Impacto de la superación profesional en la meteoro labilidad de la enfermedad cerebrovascular / Climate change and cardiovascular disease: impact of professional development

Introducción: La enfermedad cerebrovascular (ECV) es una urgencia neurológica que en ocasiones se encuentra influenciada por los cambios del tiempo. La ECV isquémica es una emergencia médica con una ventana estrecha para su diagnóstico y tratamiento. El daño generado por esta enfermedad se estima mediante de la mortalidad, discapacidad e impacto social. Objetivo: Proponer un programa de capacitación basado en los efectos fisiopatológicos que provocan en los pacientes, cambios de tiempo y ritmo circadiano en el contexto de la adaptación al cambio climático. Método: Se desarrolló un estudio multietápico prospectivo en el Hospital Universitario Mártires del 9 de Abril del municipio Sagua la Grande entre los años 1993 a 2017. En la primera etapa se seleccionó un universo de 52 profesionales de la salud que atendieron a estos pacientes; en la segunda, 48 y en la tercera, 61. Resultados: El nivel de conocimiento del personal de salud en una primera etapa era inadecuado (78,85 %); en la tercera, este porcentaje disminuyó (14,75 %). Como resultado de la capacitación mejoraron los tiempos de atención a los pacientes con ECV a su llegada al hospital, y en la tercera, más del 50 % de los enfermos fueron atendidos antes de las seis horas de inicio de los síntomas. Conclusiones: La capacitación sobre ECV basada en los efectos fisiopatológicos que provocan en los pacientes el cambio climático y el ritmo circadiano disminuyó el tiempo de espera, y se asoció con una reducción de la morbilidad y la mortalidad, después de aplicar este programa.

Introduction: cerebrovascular disease (CVD) is a neurological emergency that is sometimes influenced by climate changes. Ischemic CVD is a medical emergency with a narrow window for diagnosis and treatment. The damage generated by this disease is estimated through mortality, disability and social impact. Objective: to propose a training program based on the pathophysiological effects in patients caused by changes in time and circadian rhythm in the context of adaptation to climate change. Methods: a multistage prospective study was conducted at "Mártires del 9 de Abril" University Hospital in Sagua la Grande municipality between 1993 and 2017. A universe of health professionals who cared for these patients was selected as follows: 52 in the first stage; 48 in the second stage, and 61 in the third ones. Results: the level of knowledge of health personnel in the first stage was inadequate (78.85%); this percentage decreased in the third stage (14.75%). Care times for CVD patients improved upon arrival at the hospital as a result of the training, as well as in the third ones, more than 50% of the patients were seen within six hours of the onset of symptoms. Conclusions: CVD training based on the pathophysiological effects of climate change and circadian rhythm on patients decreased waiting time, and was associated with reduced morbidity and mortality, after applying this program.

Post-varicella arterial ischemic stroke in children and neurocognitive performance: a 4-year follow-up study

ABSTRACT Objective To analyze data from children who were previously healthy and presented with post-varicella arterial ischemic stroke upon arrival when admitted to the emergency room, with focus on the clinical/laboratory aspects, and neurocognitive performance after four-year follow-up. Methods Seven children presenting with arterial ischemic stroke after varicella were evaluated at pediatric emergency services in the city of São Paulo (SP), Brazil. Ischemic stroke was determined by magnetic resonance imaging/magnetic resonance angiography in a topography compatible with the areas supplied by the middle cerebral or internal carotid arteries. IgG-class antibodies against varicella zoster virus and varicella-zoster virus DNA by polymerase chain reaction in cerebrospinal fluid were tested. Patients with prothrombotic conditions were excluded. The Pediatric Stroke Outcome Measure was applied upon admission and 4-years after the stroke. Results All patients (age range: 1.3 to 4 years) included presented chickenpox 5.1 (±3.5) months before. All patients had analysis of anti-varicella-zoster-virus-IgG in cerebrospinal fluid, but only three (43%) had a positive result. Of the patients 43% had no vascular lesions identified in magnetic resonance angiography. All patients showed improvement in their sequela scores. After 4 years, five patients displayed good evolution in the Pediatric Stroke Outcome Measure, and only one patient presented with a score of 2 in the sensorimotor and cognition areas. No recurrence of arterial ischemic stroke was observed. Conclusion We reinforced the non-progressive course of post-varicella arterial ischemic stroke after 4-year follow-up. The presence of varicella-zoster-virus-DNA detected by polymerase chain reaction, and/or intrathecal IgG antibody against varicella zoster virus, and angiopathy location in magnetic resonance angiography were not determining for the diagnosis. Invasive tests, with low sensitivity, should be well considered in the diagnosis of post-varicella arterial ischemic stroke.

Moyamoya disease / Enfermedad de Moyamoya

Moyamoya disease is a chronic neurovascular disease characterized by progressive bilateral stenosis of the internal carotid arteries with abnormal formation of new abnormal blood vessels whose blockage of blood flow causes a variety of clinical manifestations and complications associated with acute cerebrovascular events (ischemic or hemorrhagic), which may even be fatal. This article seeks to describe this entity, its incidence, prevalence, forms of presentation, therapeutic measures and prognosis through a clinical case report. (Acta Med Colomb 2020; 45. DOI:http://doi.org/10.36104/amc.2020.1424).

La enfermedad de Moyamoya es una enfermedad neurovascular crónica caracterizada por una estenosis progresiva bilateral de las arterias carótidas internas, con la formación anormal de nuevos vasos sanguíneos, cuyo bloqueo en flujo sanguíneo ocasiona variadas manifestaciones clínicas y complicaciones asociadas a eventos cerebrovasculares (isquémicos o hemorrágicos) agudos que pueden llegar a ser incluso mortales. El presente artículo pretende realizar una aproximación acerca de esta entidad, su incidencia, prevalencia, formas de presentación y medidas terapéuticas y pronostico mediante el reporte de un caso clínico.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1424).

Analysis of the effect of folic acid combined with mecobalamin in the treatment of cerebral small vessel disease with hyperhomocysteinemia / 中国基层医药

Objective To investigate the clinical effect of folic acid combined with methylcobalamin in the treatment of cerebral small vessel disease with hyperhomocysteinemia.Methods From January 2015 to December 2016,78 patients who were diagnosed cerebral small vessel disease with high homocysteinemia(Hcy)and also associ-ated with vascular mild cognitive impairment in the Second People's Hospital of Liaocheng were selected as the research objects,and they were randomly divided into control group and observation group,with 39 cases in each group.The control group was given routine treatment,and the observation group was treated with folic acid combined with mecobalamin on the bassis treatment of the control group.The levels of The Hcy,vitamin B12,folic acid and the Alzheimer's disease assessment scale－cognitive subscale(ADAS－cog)scores before and after treatment for 3 and 6 months were compared between the two groups.Results Before treatment,there was no statistically significant differ-ence in the level of plasma Hcy between the two groups(t＝0.34,P＝0.74).There was no statistically significant difference in the level of plasma Hcy of the control group between before and after 3 and 6 months treatment(t＝0.36,1.30,all P＞0.05).The plasma Hcy level in the observation group after 3 and 6 months treatment[(19.98 ± 3.65)mol/L,(14.96 ±3.54)mol/L]were significantly lower than that before treatment[(26.38 ±2.95)mol/L] (t＝8.52,15.48,all P＜0.05),which were also significantly lower than that in the control group(t＝7.11,12.35, all P＜0.05).Before treatment,there were no statistically significant differences in vitamin B12 and folic acid levels between the two groups(t＝0.27,0.86,all P＞0.05).There was no statistically significant difference in the levels of vitamin B12 and folic acid of the control group between before and after 3 and 6 months treatment(all P＞0.05).The vitamin B12 and folic acid levels in the observation group after 3 and 6 month treatment were significantly higher than those before treatment(all P＜0.05 ),which were also significantly higher than those in the control group(all P＜0.05).Before treatment,there were no statistically significant differences in the ADAS－cog scale score between the two groups(t＝0.14,P＞0.05).There was no statistically significant difference in the ADAS－cog scale score of the control group between before and after 3 and 6 months treatment(all P＞0.05 ).The scores of ADAS－cog scale in the observation group after 3 and 6 months treatment[(12.05 ±2.13)points,(10.24 ±2.84)points]were signifi-cantly lower than that before treatment[(15.07 ±3.56)points](t ＝4.55,6.62,all P＜0.05),which were also significantly lower than that in the control group(all P＜0.05).Conclusion Folic acid combined with methylcobal-amin in the treatment of cerebral small vessel disease with hyperhomocysteinemia can significantly reduce the Hcy, vitamin B12 and folic acid levels,which can help to relieve the vascular cognitive impairment,so it is worthy of promo-tion and application.

Clinical observation of integrated traditional Chinese and western medicine in the treatment of intractable hiccup caused by cerebrovascular disease Medicine / 中国基层医药

Objective To explore the clinical effect of integrated traditional Chinese and western medicine in the treatment of intractable hiccup caused by cerebrovascular disease.Methods A total of 74 patients with intractable hiccup caused by cerebrovascular disease were selected.The patients were randomly divided into observation group and control group according to random number table method.28 patients in the control group were given simple western medicine treatment.46 patients in the observation group were treated with integrated traditional Chinese and western medicine.The total effective rate and symptom improvement were observed after treatment.Results The total effective rate of observation group was 94.48%,that was 78.57% in the control group,the difference was statistically significant(x2=2.0,P<0.05).Conclusion Combined traditional Chinese and western medicine can significantly reduce intractable hiccup caused by cerebrovascular disease,improve total efficacy,improve the quality of life.

Clinical manifestations in eight patients with multiple dilated Virchow-Robin spaces in striatum / 中华神经科杂志

Objective To investigate the clinical feactures of patients with numerous dilated Virchow-Robin space in basal gangalia.Methods Eight patients with cribriform state in striatum in brain MRI at Peking Union Medical College Hospital from March 2013 to October 2013 were enrolled.The clinical data including age,gender,common vascular risk factors and clinical manifestations were analyzed.Cognitive functions,balance and gait disturbance,as well as activity of daily living were assessed.Results All of the eight patients are male,aged from 69 to 80.All the patients had a history of hyperlipidemia,while 7 of them had hypertension.The primary complaint was either gradual motor function decline or memory impairments (3/8),or dizziness (1/8).The other 4 of them were diagnosed as stroke or transient ischemic attack.Among the 8 patients,four had mild deterioration in activity of daily living function (Barthel index 65-85).Cognitive impairment was common (8/8,the Montreal Cognitive Assessment scores 19-27),while word recall was the mostly affected cognitive domain (8/8).Gait and balance dysfunction were found in three patients (3/8,Tinetti scores ≤ 24).Conclusions Man is more likely to have predisposition to cribriform state in striatum.Mild cognitive impairments and gait abnormality are common clinical manifestations of the disease.

Isolated Lenticulostriate Artery Aneurysm Rupture in a Patient with Behcet's Disease

Behcet's disease (BD) is characterized by recurrent oro-genital ulcers, skin lesions, and intraocular inflammation, but can also affect various internal organs. Vascular BD usually presents with luminal stenosis, thrombosis, or aneurysm formation in aorta and peripheral arteries. However, intracranial artery involvement has been uncommonly reported in patients with BD and BD cases with lenticulostriate artery aneurysm have been rarely described in the English-language literature. We hereby reported the first case of a Korean BD patient presenting with a ruptured lenticulostriate artery aneurysm, who received medical treatment, and reviewed the literature on reported cases of BD with intracranial aneurysms.

Sonographic lenticulostriate vasculopathy in fetus / 中华医学超声杂志（电子版）

Objective To explore the value of prenatal diagnosis and sonographic features of lenticulostriate vasculopathy (LSV). Methods Prenatal ultrasonographic features of three cases of fetal lenticulostriate vasculopathy were retrospectively analysed associated with maternal TORCH screen, fetal magnetic resonance imaging, neonatal physical examination and TORCH screen. Results Prenatal sonographic diagnosis of case 1 demonstrated fetal LSV as well as fetal growth restriction (FGR), periventricular hemorrhage, mitral and tricuspid regurgitation, hydropericardium and catatact. Prenatal sonographic diagnosis of case 2 demonstrated fetal LSV, FGR, periventricular hemorrhage, mitral and tricuspid regurgitation. Prenatal sonographic diagnosis of case 3 showed fetal LSV and intraventricular hemorrhage. Maternal TORCH screens of case 1 and case 3 was negative, while in case 2 was positive. Neonatal examinations of case 1 showed cataract, hearing impairment and congenital infection. Case 3 showed prompted retinal hemorrhage, sinus bradycardia, hyperbilirubinemia and congenital infection. In case 2, maternal teratogenic pathogen screen was positive and the baby did not survive because the mother decided to stop pregnancy in 34 weeks. Conclusions Fetal LSV could be imaged by prenatal ultrasonography. Fetal LSV might indicate intrauterine infection when other abnormalities were accompanied. Ultrasound might be useful for the cases with negative maternal TORCH screen results.