to assess its content validity. It was applied to 33 acute stroke patients, with signs of OD, to analyze its psychometric properties. Finally, the prevalence of impaired signs of safety and efficacy was analyzed. Results: The V-VST: EP and its instruction manual (content) demonstrate very good agreement values. Most of the results for inter and intra-evaluator reliability presented Cohen's kappa values higher than 0.60 or 0.80 (75.0%). The concurrent validity (against the 3 OZ wst) presented a sensitivity of 100% and a specificity of 57.1%. For evaluator 1, the results presented are for the nectar, liquid and pudding consistencies, the prevalence values for the 5 ml, 10 ml and 20 ml volume capacity was: impaired lip closure (36%, 39%, 18%), piecemeal deglutition (50%, 50%, 50%), oral residue (7%, 0%, 9%), pharyngeal residue (25%, 17%, 9%) and safe swallowing (89%, 33%, 94%), respectively.(AU)

Propósito: La identificación temprana de la disfagia orofaríngea (DO) en pacientes después de un accidente cerebrovascular, utilizando instrumentos no invasivos y de fácil administración, puede minimizar sus consecuencias y reducir la comorbilidad y la mortalidad. El examen Volume-Viscosity Swallow Test (V-VST) es una prueba de detección que lo hace posible. El objetivo de este estudio es contribuir para la validación del V-VST Versión en portugués europeo (V-VST: EP) y estudio de prevalencia de signos de seguridad y eficacia en pacientes con ictus agudo. Método: Se presentó el V-VST: EP, su manual de instrucciones y algoritmo, a un panel de expertos, para evaluar su validez de contenido. Se aplicó a 33 pacientes con ictus agudo, con signos de DO, para analizar sus propiedades psicométricas. Finalmentese analizó la prevalencia de señales de deterioro de seguridad y eficacia. Resultados: El V-VST: EP y su manual de instrucciones (contenido) demuestran valores demuy buenaconcordancia. La mayoría de los resultados de confiabilidad inter e intra evaluador presentaron valoreskappa de Cohen superiores a 0,60 o 0,80 (75,0%). La validez concurrente (contra el peso de 3 OZ) presentada una sensibilidad del 100% y una especificidad del 57,1%. Para el evaluador 1, los resultados presentados son para las consistencias de néctar, líquido y budín, los valores de prevalencia para los 5 ml, 10 ml y 20 ml capacidad de volumen fue: deterioro del cierre de los labios (36%, 39%, 18%), deglución fragmentaria (50%, 50%, 50%), residuo oral (7%, 0%, 9%), residuo faríngeo (25%, 17%, 9%) y deglución segura (89%, 33%, 94%), respectivamente.(AU)

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Introducción: La segunda causa de muerte a nivel mundial corresponde a los ataques cerebrovasculares (ACV), de los cuales más de dos terceras partes son de origen isquémico. Causan discapacidad a largo plazo por lo que conocer la anatomía de la circulación cerebral y las posibles manifestaciones clínicas del ACV isquémico permite sospechar, diagnosticar y brindar un manejo oportuno y apropiado, reduciendo el impacto en la salud y la calidad de vida del paciente y sus cuidadores. Objetivo: relacionar los últimos hallazgos en la anatomía arterial cerebral, los mecanismos fisiopatológicos y las manifestaciones clínicas del ACV isquémico de la arteria cerebral media (ACM). Materiales y métodos: revisión de la literatura mediante la búsqueda con términos MeSH en la base de datos Medline, incluyendo estudios, ensayos y metaanálisis publicados entre 2000 y 2020 en inglés y español, además de otras referencias para complementar la información. Resultados: se seleccionaron 59 publicaciones, priorizando las de los últimos 5 años y las más relevantes del rango temporal consultado. Conclusiones: son escasos los estudios sobre la presentación clínica de los ACV, lo que sumado a la variabilidad interindividual de la irrigacióncerebral, dificulta la determinación clínica de la localización de la lesión dentro del lecho vascular. La reperfusión del área de penumbra isquémica como objetivo terapéutico se justifica por los mecanismos fisiopatológicos de la enfermedad.

Introduction: Cerebrovascular accidents (CVAs) are the second leading cause of death worldwide, of which more than two thirds are ischemic. They cause long-term disability, therefore, knowledge on the cerebral circulation anatomy and possible clinical manifestations of ischemic CVAs allows us to suspect, diagnose and provide timely and appropriate management, reducing the negative impact on the health and quality of life of patients and caregivers. Objective: to list the latest findings on cerebral arterial anatomy, pathophysiological mechanisms and clinical manifestations of ischemic middle cerebral artery (MCA) CVAs. Materials and methods: a literature review using a MeSH terms search in the Medline database, including studies, trials and meta-analyses published in English and Spanish between 2000 and 2020, using other complementary references. Results: 59 publications were selected prioritizing those published in the past 5 years and the most relevant in said period. Conclusions: there are few studies on the clinical presentation of CVAs, which, added to the interindividual variability of cerebral circulation anatomy, makes clinical identification of lesion location, within the vascular bed, difficult. Reperfusion of the ischemic penumbra region, as a therapeutic objective, is based on the pathophysiological mechanisms of the disease.

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Objective: We aimed to investigate the correlation between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and acute ischemic stroke (AIS) severity and recurrence, which could indicate the diagnostic and prognostic values of Lp-PLA2.MethodsTwo hundred and fifty-one AIS patients who were diagnosed in the department of neurology, China-Japan Union Hospital, from April 2018 to June 2019 and 100 non-cerebrovascular disease patients were included in this study. Demographic data and clinical materials including age, sex, BMI, medical history, bad habits, imaging data, blood tests, etc., were collected. Stroke severity and risk were evaluated, respectively. AIS patients were followed up for 6 months for stroke recurrence monitoring.ResultsThe AIS group had significantly higher Lp-PLA2 level than the control group. High Lp-PLA2 level was the independent risk factor of AIS (OR 1.010; 95% CI 1.007–1.013, P<0.001). Admission NIHSS was compared between Lp-PLA2 categories dichotomized by median. Serum Lp-PLA2 level was positively correlated with NIHSS (r=0.268, P<0.001). Mild stroke group and severe stroke group were defined based on NIHSS. Compared with the mild stroke group, the severe stroke group had higher smoking ratio, posterior circulation stenosis incidence, LDL level, Lp-PLA2 level and admission Essen score. (AU)

Objetivo: Nuestro objetivo fue investigar la correlación entre el nivel sérico de fosfolipasa A2 asociada a lipoproteína (Lp-PLA2) y la gravedad y recurrencia de los accidentes cerebrovasculares agudos (ACV), lo cual podría ser indicativo de los valores diagnóstico y pronóstico de Lp-PLA2.MétodosSe incluyó en el estudio a 251 pacientes de ACV diagnosticados en el Departamento de Neurología del Hospital China-Japan Union, desde abril de 2018 a junio de 2019, y a 100 pacientes sin enfermedad cerebrovascular. Se recopilaron los datos demográficos y materiales clínicos incluyendo edad, sexo IMC, historia médica, malos hábitos, estudios por imagen, análisis de sangre, etc. Se evaluaron la gravedad del accidente cerebrovascular y el riesgo, respectivamente, realizándose un seguimiento de supervisión de la recurrencia del accidente, de 6 meses de duración, a los pacientes de ACV.ResultadosEl grupo ACV tuvo un nivel de Lp-PLA2 significativamente superior al del grupo control. El nivel alto de Lp-PLA2 fue el factor de riesgo independiente de ACV (OR: 1,010; IC 95%: 1,007-1,013; p<0,001). Se comparó el valor de la escala NIHSS durante el ingreso entre las categorías Lp-PLA2, dicotomizadas por mediana. El nivel sérico de Lp-PLA2 se correlacionó positivamente con NIHSS (r=0,268; p<0,001). Se definieron el grupo de accidente leve y el grupo de accidente grave sobre la base de NIHSS. En comparación con el grupo de accidente leve, el grupo de accidente grave tenía un ratio más alto de fumadores, incidencia de estenosis circulatoria posterior, nivel de LDL, nivel de Lp-PLA2 y puntuación Essen durante el ingreso. La regresión logística reflejó que los niveles Lp-PLA2 por 50ng/ml (OR: 1,381; IC 95%: 1,212-1,573; p<0,001) y la categoría Lp-PLA2 (OR: 2,420; IC 95%: 1,363-4,297; p=0,003) estaban independientemente asociados a los accidentes graves. Durante el seguimiento de 6 meses realizado a los 251 pacientes de ACV, se observaron 31 casos de recurrencia de accidentes. (AU)

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OBJECTIVE: We aimed to investigate the correlation between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and acute ischemic stroke (AIS) severity and recurrence, which could indicate the diagnostic and prognostic values of Lp-PLA2. METHODS: Two hundred and fifty-one AIS patients who were diagnosed in the department of neurology, China-Japan Union Hospital, from April 2018 to June 2019 and 100 non-cerebrovascular disease patients were included in this study. Demographic data and clinical materials including age, sex, BMI, medical history, bad habits, imaging data, blood tests, etc., were collected. Stroke severity and risk were evaluated, respectively. AIS patients were followed up for 6 months for stroke recurrence monitoring. RESULTS: The AIS group had significantly higher Lp-PLA2 level than the control group. High Lp-PLA2 level was the independent risk factor of AIS (OR 1.010; 95% CI 1.007-1.013, P<0.001). Admission NIHSS was compared between Lp-PLA2 categories dichotomized by median. Serum Lp-PLA2 level was positively correlated with NIHSS (r=0.268, P<0.001). Mild stroke group and severe stroke group were defined based on NIHSS. Compared with the mild stroke group, the severe stroke group had higher smoking ratio, posterior circulation stenosis incidence, LDL level, Lp-PLA2 level and admission Essen score. Logistic regression showed Lp-PLA2 levels per 50ng/mL (OR 1.381, 95% CI 1.212-1.573, P<0.001) and Lp-PLA2 category (OR 2.420, 95% CI 1.363-4.297, P=0.003) were both independently associated with severe stroke. During the 6-month follow-up of all 251 AIS patients, 31 stroke recurrence cases were observed. Both Lp-PLA2 levels per 50ng/mL (OR 1.420, 95% CI 1.212-1.664, P<0.001) and Lp-PLA2 category (OR 2.726, 95% CI 1.201-6.178, P=0.016) were significantly associated with the stroke recurrence. Under the receiver Operating Characteristic curve, Lp-PLA2 showed significant predicting ability for stroke recurrence (AUC 0.723; 95% CI 0.620-0.826, P<0.001). CONCLUSION: High serum Lp-PLA2 level is correlated with AIS incidence, disease severity and recurrence, which could be utilized to guide clinical practice.

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Introducción y objetivos: La fibrilación auricular es la arritmia cardiaca más frecuente y una de las complicaciones más temidas es la embolia sistémica y/o el accidente cerebrovascular (ACV). En la actualidad se cuenta con diversas terapias antitrombóticas para prevención del primero, sin embargo, hay temor por complicaciones relacionadas con la anticoagulación, y aunque existen recomendaciones de diferentes guías de prácticas clínicas, continúa el uso subóptimo de la misma. El objetivo del estudio es describir datos clínicos, diagnósticos y terapéuticos de pacientes con fibrilación auricular que ingresan al servicio de urgencias, además, se realizó una correlación entre el riesgo de embolia sistémica y de sangrado con el tipo de terapia recibida. Métodos: Estudio descriptivo retrospectivo tipo serie de casos de pacientes con diagnóstico de la fibrilación auricular no valvular durante un año. Se reportan las frecuencias de comorbilidades, diagnósticos de ingreso y tipo de terapia específica. Resultados: Se incluyeron 98 pacientes, la media de edad fue 72 años, la falla cardiaca y la hipertensión arterial fueron las principales comorbilidades; el 92% tenían indicación de anticoagulación por la escala CHA2DS2VASc, 54% de estos pacientes no la venían recibiendo a pesar de que se calculó en la mayoría bajo riesgo de sangrado. El 5% de los pacientes ingresaron con diagnóstico de ACV isquémico y el 5% presentaban sobreanticogulación. Conclusión: Las características de nuestra población con la fibrilación auricular es similar a la descrita en la literatura, pero existe baja adherencia a las recomendaciones terapéuticas en anticoagulación.

Introduction and motivation: Atrial fibrillation is the most common cardiac arrhythmia. One of its most feared complications is the systemic embolism and/or the cerebrovascular accident (CVA) or stroke. Nowadays several antithrombotic therapies are available for the former; however, there are fears regarding complications related to anticoagulation, and even though recommendations of different clinical practice guidelines exist, blood-thinning drugs are still being underused. The goal of this study is to describe clinical, diagnostic and therapeutic data of patients admitted in the emergency room with atrial fibrillation; in addition, a correlation was made between the risk of systemic embolism and bleeding depending on the received treatment. Methods: Retrospective, descriptive study of case series of patients diagnosed with non-valvular atrial fibrillation during a year. Comorbidity frequencies, admission diagnoses and specific therapy types are reported. Results: 98 patients were included, average age was 72 years old, cardiac failure and high blood pressure were the main comorbidities; 92% showed an indication for anticoagulation therapy according to the CHA2DS2-VASc scale, 54% of those patients had not been receiving this therapy despite a low risk for bleeding was established for most of them. 5% of the patients received an admission diagnosis of ischemic stroke and 5% showed overanticoagulation. Conclusion: The characteristics of our sample with atrial fibrillation are similar to those described in the literature, but there is a low adherence to the treatment recommendations for anticoagulation therapy.

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Apathy is a motivational disturbance that can be defined as a quantitative reduction of goal-directed behaviour. Patients present with loss of motivation, concern, interest, and emotional response, resulting in a loss of initiative, decreased interaction with their environment, and a reduced interest in social life. Apathy not only appears to be common in stroke patients, but it has also been related to a wide range of negative consequences for the patients and their caregivers, including poor functional recovery, loss of social independence, and caregiver distress. Clear definition and consensus diagnostic criteria for apathy are needed to accomplish an accurate assessment and an individualised treatment plan. Although there have been reports of successful behavioural therapy treatment of apathetic states, there is a paucity of controlled clinical trials on the efficacy of apathetic behaviours using pharmacotherapy.

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