Fatores associados à exposição ao HIV em usuários de álcool / Factors associated with HIV exposure in alcohol users

Introdução: A prevalência de HIV é maior em Porto Alegre comparada ao restante do país. O abuso de álcool afeta o juízo crítico, sendo associado a comportamentos de risco que podem levar à contaminação pelo HIV. Objetiva-se analisar fatores associados à exposição ao HIV em alcoolistas com práticas sexuais de risco comparando com aqueles que se previnem.Métodos: Estudo transversal com 126 homens alcoolistas (HIV negativo), divididos em 2 grupos: Exposto Sexual (n = 42) e Pouco Exposto Sexual (n = 84), considerando uso de preservativo e número de parceiros sexuais.Resultados: A maioria dos sujeitos do grupo Exposto Sexual era solteiro, sem ocupação laboral, com histórico de moradia de rua e de relação com profissional do sexo, apresentavam maior preocupação com infecção por HIV (p < 0,05).Conclusão: Sugere-se o desenvolvimento e monitoramento de intervenções preventivas específicas, considerando as características do abuso de álcool e seu papel na transmissão do HIV.

Introduction: The HIV prevalence is higher in Porto Alegre compared to other capitals in Brazil. Alcohol abuse affects critical judgment, being associated with risky behaviors that can lead to HIV infection. Aim:To analyze factors associated with exposure to HIV in alcohol users, comparing those with risky sexual practices and those who use prevention methods.Methods: Cross-sectional study with 126 male alcohol users (HIV negative), divided into 2 groups: Sexually Exposed (n = 42) and Less Sexually Exposed (n = 84), considering condom use and number of sexual partners.Results: Most subjects in the Sexually Exposed group were single, without a job, with a history of homelessness and a relationship with a sexual worker, and were more concerned about HIV infection (p < 0.05).Conclusion: The development and monitoring of specific preventive interventions is suggested, considering the characteristics of alcohol abuse and its role in HIV transmission.

Differential impact on suicide mortality during the COVID-19 pandemic in Brazil

Objectives: To compare suicide rates observed in Brazil after the onset of the COVID-19 pandemic with the estimated rate based on suicide deaths between 2010 and 2020, and identify sociodemographic variables associated with this outcome. Methods: Ecological time-series study. Data were obtained from Brazilian Unified Health System Department of Information Technology (DATASUS), with the structural break of the data set in March 2020. The number of actual suicides observed and the number of expected suicides if there were no COVID-19 pandemic were analyzed through bayesian structural time series modeling. Results: The overall incidence of suicides in Brazil remained stable after the start of the COVID-19 pandemic compared to what would be expected. However, there was a significant increase in suicide deaths among women (6.9%) and older adult (9.1%). Analysis by macro-regions of the country showed significant increases in suicide deaths in the Center-West (7.4%), Northeast (5.7%), and Southeast (10%). Stratified analyses revealed differences according to age, sex, education, and skin color. Conclusions: Despite stability in the overall number of suicides, this phenomenon occurs heterogeneously among different population groups and regions of Brazil. Rates have increased in populations with a history of poor access to health, which may have been more severely impacted by the pandemic.

Childhood trauma subtypes may influence the pattern of substance use and preferential substance in men with alcohol and/or crack-cocaine addiction

Objective: To compare the prevalence and subtypes of childhood maltreatment (CM) between individuals with and without substance use disorder (SUD) and investigate the influence of different traumas on the preferential use of substances and the severity of dependence. Methods: The sample consisted of 1,040 men with SUD (alcohol users [n=315], crack-cocaine users [n=406], multiple-substance users [n=319]) and 201 controls. The Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index-6 (ASI-6) were used to assess CM and drug-use patterns. Results: Individuals with SUD had a higher prevalence of CM than controls (63.4 vs. 28.1%, respectively). Exposure to physical trauma was associated with alcohol use disorder and severity of alcohol use. In contrast, emotional trauma was associated with use of multiple substances and severity of drug use in crack-cocaine users. Conclusions: This study corroborates the association of CM with SUD susceptibility. Our results suggest that the type of CM may influence preferential substance use and addiction severity. In this sense, physical traumas are more associated with alcohol use, while emotional and sexual traumas favor use of multiple drugs, especially crack cocaine. These findings may help the development of tailored prevention and intervention strategies.

Surgical Site Infection after Cesarean Delivery in Times of COVID-19 / Infecção de sítio cirúrgico após cesariana em tempos de COVID-19

Abstract Objective To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections. Methods A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation asml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period. Results There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period. Conclusion The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement.

Resumo Objetivo Analisar os efeitos da pandemia de COVID-19 sobre o consumo de equipamentos e produtos de proteção individual (EPPI), assim como a frequência de infecção de sítio cirúrgico (ISC) em pacientes não infectadas por COVID-19 submetidas a cesarianas. Métodos Foi realizado umestudo retrospectivo em umamaternidade de um hospital público de ensino que não fazia parte do serviço de referência para o tratamento do COVID-19. Foram comparados o consumo de EPPI e a ocorrência de ISC após cesárea nos períodos mensais antes e após a ocorrência do primeiro caso de COVID-19 em Porto Alegre, RS, Brasil. O consumo de EPPI foimedido emunidades demáscaras, luvas, aventais e gorros, e o uso de produtos à base de álcool ou de sabonete para higienização das mãos em ml/paciente/dia. O índice SSI foi calculado como a proporção de casos de ISC sobre o número de cesarianas realizadas mensalmente durante o período do estudo. Resultados Houve aumento em todos os itens medidos do EPPI, com o consumo de máscaras descartáveis apresentando uma mediana de 1.450 no período pré-COVID e de 2550 no período pós-COVID (aumento de 75,9%). Detectou-se também diminuição de ISC, com medianas de 1,74 no período pré-COVID e de 0,89 no período pós-COVID, com redução de 49% no valor da mediana. Conclusão O aumento do consumo de EPPI pode ser resultado de práticas mais seguras adotadas pelos profissionais de saúde com o advento do COVID-19, do qual a redução na ocorrência de ISC pode ser uma consequência direta. Apesar da gravidade da crise, pode-se afirmar que situações extremas podem gerar reflexões valiosas e oportunidades de melhorias.

Crack-cocaine users have less family cohesion than alcohol users

Objective: Many studies correlate characteristics of family functioning and the development of drug addiction. This study sought to evaluate and compare the family environment styles of two groups of psychoactive substance users: 1) alcohol-only users and 2) crack-cocaine users. Methods: Three hundred and sixty-four users of alcohol, crack-cocaine, and other drugs, recruited from research centers in four Brazilian capitals participated in this study. Subjects were evaluated through the Family Environment Scale and the Addiction Severity Index, 6th version (ASI-6). ASI-6 t-scores were compared by analysis of variance (ANOVA) and post-hoc tests. A final model was obtained using a logistic regression analysis. All analyses were adjusted for partner, age, and psychiatric t-score. Results: We found a significant difference between groups in the cohesion subscale (p = 0.044). The post-hoc test revealed a difference of 1.06 points (95%CI 0.11-2.01) between groups 1 (6.45±0.28) and 2 (5.38±0.20). No significant between-group differences were observed in the other subscales. However, categorical analyses of variables regarding family dynamic showed that crack users more often reported that sometimes people in their family hit each other (30.4% vs. 13.2%, p = 0.007) and that people in their family frequently compared each other regarding work and/or school achievement (57.2% vs. 42.6%, p = 0.041). Conclusion: These results suggest that families of crack-cocaine users are less cohesive than families of alcohol users. This type of family environment may affect treatment outcome, and should thus be adequately approached.

Personality disorder and substance related disorders: a six-month follow-up study with a Brazilian sample / Transtorno de personalidade e transtorno por uso de substâncias: experiência brasileira com seis meses de seguimento

ABSTRACT Objectives A few Brazilian researches correlate personality disorders (PD) and substance related disorders (SRD). The aim of the present study is to investigate the association between them, to evaluate the PD frequency among chemical dependents inpatients, this comorbidity association with social and demographic characteristics, used drug of choice, its impact on clinical evolution until the moment of their committal, the frequency of relapse, self-help group – and psychotherapic adherence among SRD patients six months following committal. Methods A 101 inpatients sample of chemical dependents was enrolled in 2 hospitals. The following instruments were applied: a questionnaire for social and demographic characteristics identification and drug use pattern, some questions from the sixth version of the Addiction Severity Index (ASI-6), the SCID-II questionnaire and specific questions concerning psychotherapic and self-help groups participation, and medication use. Results From these 101 patients, 55.4% were diagnosed with PD, being avoidant (14.9%), borderline (11.9%) and antisocial (8.9%) the more frequent ones found. PD patients had an earlier crack use in life (p = 0.038) and had also more previous treatments than the ones without PD (p = 0.005). Borderline PD patients were less worried to substance use problem (p = 0.003). After 6-months follow-up, no statistical significance was found between patients with and without PD regarding drug use or treatment adherence. Conclusion A high PD diagnosis was found in drug use inpatients. Patients diagnosed with SRD and PD need the identification of this comorbidity and of their personality characteristics in order to plan a more comprehensive and effective treatment.

RESUMO Objetivos Poucos estudos brasileiros correlacionam transtornos de personalidade (TP) com transtorno por uso de substâncias (TUS). O objetivo deste estudo é verificar a associação entre eles, avaliar a frequência dos TP na população de dependentes químicos internados, correlacionar com características sociodemográficas, drogas de escolha, frequência de recaída, aderência a grupos de autoajuda e psicoterapia em até seis meses após a alta hospitalar. Métodos Uma amostra de 101 pacientes internados em dois hospitais foi selecionada. Os seguintes instrumentos foram aplicados: um questionário para identificação de características sociodemográficas e padrão de uso de drogas, algumas questões da sexta versão do ASI-6 (Addiction Severity Index), o SCID-II e algumas questões específicas sobre participação em grupos de autoajuda e em psicoterapia, bem como o uso de medicações. Resultados Destes 101 pacientes, 55,4% foram diagnosticados com TP, sendo evitativa (14,9%), limítrofe (11,9%) e antissocial (8,9%) as mais frequentemente encontradas. Pacientes com TP demonstraram ter feito uso mais precoce de crack na vida (p = 0,038) e também tinham mais tratamentos anteriores do que aqueles sem TP (p = 0,005). Pacientes com TP limítrofe estavam menos preocupados com o problema de abuso de substâncias (p = 0,003). Após seis meses de seguimento, nenhuma diferença estatística significativa foi encontrada entre pacientes com e sem TP acerca do uso de drogas ou aderência ao tratamento. Conclusão Uma alta prevalência de TP foi encontrada em pacientes internados por TUS. Pacientes diagnosticados com TP e TUS necessitam a identificação da comorbidade e das características de sua personalidade, a fim de planejar um tratamento mais abrangente e eficaz.

EFFECT OF SIZE OF INTESTINAL DIVERSIONS IN OBESE PATIENTS WITH METABOLIC SYNDROME SUBMITTED TO GASTRIC BYPASS / EFEITO DA DIMENSÃO DAS DERIVAÇÕES INTESTINAIS EM OBESOS COM SÍNDROME METABÓLICA SUBMETIDOS AO BYPASS GÁSTRICO

ABSTRACT Background: There is no consensus on the ideal size of intestinal loops in gastric bypass of bariatric surgeries. Aim: To evaluate the metabolic outcome of patients submitted to gastric bypass with alimentary and biliopancreatic loops of different sizes. Methods: Was conducted a retrospective cohort study in diabetic obese patients (BMI≥35 kg/m2) with metabolic syndrome submitted to gastric bypass. The patients were divided into three groups according to the size of the intestinal loop: group 1, biliopancreatic limb 50 cm length and alimentary limb 100 cm length; group 2 , biliopancreatic limb 50 cm length and alimentary limb 150 cm length; and group 3, biliopancreatic limb 100 cm length and alimentary limb 150 cm length. The effect of gastric bypass with different sizes of intestinal loops in relation to the parameters that define metabolic syndrome was determined. Results: Sixty-three patients were evaluated, and they had a mean age of 44.7±9.4 years. All were diabetics, with 62 (98.4%) being hypertensive and 51 (82.2%) dyslipidemic. The three groups were homogeneous in relation to the variables. In 24 months, there was a remission of systemic arterial hypertension in 65% of patients in group 1, 62.5% in group 2 and 68.4% in group 3. Remission of diabetes occurred in 85% of patients in group 1, 83% in group 2 and 84% in group 3. There was no statistical difference in %LEW between the groups, and waist measurements decreased in a homogeneous way in all groups. The size of loops also had no influence on the improvement in dyslipidemia. Conclusion: Variation in size of intestinal loops does not appear to influence improvement in metabolic syndrome in this group of patients.

RESUMO Racional: Não há consenso sobre o tamanho ideal das alças intestinais no bypass gástrico em Y-de-Roux em cirurgias bariátricas. Objetivo: Avaliar os desfechos metabólicos de pacientes submetidos ao bypass gástrico com alça intestinal alimentar e biliopancreática de tamanhos diferentes. Métodos: Realizou-se coorte retrospectiva em pacientes obesos (IMC≥35 kg/m2) diabéticos com síndrome metabólica submetidos ao bypass gástrico em Y-de-Roux. Foram divididos em três grupos conforme a dimensão das alças intestinais: grupo 1, alça biliopancreática de 50 cm e alça alimentar de 100 cm; grupo 2, alça biliopancreática de 50 cm e alça alimentar de 150 cm e grupo 3, alça biliopancreática de 100 cm e alça alimentar de 150 cm. Foram avaliados os parâmetros que compõem a síndrome metabólica. Resultados: Incluíram-se 63 pacientes, com média de idade de 44.7±9.4 anos. Todos eram diabéticos, 62 (98.4%) hipertensos e 51 (82.2%) dislipidêmicos. Os três grupos eram homogêneos em relação às variáveis estudadas. Em 24 meses houve remissão da hipertensão arterial sistêmica em 65% do grupo 1, 62.5% no grupo 2 e 68.4% no grupo 3. A remissão do diabete melito tipo 2 ocorreu em 85% dos pacientes do grupo 1, 83% no grupo 2, e 84% no grupo 3. Não houve diferença estatística na porcentagem de perda do excesso de peso entre os grupos e as medidas da cintura abdominal reduziram de forma homogênea em todos os grupos. A dimensão das alças também não influenciou na melhora da dislipidemia. Conclusão: A variação da dimensão das alças intestinais não influenciou na melhora da síndrome metabólica neste grupo de pacientes.

Differences between attendance in emergency care of male and female victims of traffic accidents in Porto alegre, Rio Grande do Sul state, Brazil / Diferenças entre homens e mulheres vítimas de acidente de trânsito atendidos em emergências de Porto Alegre, RS, Brasil

Driving under the influence of alcohol/ drugs (DUI) is a well-established risk factor for traffic accidents, and men and women have different consumption patterns. The scope of this paper is to analyze differences in alcohol and drug consumption, as well as on behavior associated with traffic accidents among men and women. A cross-sectional study was conducted with 609 sequential traffic accident victims attended in emergency care from Porto Alegre. Subjects gave a structured interview, were breathalyzed and had a saliva test for alcohol/drug screening. Results showed that women were mainly passengers or pedestrians (p < 0.001). There was no significant difference in positive blood alcohol concentration. However, men reported more binge drinking and THC use, while women had more benzodiazepine in their saliva (p<0.05). This is the first Brazilian study to compare alcohol and drug use among men and women who were the victims of traffic accidents. Results point to differences in the pattern of substance abuse, as well on risk behavior. Data may be useful for specific prevention strategies that take gender differences into consideration.

Dirigir sob a influência de álcool/drogas (DUI) contribui para ocorrência de acidentes de trânsito, sendo que homens e mulheres diferem quanto ao seu consumo. Objetivo: Analisar as diferenças no consumo de álcool/drogas e nos comportamentos de risco para dirigir entre homens e mulheres. Método: Estudo transversal, com amostra consecutiva de 609 vítimas de acidentes de trânsito atendidas nas emergências de Porto Alegre. Realizou-se entrevista estruturada, teste de bafômetro e saliva para screening de álcool e drogas. Resultados: As mulheres acidentaram-se principalmente como passageiras e pedestres, (p < 0.001). Não houve diferença na triagem para abuso/dependência ou alcoolemia positiva. Porém, os homens referiram mais "beber pesado" e utilizaram mais THC e cocaína, enquanto as mulheres utilizaram benzodiazepínicos (p < 0.05). Conclusão: Este é o primeiro estudo brasileiro a comparar uso de álcool e drogas entre homens e mulheres vítimas de acidentes de trânsito. Os dados podem ser úteis na elaboração de estratégias específicas de prevenção que considerem as diferenças de gênero. .

Crack/cocaine users show more family problems than other substance users

OBJECTIVES: To evaluate family problems among crack/cocaine users compared with alcohol and other substance users. METHODS: A cross-sectional multi-center study selected 741 current adult substance users from outpatient and inpatient Brazilian specialized clinics. Subjects were evaluated with the sixth version of the Addiction Severity Index, and 293 crack users were compared with 126 cocaine snorters and 322 alcohol and other drug users. RESULTS: Cocaine users showed more family problems when compared with other drug users, with no significant difference between routes of administration. These problems included arguing (crack 66.5%, powder cocaine 63.3%, other drugs 50.3%, p = 0.004), having trouble getting along with partners (61.5%×64.6%×48.7%, p = 0.013), and the need for additional childcare services in order to attend treatment (13.3%×10.3%×5.1%, p = 0.002). Additionally, the majority of crack/cocaine users had spent time with relatives in the last month (84.6%×86.5%×76.6%, p = 0.011). CONCLUSIONS: Brazilian treatment programs should enhance family treatment strategies, and childcare services need to be included. .

Uso de bebidas alcoólicas em postos de gasolina de Porto Alegre: estudo piloto / Alcohol use on premises of gas stations of Porto Alegre, Brazil: pilot study

INTRODUÇÃO: O uso de álcool é um forte preditor de acidentes de trânsito. Este artigo descreve a factibilidade e dados preliminares de um estudo que avalia a alcoolemia entre jovens que utilizam bebidas alcoólicas em estacionamentos de postos de gasolina de Porto Alegre (RS). MÉTODO: Estudo transversal, com amostra em alvo, estratificada por idade e gênero. Os dados foram coletados através de um questionário autopreenchido, e a alcoolemia foi estimada com uso de bafômetro. RESULTADOS: A taxa de recusa foi de 13,7 por cento, e medida da alcoolemia acima de 0,06 por cento foi encontrada em 35,5 por cento (IC95 por cento 24,3-47,9) da amostra. Aproximadamente 10 por cento destes indivíduos (18 por cento dos homens) relatavam intenção de dirigir nas 2 horas subseqüentes à coleta. CONCLUSÃO: É discutida a potencial utilização deste tipo de dado, bem como a necessidade de novos estudos sobre uso de substâncias em motoristas brasileiros.

INTRODUCTION: Alcohol use is a strong predictor of traffic accidents. This paper reports feasibility issues and preliminary data on blood alcohol concentration in youths who drink alcohol in gas stations of Porto Alegre, Brazil. METHOD: It used a cross-sectional design with a purposive sample stratified by age and gender. Data were collected through a self-administered questionnaire and blood alcohol concentration was estimated with breath alcohol analyzers. RESULTS: Refusal rate was 13.7 percent and blood alcohol concentration over 0.06 percent was found in 35.5 percent (95 percentCI 24.3-47.9) of the sample. Almost 10 percent of the subjects (18 percent of the males) reported they would drive within 2 hours of the interview. CONCLUSION: The potential utilization of such measures is discussed, as well as the need for studies on substance use in young Brazilian drivers.

Valor diagnóstico de los síntomas y signos clinicos en el Síndrome Tunelar Carpiano / Diagnosis value of clinics symptoms and signs in the Carpal Tunnel Syndrome

El Síndrome Tunelar Carpiano (S.T.C.) es la neuropatía por atrapamiento más frecuente del miembro superior. Existe en la literatura considerable discrepancia respecto a la sensibilidad y especificidad de síntomas y signos relacionados al S.T.C.. El objetivo de esté estudio fue determinar la validez diagnóstica de los síntomas y signos clínicos típicos de S.T.C. en pacientes con diagnósticos positivos por Estudio neurofisiológico (Gold Standard diagnóstico). Se estudiaron prospectivamente 73 manos con diagnóstico presuntivo de S.T.C.. Los mejores predictores de diagnóstico positivo de S.T.C. fueron: parestesias nocturnas que mejoran con el "shaking", falta de discriminación de dos puntos y atrofia tenar.

Carpal Tunner Syndrome (C.T.S.) is the most frequently recognized entrapment neuropathy on upper limbs. In the literature, there is a considerable disagreement about signs` and symptoms` sensibility and specificity related to C.T.S.. Our objective was to determine the diagnosis validity of typical signs and symptoms of C.T.S. in patients with positive neurophysiologic diagnosis (Gold Standard diagnosis). In a prospective way, we studied 73 hands with presumptive diagnosis of C.T.S.. The best predictors for a positive diagnosis were: numbness at night that reduce with shaking, impossibility to discriminate two points and thenar atrophy.

Evaluación de la perfusión periférica a la salida de la circulación extracorpórea / Evaluation of peripheral perfusion after end of cardiopulmonary bypass (CPB)

A la salida de la circulación extracorpórea (CEC) existe el riesgo de que se presenten alteraciones circulatorias con hipoperfusión tisular. Ambas se interrelacionan pero deben ser evaluadas separadamente. Objetivo: Analizar la perfusión periférica a la salida de la CEC por medio de diferentes indicadores y correlacionarlos con los datos hemodinámicos. Pacientes y métodos: Fueron estudiados 23 pacientes sometidos a cirugía cardíaca para revascularización miocárdica y/o sustitución valvular. Los parámetros estudiados antes y después de la CEC fueron: presión arterial media (PAM), venosa central (PVC) y capilar pulmonar (PCP), índice cardíaco (IC) por técnica de termodilución y resistencias vasculares sistémicas (RVS). Se calculó la disponibilidad (DO2), el consumo (VO2) y el índice de extracción de oxígeno (IE O2). Se realizaron medidas de saturación de oxígeno de sangre venosa mezclada (SvO2), diferencia veno-arterial de CO2 (Va CO2) y lactato en sangre arterial. Resultados: Previo a la CEC los pacientes presentaron PAM y PVC dentro de límites normales con un IC severamente disminuido (1.9 ± 0.5 l/min/m2) y RVS aumentadas (1869 ± 624 d.seg/cm-5 ).A la salida de la CEC la PAM cayó significativamente de 92 ± 15 a 75 ± 11 mmHg; y la PVC aumentó. Sin embargo, hubo un aumento del IC a 3 ± 0.5 l/min/m2 con una caída significativa de las RVS. Nueve pacientes (39 por ciento) presentaron RVS iguales o menores a 800 d.seg/cm-5 con IC >= 2.5 l/min/m2. No existió correlación entre PAM e IC pero sí entre PAM y RVS. Las DO2, VO2 e IE02 no se modificaron a pesar de una caída significativa de la hemoglobina. Existió una tendencia no significativa hacia la disminución del número de pacientes con SvO2 < 70 por ciento (de 15 a 8) y Va CO2 menor de 6 luego de la CEC. El lactato aumentó significativamente, pero en ningún caso por encima de 4mM. No existió correlación entre el IC y lactato, Sv02 y Va CO2. Conclusiones: 1) la evaluación de la PAM y PVC no refleja el estado circulat...

Ataque cerebrovasculare: un estudio epidemiológico prospectivo en el Hospital de Clínicas de Montevideo / Stroke: a prospective epidemiologic study in the Hospital de Clinicas of Montevideo

La implementación de medidas viables y efectivas en la prevención y tratamiento de los pacientes con ataque cerebrovascular (ACV) o stroke, implica un conocimiento profundo de la situación local. Nuestros objetivos fueron: 1) Describir algunas variables de la población que ingresa al Hospital de Clínicas por ACV. 2) Conocer el manejo asistencial actual de estos pacientes. 3) Conocer su morbilidad. Se incluyeron 148 pacientes consecutivos captados en las primeras 24 horas de su ingreso por ACV. Se analizaron factores de riesgo vascular, situación neurológica al ingreso, estudios complementarios, tratamientos realizados y morbimortalidad temprana. 85 pacientes (57 por ciento) sufrieron un ACV isquémico y 63 (43 por ciento) una hemorragia intracerebral. Se observó una elevada prevalencia de hipertensión arterial (79 por ciento) y ACV previo (30 por ciento). Se constató un uso frecuente de antihipertensivos en las primeras horas (30 por ciento), así como de antiepilépticos (25 por ciento de los pacientes sin crisis). La evolución fue hacia la agravación neurológica (coma diferido) en 10,5 por ciento de los pacientes. Se observó una recurrencia precoz del ACV de 2,9 por ciento. Ambas complicaciones aparecieron en el período de 24 a 96 horas del ingreso. La complicación extraneurológica más frecuente y grave fue la infección intrahospitalaria, causando 22 por ciento de las muertes. Se constató una mortalidad global de 25 por ciento de la población, generalmente secundaria al propio ACV (88 por ciento) y precoz. Se identificó un período de alto riesgo (48-96 horas) de agravación neurológica, recurrencia de ACV y muerte. Concluyendo se debería insistir en el diagnóstico y tratamiento de la hipertensión arterial, así como en la profilaxis secundaria del ACV y en la actualización del tratamiento en emergencia