RESUMO
BACKGROUND: Improper use of antibiotics increases antimicrobial resistance. OBJECTIVE: Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. MATERIAL AND METHODS: Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. ANALYSIS: Frequencies, percentages, medians, ranges and X2 test. RESULTS: Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). CONCLUSIONS: Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.
Assuntos
Antibioticoprofilaxia , Gestão de Antimicrobianos/organização & administração , Prescrição Inadequada/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Cuidados Pré-Operatórios , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos , Feminino , Hospitais Urbanos , Humanos , Prescrição Inadequada/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , México , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto JovemRESUMO
Antecedentes: La presencia de quilotórax se define como un líquido pleural con abundantes concentraciones de quilomicrones, o con niveles elevados de triglicéridos, mayor a 110 mg/dl y bajos de colesterol. Dentro de las causas más frecuentes de quilotórax no traumático o secundario a un abordaje quirúrgico tenemos las neoplasias hematológicas y tumoraciones mediastinales. Objetivo: Reportar el éxito de ésta opción terapéutica ofrecida. Caso clínico: Paciente femenino de 58 años con antecedente de 1 año de evolución con dolor lumbar. La tomografía reporta tumoración mediastinal con derrame pleural bilateral. Se realiza toracocentésis obteniendo calidad del liquido como quilotórax bilateral. Se inicia manejo medico y se procede a realizar toracotomía izquierda y toracoscopía derecha con pleurodesis química con iodopovidona. La paciente evoluciona favorablemente, dependiente de oxígeno. Los resultados finales de patología reportan mediastinitis fibrosante IgG4 negativo. Discusión: Los síntomas de presentación de la enfermedad son poco específicos y depende de la afectación de órganos torácicos. En nuestro caso se trató de afectación del conducto torácico, con la consecuente formación de quilotórax bilateral. Conclusiones: No existe un tratamiento curativo definitivo para esta enfermedad. La mortalidad es variable, reportándose de hasta 30% a 6 años y esta relacionada a la afectación de los órganos intratorácicos.
Background: The prescience of chylothorax is defined as pleural liquid with abundant concentrations of chylomicrons, with high levels of triglycerides, more than 110 mg/dl and low in cholesterol. Between the most frequent causes of non-traumatic chylothorax are secondary to a surgical procedure, hematologic neoplasms and mediastinal tumors. Objective: Report de success rate of the therapeutic technique used in this patient. Clinical Case: A 48-year-old female with history of 1 year of lumbar pain, a computer tomography was performed where mediastinal tumor and bilateral pleural effusion was diagnosed. A thoracentesis was performed diagnosing bilateral chylothorax. Medical treatment was started without improvement, a left thoracotomy and right thoracoscopy with chemical pleurodesis were performed. Patient improved clinically, dependent of oxygen. Final pathologic exam reported IgG4 negative fibrosant mediastinitis. Discussion: The symptoms of presentation of the disease are not specific and depend on the invasion to adjacent thoracic organs, with the consequent formation of bilateral chylothorax. Conclusions: No curative treatment exists for this disease. It presents with variable mortality, some of 30% at 6 years and it is related with intrathoracic organ affection.
Assuntos
Fibrose , QuilotóraxRESUMO
BACKGROUND: The rheumatoid arthritis is a clinical entity capable to cause hearing impairment that can be diagnosed promptly with high frequencies audiometry. OBJECTIVE: To detect subclinical sensorineural hearing loss in patients with rheumatoid arthritis. MATERIAL AND METHODS: Cross-sectional study on patients with rheumatoid arthritis performing high frequency audiometry 125Hz to 16,000Hz and tympanometry. The results were correlated with markers of disease activity and response to therapy. RESULTS: High frequency audiometry was performed in 117 female patients aged from 19 to 65 years. Sensorineural hearing loss was observed at a sensitivity of pure tones from 125 to 8,000 Hz in 43.59%, a tone threshold of 10,000 to 16,000Hz in 94.02% patients in the right ear and in 95.73% in the left ear. Hearing was normal in 8 (6.84%) patients. Hearing loss was observed in 109 (93.16%), and was asymmetric in 36 (30.77%), symmetric in 73 (62.37%), bilateral in 107 (91.45%), unilateral in 2 (1.71%), and no conduction and/or mixed hearing loss was encountered. Eight (6.83%) patients presented vertigo, 24 (20.51%) tinnitus. Tympanogram type A presented in 88.90% in the right ear and 91.46% in the left ear, with 5.98 to 10.25% type As. Stapedius reflex was present in 75.3 to 85.2%. Speech discrimination in the left ear was significantly different (p = 0.02)in the group older than 50 years. No association was found regarding markers of disease activity, but there was an association with the onset of rheumatoid arthritis disease. CONCLUSIONS: Patients with rheumatoid arthritis had a high prevalence of sensorineural hearing loss for high and very high frequencies.
Assuntos
Artrite Reumatoide/complicações , Perda Auditiva Neurossensorial/etiologia , Testes de Impedância Acústica , Adulto , Idoso , Audiometria de Tons Puros , Estudos Transversais , Feminino , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Bilateral/etiologia , Perda Auditiva de Alta Frequência/diagnóstico , Perda Auditiva de Alta Frequência/etiologia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Unilateral/diagnóstico , Perda Auditiva Unilateral/etiologia , Humanos , Pessoa de Meia-Idade , Testes de Discriminação da Fala , Zumbido/etiologia , Vertigem/etiologiaRESUMO
Regrettably, stroke has been scarcely studied in México, and the available data suffer from great variability in diagnostic testing, risk factor definitions, and poor generalizability. The current cumulative incidence of stroke in Mexico is 232.2 per 100,000, whereas prevalence among people aged 60 years or older is 18.2 per 1000. Hypertension and diabetes are the main risk factors. Ischemic stroke is the most frequent sub-type. Stroke mortality has been increasing during last years, and 30-day case fatality rate doubles at one-year follow-up. A remarkable finding of a hospital-based registry was that most of ischemic stroke cases are of undetermined etiology and even when a quarter of patients arrive on time for thrombolysis, less than 1% received this management.
Assuntos
Acidente Vascular Cerebral , Efeitos Psicossociais da Doença , Humanos , México , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapiaRESUMO
Background. The benign metastasizing leiomyoma is an exceptionally rare entity; it presents with ectopic leiomyoma nodules with a benign pattern. Symptoms vary according to the anatomic location. The diagnosis is histopathological, usually in patients with history of hysterectomy. Case Presentation. A 36-year-old female with 2-month history of left knee pain was diagnosed with bone fibrosarcoma. A CT scan showed pulmonary nodules. The patient started neoadjuvant chemotherapy. Conservative surgery of pelvic limb was achieved. A new CT scan reported pulmonary nodules that remained in relation to the previous CT. A nodule resection by thoracotomy and TOB (transoperative biopsy) was performed. The final pathology report described benign proliferative lesions consistent with benign metastatic leiomyoma. Conclusions. Benign metastatic leiomyoma is a rare condition presenting with uterine and extrauterine nodules most commonly in the lung. The diagnosis is histopathological. The surgical procedure must be reserved for selected patients.
RESUMO
Cada año, cientos de miles de personas en Latinoamérica sufren un accidente cerebrovascular (ACV), y se prevé que la cantidad de ACV por año aumente dramáticamente a medida que la población envejece. Esta es una epidemia que ya comienza a aparecer, y se requieren medidas inmediatas para evitar una crisis. Muchos de estos pacientes mueren a causa de un ACV; otros quedan con discapacidades graves, lo que es devastador no sólo para sus vidas, sino también para sus familiares y cuidadores. No sorprende que las consecuencias económicas del ACV sean enormes, tanto para las personas como para los sistemas de atención médica. La fibrilación auricular (FA) -la anomalía sostenida más común del ritmo cardíaco- afecta a millones de personas en Latinoamérica. Por ejemplo, en Brasil, se ha estimado que, aproximadamente, 1,5 millones de pacientes viven con FA. Las personas con FA tienen un riesgo cinco veces mayor de ACV en comparación con la población general. Más aún, los ACV relacionados con la FA son más graves, tienen peor evolución y son más costosos que los ACV en pacientes sin FA. Por lo tanto, los pacientes con FA constituyen una población importante para reducir la carga general del ACV. Este informe tiene como objetivo generar conciencia entre los profesionales de la salud y quienes tienen poder de decisión sobre la salud acerca de que la mejor comprensión y tratamiento de la FA y una mejor prevención del ACV son posibles. Sin embargo, se necesita una mayor inversión en la prevención del ACV, especialmente, en pacientes con FA. Se requiere con urgencia la acción coordinada de los gobiernos de los países latinoamericanos, a fin de lograr el diagnóstico más temprano y el mejor tratamiento de la FA, y para reducir el riesgo de ACV en pacientes con FA. La implementación de las recomendaciones detalladas en este informe, a nivel regional y nacional, será crucial.
Eachyear, hundredsof thousands of peoplein Latin America suffera stroke, and it is expected that the number of strokes per year increases dramatically as the population ages. This is an epidemic that is beginning to emerge, requiring immediate action to avoid a crisis. Many of these patients die from a stroke; others are severely disabled, which is devastating not only for their lives, but also for their families and caregivers. Not surprisingly, the economic consequences of stroke are enormous, both for individuals and for health care systems. Atrial fibrillation (AF) -the most common sustained abnormality of heart rhythm- affects about 6 million people in Latin America. For example,in Brazil, it was estimated that approximately1.5 million patients living AF. Individuals with AF are at a fivefold increased risk of stroke compared with the general population. Furthermore, strokes related to AF are more severe and have poorer outcomes than strokes in patients without AF. Patients with AF are therefore an important target population for reducing the overall burden of stroke. This report aims to raise awareness among patients, policy makers, healthcare professionals and the general public that better knowledge and management of AF and better prevention of stroke are possible. However, greater investment in preventing stroke is needed, particularly in patients with AF. Coordinated action bygovernmentsof Latin American countries is urgently required to achieve earlier diagnosis and better management of AF and to reduce the risk of stroke in patients with AF. Implementation of the recommendations detailed in this report, at regional and national level, will be crucial.
A cada ano, centenas de milhares de pessoas na América Latina manifestam um acidente vascular cerebral (AVC) e está previsto que o número de AVC por ano aumentará drasticamente com o envelhecimento da população. Esta é uma epidemia que já teve início, necessitando de ação imediata para que se evite uma crise. Muitos desses pacientes vêm a falecer de AVC; outros ficam com graves sequelas que devastam não somente a sua vida, mas a de seus familiares e cuidadores. De forma não surpreendente, as implicações de AVC são imensas tanto para os indivíduos como para os sistemas de saúde. A fibrilação atrial (FA) -a arritmia cardíaca sustentada mais comum- afeta milhões de pessoas na América Latina. Por exemplo, no Brasil, estimou-se que há aproximadamente 1,5 milhões de pacientes que convivem com FA. Indivíduos com FA têm risco cinco vezes maior de AVC comparados à população geral. Além disso, os AVC relacionados à FA são mais graves, têm desfechos piores e são mais onerosos do que AVC em pacientes sem FA. Portanto, pacientes com FA são uma população alvo importante para a redução do ônus geral de AVC. Este relatório visa aumentar a conscientização entre os elaboradores de políticas e os profissionais de saúde de que é possível obter melhor conhecimento e manejo da FA e melhor prevenção de AVC. Entretanto, é necessário um investimento maior na prevenção de AVC, principalmente em pacientes com FA. A ação coordenada entre governos nacionais de países latinoamericanos é urgentemente necessária para se obter um diagnóstico precoce e manejar melhor a FA, e para reduzir o risco de AVC em pacientes com FA. A implementação das recomendações pormenorizadas neste relatório, em âmbito regional e nacional, será crucial.
RESUMO
Cada año, cientos de miles de personas en Latinoamérica sufren un accidente cerebrovascular (ACV), y se prevé que la cantidad de ACV por año aumente dramáticamente a medida que la población envejece. Esta es una epidemia que ya comienza a aparecer, y se requieren medidas inmediatas para evitar una crisis. Muchos de estos pacientes mueren a causa de un ACV; otros quedan con discapacidades graves, lo que es devastador no sólo para sus vidas, sino también para sus familiares y cuidadores. No sorprende que las consecuencias económicas del ACV sean enormes, tanto para las personas como para los sistemas de atención médica. La fibrilación auricular (FA) -la anomalía sostenida más común del ritmo cardíaco- afecta a millones de personas en Latinoamérica. Por ejemplo, en Brasil, se ha estimado que, aproximadamente, 1,5 millones de pacientes viven con FA. Las personas con FA tienen un riesgo cinco veces mayor de ACV en comparación con la población general. Más aún, los ACV relacionados con la FA son más graves, tienen peor evolución y son más costosos que los ACV en pacientes sin FA. Por lo tanto, los pacientes con FA constituyen una población importante para reducir la carga general del ACV. Este informe tiene como objetivo generar conciencia entre los profesionales de la salud y quienes tienen poder de decisión sobre la salud acerca de que la mejor comprensión y tratamiento de la FA y una mejor prevención del ACV son posibles. Sin embargo, se necesita una mayor inversión en la prevención del ACV, especialmente, en pacientes con FA. Se requiere con urgencia la acción coordinada de los gobiernos de los países latinoamericanos, a fin de lograr el diagnóstico más temprano y el mejor tratamiento de la FA, y para reducir el riesgo de ACV en pacientes con FA. La implementación de las recomendaciones detalladas en este informe, a nivel regional y nacional, será crucial.(AU)
Eachyear, hundredsof thousands of peoplein Latin America suffera stroke, and it is expected that the number of strokes per year increases dramatically as the population ages. This is an epidemic that is beginning to emerge, requiring immediate action to avoid a crisis. Many of these patients die from a stroke; others are severely disabled, which is devastating not only for their lives, but also for their families and caregivers. Not surprisingly, the economic consequences of stroke are enormous, both for individuals and for health care systems. Atrial fibrillation (AF) -the most common sustained abnormality of heart rhythm- affects about 6 million people in Latin America. For example,in Brazil, it was estimated that approximately1.5 million patients living AF. Individuals with AF are at a fivefold increased risk of stroke compared with the general population. Furthermore, strokes related to AF are more severe and have poorer outcomes than strokes in patients without AF. Patients with AF are therefore an important target population for reducing the overall burden of stroke. This report aims to raise awareness among patients, policy makers, healthcare professionals and the general public that better knowledge and management of AF and better prevention of stroke are possible. However, greater investment in preventing stroke is needed, particularly in patients with AF. Coordinated action bygovernmentsof Latin American countries is urgently required to achieve earlier diagnosis and better management of AF and to reduce the risk of stroke in patients with AF. Implementation of the recommendations detailed in this report, at regional and national level, will be crucial.(AU)
A cada ano, centenas de milhares de pessoas na América Latina manifestam um acidente vascular cerebral (AVC) e está previsto que o número de AVC por ano aumentará drasticamente com o envelhecimento da populaþÒo. Esta é uma epidemia que já teve início, necessitando de aþÒo imediata para que se evite uma crise. Muitos desses pacientes vÛm a falecer de AVC; outros ficam com graves sequelas que devastam nÒo somente a sua vida, mas a de seus familiares e cuidadores. De forma nÒo surpreendente, as implicaþ§es de AVC sÒo imensas tanto para os indivíduos como para os sistemas de saúde. A fibrilaþÒo atrial (FA) -a arritmia cardíaca sustentada mais comum- afeta milh§es de pessoas na América Latina. Por exemplo, no Brasil, estimou-se que há aproximadamente 1,5 milh§es de pacientes que convivem com FA. Indivíduos com FA tÛm risco cinco vezes maior de AVC comparados O populaþÒo geral. Além disso, os AVC relacionados O FA sÒo mais graves, tÛm desfechos piores e sÒo mais onerosos do que AVC em pacientes sem FA. Portanto, pacientes com FA sÒo uma populaþÒo alvo importante para a reduþÒo do ¶nus geral de AVC. Este relatório visa aumentar a conscientizaþÒo entre os elaboradores de políticas e os profissionais de saúde de que é possível obter melhor conhecimento e manejo da FA e melhor prevenþÒo de AVC. Entretanto, é necessário um investimento maior na prevenþÒo de AVC, principalmente em pacientes com FA. A aþÒo coordenada entre governos nacionais de países latinoamericanos é urgentemente necessária para se obter um diagnóstico precoce e manejar melhor a FA, e para reduzir o risco de AVC em pacientes com FA. A implementaþÒo das recomendaþ§es pormenorizadas neste relatório, em Ômbito regional e nacional, será crucial.(AU)
RESUMO
Cada año, cientos de miles de personas en Latinoamérica sufren un accidente cerebrovascular (ACV), y se prevé que la cantidad de ACV por año aumente dramáticamente a medida que la población envejece. Esta es una epidemia que ya comienza a aparecer, y se requieren medidas inmediatas para evitar una crisis. Muchos de estos pacientes mueren a causa de un ACV; otros quedan con discapacidades graves, lo que es devastador no sólo para sus vidas, sino también para sus familiares y cuidadores. No sorprende que las consecuencias económicas del ACV sean enormes, tanto para las personas como para los sistemas de atención médica. La fibrilación auricular (FA) -la anomalía sostenida más común del ritmo cardíaco- afecta a millones de personas en Latinoamérica. Por ejemplo, en Brasil, se ha estimado que, aproximadamente, 1,5 millones de pacientes viven con FA. Las personas con FA tienen un riesgo cinco veces mayor de ACV en comparación con la población general. Más aún, los ACV relacionados con la FA son más graves, tienen peor evolución y son más costosos que los ACV en pacientes sin FA. Por lo tanto, los pacientes con FA constituyen una población importante para reducir la carga general del ACV. Este informe tiene como objetivo generar conciencia entre los profesionales de la salud y quienes tienen poder de decisión sobre la salud acerca de que la mejor comprensión y tratamiento de la FA y una mejor prevención del ACV son posibles. Sin embargo, se necesita una mayor inversión en la prevención del ACV, especialmente, en pacientes con FA. Se requiere con urgencia la acción coordinada de los gobiernos de los países latinoamericanos, a fin de lograr el diagnóstico más temprano y el mejor tratamiento de la FA, y para reducir el riesgo de ACV en pacientes con FA. La implementación de las recomendaciones detalladas en este informe, a nivel regional y nacional, será crucial.
Each year, hundreds of thousands of people in Latin America suffer a stroke, and it is expected that the number of strokes per year increases dramatically as the population ages. This is an epidemic that is beginning to emerge, requiring immediate action to avoid a crisis. Many of these patients die from a stroke; others are severely disabled, which is devastating not only for their lives, but also for their families and caregivers. Not surprisingly, the economic consequences of stroke are enormous, both for individuals and for health care systems. Atrial fibrillation (AF) -the most common sustained abnormality of heart rhythm- affects about 6 million people in Latin America. For example, in Brazil, it was estimated that approximately1.5 million patients living AF. Individuals with AF are at a fivefold increased risk of stroke compared with the general population. Furthermore, strokes related to AF are more severe and have poorer outcomes than strokes in patients without AF. Patients with AF are therefore an important target population for reducing the overall burden of stroke. This report aims to raise awareness among patients, policy makers, healthcare professionals and the general public that better knowledge and management of AF and better prevention of stroke are possible. However, greater investment in preventing stroke is needed, particularly in patients with AF. Coordinated action by governments of Latin American countries is urgently required to achieve earlier diagnosis and better management of AF and to reduce the risk of stroke in patients with AF. Implementation of the recommendations detailed in this report, at regional and national level, will be crucial.
A cada ano, centenas de milhares de pessoas na América Latina manifestam um acidente vascular cerebral (AVC) e está previsto que o número de AVC por ano aumentará drasticamente com o envelhecimento da população. Esta é uma epidemia que já teve início, necessitando de ação imediata para que se evite uma crise. Muitos desses pacientes vêm a falecer de AVC; outros ficam com graves sequelas que devastam não somente a sua vida, mas a de seus familiares e cuidadores. De forma não surpreendente, as implicações de AVC são imensas tanto para os indivíduos como para os sistemas de saúde. A fibrilação atrial (FA) -a arritmia cardíaca sustentada mais comum- afeta milhões de pessoas na América Latina. Por exemplo, no Brasil, estimou-se que há aproximadamente 1,5 milhões de pacientes que convivem com FA. Indivíduos com FA têm risco cinco vezes maior de AVC comparados à população geral. Além disso, os AVC relacionados à FA são mais graves, têm desfechos piores e são mais onerosos do que AVC em pacientes sem FA. Portanto, pacientes com FA são uma população alvo importante para a redução do ônus geral de AVC. Este relatório visa aumentar a conscientização entre os elaboradores de políticas e os profissionais de saúde de que é possível obter melhor conhecimento e manejo da FA e melhor prevenção de AVC. Entretanto, é necessário um investimento maior na prevenção de AVC, principalmente em pacientes com FA. A ação coordenada entre governos nacionais de países latinoamericanos é urgentemente necessária para se obter um diagnóstico precoce e manejar melhor a FA, e para reduzir o risco de AVC em pacientes com FA. A implementação das recomendações pormenorizadas neste relatório, em âmbito regional e nacional, será crucial.
RESUMO
Cada año, cientos de miles de personas en Latinoamérica sufren un accidente cerebrovascular (ACV), y se prevé que la cantidad de ACV por año aumente dramáticamente a medida que la población envejece. Esta es una epidemia que ya comienza a aparecer, y se requieren medidas inmediatas para evitar una crisis. Muchos de estos pacientes mueren a causa de un ACV; otros quedan con discapacidades graves, lo que es devastador no sólo para sus vidas, sino también para sus familiares y cuidadores. No sorprende que las consecuencias económicas del ACV sean enormes, tanto para las personas como para los sistemas de atención médica. La fibrilación auricular (FA) -la anomalía sostenida más común del ritmo cardíaco- afecta a millones de personas en Latinoamérica. Por ejemplo, en Brasil, se ha estimado que, aproximadamente, 1,5 millones de pacientes viven con FA. Las personas con FA tienen un riesgo cinco veces mayor de ACV en comparación con la población general. Más aún, los ACV relacionados con la FA son más graves, tienen peor evolución y son más costosos que los ACV en pacientes sin FA. Por lo tanto, los pacientes con FA constituyen una población importante para reducir la carga general del ACV. Este informe tiene como objetivo generar conciencia entre los profesionales de la salud y quienes tienen poder de decisión sobre la salud acerca de que la mejor comprensión y tratamiento de la FA y una mejor prevención del ACV son posibles. Sin embargo, se necesita una mayor inversión en la prevención del ACV, especialmente, en pacientes con FA. Se requiere con urgencia la acción coordinada de los gobiernos de los países latinoamericanos, a fin de lograr el diagnóstico más temprano y el mejor tratamiento de la FA, y para reducir el riesgo de ACV en pacientes con FA. La implementación de las recomendaciones detalladas en este informe, a nivel regional y nacional, será crucial.(AU)
Each year, hundreds of thousands of people in Latin America suffer a stroke, and it is expected that the number of strokes per year increases dramatically as the population ages. This is an epidemic that is beginning to emerge, requiring immediate action to avoid a crisis. Many of these patients die from a stroke; others are severely disabled, which is devastating not only for their lives, but also for their families and caregivers. Not surprisingly, the economic consequences of stroke are enormous, both for individuals and for health care systems. Atrial fibrillation (AF) -the most common sustained abnormality of heart rhythm- affects about 6 million people in Latin America. For example, in Brazil, it was estimated that approximately1.5 million patients living AF. Individuals with AF are at a fivefold increased risk of stroke compared with the general population. Furthermore, strokes related to AF are more severe and have poorer outcomes than strokes in patients without AF. Patients with AF are therefore an important target population for reducing the overall burden of stroke. This report aims to raise awareness among patients, policy makers, healthcare professionals and the general public that better knowledge and management of AF and better prevention of stroke are possible. However, greater investment in preventing stroke is needed, particularly in patients with AF. Coordinated action by governments of Latin American countries is urgently required to achieve earlier diagnosis and better management of AF and to reduce the risk of stroke in patients with AF. Implementation of the recommendations detailed in this report, at regional and national level, will be crucial.(AU)
A cada ano, centenas de milhares de pessoas na América Latina manifestam um acidente vascular cerebral (AVC) e está previsto que o número de AVC por ano aumentará drasticamente com o envelhecimento da populaþÒo. Esta é uma epidemia que já teve início, necessitando de aþÒo imediata para que se evite uma crise. Muitos desses pacientes vÛm a falecer de AVC; outros ficam com graves sequelas que devastam nÒo somente a sua vida, mas a de seus familiares e cuidadores. De forma nÒo surpreendente, as implicaþ§es de AVC sÒo imensas tanto para os indivíduos como para os sistemas de saúde. A fibrilaþÒo atrial (FA) -a arritmia cardíaca sustentada mais comum- afeta milh§es de pessoas na América Latina. Por exemplo, no Brasil, estimou-se que há aproximadamente 1,5 milh§es de pacientes que convivem com FA. Indivíduos com FA tÛm risco cinco vezes maior de AVC comparados O populaþÒo geral. Além disso, os AVC relacionados O FA sÒo mais graves, tÛm desfechos piores e sÒo mais onerosos do que AVC em pacientes sem FA. Portanto, pacientes com FA sÒo uma populaþÒo alvo importante para a reduþÒo do ¶nus geral de AVC. Este relatório visa aumentar a conscientizaþÒo entre os elaboradores de políticas e os profissionais de saúde de que é possível obter melhor conhecimento e manejo da FA e melhor prevenþÒo de AVC. Entretanto, é necessário um investimento maior na prevenþÒo de AVC, principalmente em pacientes com FA. A aþÒo coordenada entre governos nacionais de países latinoamericanos é urgentemente necessária para se obter um diagnóstico precoce e manejar melhor a FA, e para reduzir o risco de AVC em pacientes com FA. A implementaþÒo das recomendaþ§es pormenorizadas neste relatório, em Ômbito regional e nacional, será crucial.(AU)
Assuntos
Angioplastia , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Endarterectomia das Carótidas , Stents , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Humanos , Prevenção SecundáriaAssuntos
Transtornos Cerebrovasculares/prevenção & controle , Estilo de Vida , Transtornos Cerebrovasculares/etiologia , Dieta , Humanos , Atividade Motora , Sobrepeso/complicações , Sobrepeso/prevenção & controle , Prevenção Primária , Prevenção Secundária , Estresse Psicológico/complicações , Estresse Psicológico/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
BACKGROUND: Information on risk factors and outcome of persons with aneurysmal subarachnoid hemorrhage (SAH) in Mexico is unknown. We sought to describe the clinical characteristics, risk factors, and outcome at discharge of Mexican patients with aneurysmal SAH. METHODS: A first-step surveillance system was conducted on consecutive cases confirmed by 4-vessel angiography from November 2002 to October 2004 in 25 tertiary referral centers. Age- and sex-matched control subjects were randomly selected by a 1:1 factor, for multivariate analysis on risk factors. RESULTS: We studied 231 patients (66% women; mean age 52 years, range 16-90 years). In 92%, the aneurysms were in the anterior circulation, and 15% had more than two aneurysms. After multivariate analysis, hypertension (odds ratio 2.46, 95% confidence interval 1.59-3.81) and diabetes mellitus (odds ratio 0.34, 95% confidence interval 0.17-0.68) were directly and inversely associated with aneurysmal SAH, respectively. Median hospital stay was 23 days (range 2-98 days). Invasive treatment was performed in 159 (69%) patients: aneurysm clipping in 126 (79%), endovascular coiling in 29 (18%), and aneurysm wrapping in 4 (2%). The in-hospital mortality was 20% (mostly due to neurologic causes), and 25% of patients were discharged with a modified Rankin score of 4 or 5. CONCLUSIONS: Hypertension is the main risk factor for aneurysmal SAH in hospitalized patients from Mexico. The female:male ratio is 2:1. A relatively low in-hospital mortality and a high frequency of invasive interventions are observed. However, a high proportion of patients are discharged with important neurologic impairment.
Assuntos
Sistema de Registros , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Angiografia Cerebral , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Tempo de Internação , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Elevated homocysteine (Hcy) plasma levels are associated with an increased risk of spontaneous cervical artery dissection (sCAD). We examined the potential association between Hcy, folate, vitamin B(12) levels and 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphisms in patients with cerebral infarct caused by sCAD. PATIENTS AND METHODS: 39 patients who survived a cerebral infarct caused by sCAD [20 (51%) women; 24 (61.5%) vertebral and 15 (38.5%) internal carotid arteries], and 76 healthy control subjects were included. Hcy plasma levels (fasting and after methionine load), folate and vitamin B(12) levels were measured. We also performed polymorphisms of MTHFR. Hcy, vitamin B(12), folates and polymorphisms of MTHFR were assessed and any associations were analyzed using multivariate statistics. RESULTS: Mean plasma fasting Hcy level was 9.81 mumol/l for cases and 6.38 for controls (p = 0.001). The occurrence of sCAD was associated with elevated fasting Hcy levels (>95th percentile over the control group) with an adjusted odds ratio of 7.9 (95% CI 1.66-35). The association between low plasma folate values (<5th percentile) and the presence of CAD was 7.9 (95% CI 1.6-31) after adjusting for confounding variables. The distribution of the MTHFR genotype showed a higher TT mutant frequency among CAD patients (p = 0.034). CONCLUSIONS: High plasma concentrations of Hcy and low plasma levels of folate were associated with an increased risk of sCAD in the sample studied. We conclude that deficiencies in nutritional status may contribute to the relatively high incidence of CAD in Mexico.
Assuntos
Dissecação da Artéria Carótida Interna/etiologia , Artérias Cerebrais , Infarto Cerebral/etiologia , Ácido Fólico/sangue , Homocisteína/sangue , Hiper-Homocisteinemia/complicações , Estado Nutricional , Dissecação da Artéria Vertebral/etiologia , Adolescente , Adulto , Dissecação da Artéria Carótida Interna/sangue , Dissecação da Artéria Carótida Interna/complicações , Dissecação da Artéria Carótida Interna/etnologia , Estudos de Casos e Controles , Infarto Cerebral/sangue , Infarto Cerebral/etnologia , Infarto Cerebral/genética , Jejum/sangue , Feminino , Frequência do Gene , Predisposição Genética para Doença , Humanos , Hiper-Homocisteinemia/sangue , Masculino , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , México , Pessoa de Meia-Idade , Estado Nutricional/etnologia , Razão de Chances , Polimorfismo Genético , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Dissecação da Artéria Vertebral/sangue , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/etnologia , Dissecação da Artéria Vertebral/genética , Vitamina B 12/sangueRESUMO
BACKGROUND AND PURPOSE: We describe the natural history, functional prognosis and long-term recurrences of patients with dissection of cervical arteries (DCA) in a sequential observational study. METHODS: We describe 130 patients with angiographically-proven DCA admitted to the Neurology Institute in Mexico City (Mexico), and analyzed clinical and neuroimaging data, treatment and outcome. Treatment with either anticoagulation or aspirin was decided by the primary physician. Primary outcome measures were recurrence (stroke and death) and clinical outcome at 6 months. Follow-up studies were performed to determine recanalization. RESULTS: Mean age was 35.4 years; 4 patients died (3%) and 126 were followed for 3,906 person/years; 17 patients (13%) had a heralding ischemic cerebral event (6 strokes, 11 TIAS) about 8 days before the diagnosis of DCA. After diagnosis, recurrent ischemic stroke occurred in 6 patients (4.8%) within the 2 first weeks (1.5 persons/1,000 follow-up years). No significant differences were found between aspirin and anticoagulation. Recanalization was more frequent in vertebral dissections. Complete recanalization of vertebral dissections was associated with a favorable prognosis [OR 3.2 (95% CI 1.1-8.8; p = 0.02)]. CONCLUSIONS: In Mexico, DCA affects young adults and may present with a heralding stroke or TIA. We found rare, early ischemic recurrences. Vertebral territory dissections had better prognosis than carotid ones, particularly in patients with demonstrated complete recanalization.
Assuntos
Anticoagulantes/uso terapêutico , Isquemia Encefálica/prevenção & controle , Dissecação da Artéria Carótida Interna/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Sistema de Registros , Acidente Vascular Cerebral/prevenção & controle , Dissecação da Artéria Vertebral/tratamento farmacológico , Adulto , Aspirina/uso terapêutico , Isquemia Encefálica/etiologia , Dissecação da Artéria Carótida Interna/complicações , Dissecação da Artéria Carótida Interna/prevenção & controle , Feminino , Humanos , Masculino , México , Prognóstico , Estudos Retrospectivos , Prevenção Secundária , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/prevenção & controleRESUMO
BACKGROUND: There are no data on Mexican population referring to frequency and prognosis of transient ischemic attacks (TIA). The purpose of the present study was to: (1) estimate the prevalence, vascular risk factors and short-term outcome in patients with TIA included in the first Mexican registry of cerebrovascular disease, and (2) analyze the acute care provided in these patients. PATIENTS AND METHODS: This national registry of cerebrovascular diseases is a multicenter, observational, and hospital-based registry that was conducted from November 2002 to October 2004. The registry was developed to improve our knowledge in Mexico regarding risk factors profile, outcome, current diagnostic and treatment strategies, and short-term follow-up in patients with acute cerebral ischemia. Standardized data assessment was used by all centers which included information on demographics, pre-hospital events (including stroke onset and arrival to hospital), emergency department triage and workup. Short-term outcome was evaluated at day 30. Of this registry, TIA cases were selected and associated risk factors, clinical characteristics, diagnosis and treatment were analyzed. RESULTS: During the study time period, 2,000 patients were enrolled; 97 (5%) with diagnosis of TIA; 51 women and 46 men, mean age 69.3 +/- 11.4 years. Among these 97 patients; 51 (52.6%) were admitted to the hospital for evaluation. The main risk factors were; age > or = 65 years in 74%, hypertension in 64%, diabetes in 45%, and dislipidemia in 36% and obesity in 31%. The affected arterial territory was carotid TIA in 74% and vertebrobasilar in 26%. TIA was attributed to atherosclerosis in 63% of the patients, cardioembolism in 17%, and small vessels disease in 5%. At 30 days follow-up; three patients died during the initial evaluation (two secondary to cardiac arrhythmia, and one secondary to pneumonia). Among 14 of the 94 survivors (14.9%) we documented an early stroke recurrence, including cerebral infarction in nine patients (9.6%) and new TIA in five cases (5.3%). Considering death and cerebral infarction, the frequency of unfavorable major events was 12.4%. There were only three cases treated with carotid endarterectomy. CONCLUSIONS: The short-term risk of ischemic stroke, death or recurrent in TIA patients is high. These findings emphasize that all patients with TIA should undergo rapid investigation and management to prevent a major stroke and other vascular events.