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.

Riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica, Lima, Perú / Risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis Lima, Peru

RESUMEN Objetivos: Evaluar el riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH). Materiales y métodos: Se realizó un estudio de cohortes en el Hospital Cayetano Heredia, durante el 2015. Fueron incluidos prematuros menores de 34 semanas que tuvieran examen histopatológico de la placenta. Los tipos de CAH evaluados fueron subcorionitis, corionitis, corioamnionitis, con o sin funisitis. El daño cerebral se evaluó en tres periodos de edad, entre 0 y 7 días, entre 7 y 30 días y a las 40 semanas gestacionales corregidas. Se realizó un seguimiento neurológico y controles con ecografía cerebral. Resultados: Se estudiaron 85 prematuros, 47,1% eran mujeres y la media de la edad gestacional fue de 30,9 semanas. El 42% (36/85) nacieron expuestos a CAH. La ruptura prematura de membrana fue la principal generatriz de sepsis, y la sepsis se relacionó con daño neurológico. La CAH estuvo asociada con hemorragia intraventricular (HIV) durante la primera semana y con lesiones de la sustancia blanca entre los 7 y 30 días de edad (p = 0,035). El tipo corioamnionitis de CAH se asoció al daño neurológico durante la primera semana (RR = 2,11; IC 95%: 1,09-4,11) y entre los 7 y 30 días de vida (RR = 2,72; IC 95%: 1,07-6,88). Conclusiones: La corioamnionitis fue un factor de riesgo para desarrollar lesiones cerebrales en prematuros menores de 34 semanas, para HIV durante los primeros 7 días y lesiones de sustancia blanca entre los 7 y los 30 días de edad. A las 40 semanas de edad corregida, los prematuros extremos con CAH tuvieron lesiones cerebrales más extensas.

ABSTRACT Objectives: To assess the risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis (HCA). Materials and methods: A cohort study was conducted at the Hospital Cayetano Heredia, during 2015. Premature infants under 34 weeks of gestational age, who had histopathological examination of the placenta, were included. The types of HCA evaluated were sub-chorionitis, chorionitis, chorioamnionitis, with or without funisitis. Brain damage was evaluated in three age periods, between 0 and 7 days, between 7 and 30 days and at 40 weeks of corrected gestational age. A neurological follow-up and regular controls were performed with brain ultrasound. Results: A total of 85 premature infants were included, 47.1% were women and the mean gestational age was 30.9 weeks. From the total, 42% (36/85) were born exposed to HCA. Premature rupture of membranes was the main cause of sepsis, which was related to neurological damage. HCA was associated with intraventricular hemorrhage (IVH) during the first week and with white matter lesions between 7 and 30 days of age (p = 0.035). The chorioamnionitis type of HCA was associated with neurological damage during the first week (RR = 2.11, 95% CI: 1.09-4.11) and between 7 and 30 days of age (RR = 2.72, 95% CI: 1.07-6.88). Conclusions: Chorioamnionitis was a risk factor for developing brain injuries in premature infants under 34 weeks of gestational age. It was also a risk factor for HIV during the first 7 days and for white matter injuries between 7 and 30 days of age. At 40 weeks of corrected gestational age, extreme premature infants with HCA had more extensive brain damage.

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).

Terapias artísticas en la rehabilitación de los pacientes tras un ictus / Art therapies in the rehabilitation of patients after ictus

Introducción: las enfermedades cerebrovasculares son un problema de salud mundial. Objetivo: evaluar la utilidad de las terapias artísticas en la rehabilitación de los pacientes tras un ictus. Materiales y Métodos: se realizó un estudio experimental, longitudinal y prospectivo en el Hospital Militar de Matanzas. El universo estuvo constituido por los pacientes con hemiplejia secundaria a un ictus que cumplieron con los criterios de la investigación. Los 62 pacientes se dividieron en dos grupos que recibieron el tratamiento rehabilitador habitual y al grupo estudio se le adicionaron las terapias artísticas. Se aplicó la escala de Yesavage para valorar la depresión en los pacientes y el índice de Barthel para evaluar la independencia para realizar las actividades de la vida diaria. Resultados: se logró disminuir la depresión y la dependencia para las actividades de la vida diaria en la mayor parte de los pacientes tratados con terapias artísticas, existiendo diferencias significativas con respecto al grupo control. El 70,9 % de los pacientes tratados con terapias artísticas obtuvieron evaluación final de bien, en el grupo control solo el 38,7 % de los pacientes obtuvo esta evaluación. Conclusiones: las terapias artísticas resultaron muy útiles en la rehabilitación de los pacientes tras un ictus (AU).

Introduction: cerebrovascular diseases are a worldwide health problem. Objective: to appraise the usefulness of the art therapies in the rehabilitation of patients after ictus. Materials and methods: A prospective, longitudinal and retrospective study was carried out in the Military Hospital of Matanzas. The universe was formed by the patients with ictus-secondary hemiplegia fulfilling the research criteria. The 62 patients were divided into two groups that received the usual treatment and the ones in the study group also received art therapies. The Yesavage scale was applied to assess depression in the patients and the Barthel index to assess the independency in performing daily activities. Results: depression and dependency in performing daily life activities decreased in most of the patients treated with art therapies, showing significant differences with the control group. 70,9 % of the patients treated with art therapies got a final evaluation of good; in the control group only 38,7 % of the patients got this evaluation. Conclusions: art therapies were very useful in the rehabilitation of patients after ictus (AU).

Características de la enfermedad cerebrovascular extracraneal en el municipio de arroyo naranjo / Characteristics of the extra-cranial cerebrovascular disease in Arroyo Naranjo municipality

Introducción: La enfermedad cerebrovascular extracraneal en Cuba está subdiagnosticada, de ahí que se desconoce su prevalencia en población general. Objetivo: Determinar las características de la enfermedad cerebrovascular extracraneal en el municipio de Arroyo Naranjo. Métodos: Se realizó estudio descriptivo en las 26 personas diagnosticadas con enfermedad carotidea de una muestra de 200 individuos obtenida por método aleatorio simple de los 208 554 residentes del municipio Arroyo Naranjo. La enfermedad se confirmó por eco-doppler carotideo. Las variables fueron: edad, sexo, porcentaje de estenosis, localización, tipo de placa, factores de riesgo y grosor íntima-media carotideo. Resultados: La prevalencia de la enfermedad fue de 12,5 x 100 000 habitantes, mayor en las mujeres (10,1) y en los mayores de 60 años (9,1). Se confirmó el diagnóstico en el 80,8 por ciento de las personas y más del 45 por ciento mostró estenosis no significativa en ambas carótidas. Predominaron las placas heterogénea (46,2 por ciento) localizadas fundamentalmente en: bifurcación carotidea y bulbo. El tabaquismo (80,8 por ciento), la hipertensión arterial (73,1 por ciento), y la enfermedad arterial periférica (65,1 por ciento) fueron los factores de riesgo más frecuentes; el 69,2 por ciento presentaba más de tres factores. Más del 75 por ciento de los mayores de 60 años, independiente del sexo, tenían valores patológicos del grosor íntima-media carotideo. Conclusiones: La prevalencia de enfermedad cerebrovascular extracraneal en el municipio es elevada. Alta incidencia de factores de riesgo. El diagnóstico precoz de dicha enfermedad en un alto porcentaje permitió remitir a sus áreas de salud a aquellas personas que requerían de un tratamiento oportuno(AU)

Introduction: Extracranial cerebrovascular disease is a problem of health internationally, in Cuba it is sub-diagnostician without knowing its prevalence in the general population. Objective: To determine the characteristics of the extracranial cerebrovascular disease in the Arroyo Naranjo municipality. Methods: a descriptive study was conducted in 26 people diagnosed with carotid disease of a sample of 200 people obtained by a simple random method of the 208 554 residents of the municipality of Arroyo Naranjo. The disease was confirmed by carotid doppler ultrasound. The variables were: age, sex, percent stenosis, location, type of plate, risk factors and thickness intima-media carotid. Results: The prevalence of the disease was 12,5 x 100 000 inhabitants, higher in women (10,1) and older adults (9,1). The diagnosis was confirmed in 80,8 percent of people, where more than 45 percent showed a non-significant stenosis in both carotid. The types of plates were the heterogeneous (46,2 percent) and the echogenic (38,6 percent), located in: carotid bifurcation, bulb, and internal carotid. Smoking (80,8 percent), hypertension (73,1 percent), and peripheral arterial disease (65,1 percent) were the most frequent risk factors, noting that 69,2 percent had more than three factors. More of the 75 percent of those older than 60 years, independent of sex, showed pathological values of the thickness intima-media carotid. Conclusions: The prevalence of the extracranial cerebrovascular disease in the municipality is high; and too the incidence of the risk factors. Early diagnosis of the disease in a high percentage allowed referring to their areas of health to those persons requiring prompt treatment(AU)

Clinical Significance of Neonatal Lenticulostriate Vasculopathy: Association with Congenital Cytomegalovirus Infection

PURPOSE: To investigate clinical characteristics of neonates with lenticulostriate vasculopathy (LSV) and determine the correlation between LSV and clinical characteristics, especially congenital cytomegalovirus (CMV) infection. METHODS: We retrospectively reviewed the medical records of neonates with LSV, born at Cheil General Hospital between January 2005 and December 2015. LSV was graded into three groups based on the number of the LSV lesions and classified into an isolated and combined group showing LSV with coexistent abnormalities noted on brain sonography. We compared clinical data based on the LSV classification. RESULTS: Our study included 102 neonates with LSV, which showed an unilateral pattern in 10 and bilateral pattern in 92 neonates. The numbers of neonates studied based on LSV grading were 33, 53, and 16 in grade 1, 2, and 3, respectively. We observed the isolated LSV in 62 and the combined type in 40 neonates. We observed that 93 (91.2%) of the neonates with LSV did not show specific underlying cause for this condition. Congenital CMV infection was detected in 7 neonates, including 0, 5, and 2 neonates belonging to grade 1, 2, and 3, respectively. Among these, 2 neonates showed the isolated, and 5 showed the combined type of LSV. Statistically, congenital CMV infection was more significantly associated with LSV in grade 2 and 3 than in grade 1 (P < 0.05). Additionally, congenital CMV infection was more commonly observed in the combined than in the isolated LSV type showing a marginal association (P=0.07). CONCLUSION: We observed that LSV was not clinically significant except when associated with CMV infection. We suggest that neonates presenting with a grade 2 or higher of LSV or a combined type of LSV detected via neonatal brain ultrasonography should be evaluated for CMV infection.

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.

Valor de la resonancia magnética de imágenes en pacientes con enfermedad cerebrovascular isquémica / Evaluation of the magnetic resonance imaging in patient with ischemic cerebrovascular disease

La resonancia magnética de imágenes permite investigar aspectos morfológicos y funcionales del cerebro, lo cual es sumamente útil para diagnosticar enfermedades neurológicas, incluidas las cerebrovasculares y, por supuesto, la isquemia cerebral en las primeras horas de ocurrida, de modo que facilita seguir la evolución del ictus, reducir la zona de necrosis y garantizar una mejor calidad de vida de los pacientes. A diferencia de la tomografía y la angiografía no utiliza radiaciones ionizantes. En este artículo se concluye, entre otras inferencias, que su elevada sensibilidad supera el número de confirmaciones obtenidas a través de la tomografía axial computarizada.

Magnetic resonance imaging allows to investigate morphological and functional aspects of the brain, something extremely useful to diagnose neurological diseases, including the cerebrovascular diseases and, of course, the cerebral ischemia in the first hours of its ocurrence, so it facilitates to follow the clinical course of ictus, to reduce the necrosis area and to guarantee a better life quality of patients. Contrary to tomography and angiography it doesn't use ionizing radiations. In this article it is concluded, among other things, that its high sensibility overcomes the number of confirmations obtained through computarized axial tomography.

Immunohistochemical identification of plasma protein deposits in the wall of lenticulostriate arteries in patients with long-standing hypertension, with and without lipohyalinosis / Identificação imuno-histoquímica de depósitos de proteínas plasmáticas na parede das artérias lentículo-estriadas em pacientes com hipertensão arterial de longa duração, com e sem lipo-hialinose

PURPOSE: To investigate, through an immunohistochemical method, whether there is deposition of plasma proteins in the wall of lenticulostriate, cortical and leptomeningeal arteries of hypertensive patients, with and without lipohyalinosis. METHOD: Forty patients with essential hypertension were selected at random, 20 with lipohyalinosis in the lenticulostriate arteries (HH group) and 20 without lipohyalinosis (H group), matched with 20 normotensive controls (C group). RESULTS: Plasma protein deposits were identified in eight patients (40 percent) in the C group, in 15 patients (75 percent) in the H group, and in all 20 patients (100 percent) in the HH group, the difference being significant for the H group and highly significant for the HH group, as compared with the C group. In all groups, the distribution of plasma protein deposits, subendothelial in normal arteries, and diffuse, irregular in the wall of arteries with lipohyalinosis, was more frequent in the lenticulostriate arteries of the putamen. CONCLUSION: Deposition of plasma proteins in the lenticulostriate arteries seems to be relatively frequent in normotensive individuals, starting in middle age. Such process appears to be intensified by hypertension, especially in individuals with lipohyalinosis.

PROPÓSITO: Investigar, por meio de método imuno-histoquímico, a deposição de proteínas plasmáticas na parede das artérias lentículo-estriadas, corticais e leptomeníngeas em pacientes com hipertensão arterial, com e sem lipo-hialinose. MÉTODO: Quarenta pacientes com hipertensão arterial foram selecionados aleatoriamente, sendo 20 com lipo-hialinose nas artérias lentículo-estriadas (grupo HH) e 20 sem lipo-hialinose (grupo H), pareados com 20 controles normotensos (grupo C). RESULTADOS: Depósitos de proteínas plasmáticas foram identificados em oito pacientes (40 por cento) do grupo C, em 15 pacientes (75 por cento) do grupo H e em todos os 20 pacientes (100 por cento) do grupo HH, a diferença sendo significativa para o grupo H e altamente significativa para o grupo HH, quando comparada com o grupo C. Em todos os grupos, a distribuição dos depósitos de proteínas plasmáticas, subendotelial em artérias normais e difusa, irregular, na parede das artérias com lipo-hialinose, foi mais freqüente nas artérias lentículo-estriadas do putâmen. CONCLUSÃO: A deposição de proteínas plasmáticas nas artérias lentículo-estriadas parece ser um fenômeno relativamente freqüente em indivíduos normotensos, a partir da meia-idade. Tal processo parece ser intensificado pela hipertensão arterial, particularmente naqueles pacientes com lipo-hialinose.

Características tomográficas de la enfermedad cerebrovascular isquémica / Tomographic characteristics of the ischemic cerebrovascular disease

Se realizó un estudio descriptivo y transversal para describir las características tomográficas de la enfermedad cerebrovascular isquémica en los 209 pacientes ingresados en el Hospital Provincial Saturnino Lora de Santiago de Cuba desde agosto del 2005 hasta julio del 2006. Las imágenes tomográficas revelaron que el infarto isquémico predominó en el lóbulo temporal, pacientes del sexo masculino, mayores de 75 años y con antecedentes de hipertensión arterial, diabetes mellitus y tabaquismo. La mayor positividad diagnóstica se obtuvo en la etapa subaguda y hubo una elevada coincidencia entre el resultado de la tomografía y el hallazgo anatomopatológico.

A descriptive and cross-sectional study was carried out to describe tomographic characteristics of the ischemic cerebrovascular disease in 209 patients admitted to Saturnino Lora Provincial Hospital in Santiago de Cuba from August, 2005 to July, 2006. Tomographic images revealed that ischemic infarction prevailed in the temporal lobe, in male patients older than 75 years with history of hypertension, diabetes mellitus and smoking habit. The higher rate of positive diagnosis was observed in the subacute stage and there was a high coincidence between the result of tomography and the pathologic finding.

Acidente vascular cerebral e outras complicações do sistema nervoso central nas doenças falciformes / Stroke and other vascular complications of the central nervous system in sickle cell disease

A principal complicação da doença falciforme na infância é a das artérias cerebrais, mas após os 20 anos também pode se manifestar, como seqüela de lesões anteriores ou neoformadas. A vasculopatia tem a maior importância no desenvolvimento da criança e na qualidade de vida. Além do acidente vascular cerebral completo ou incompleto ("silencioso"), existem outras complicações do sistema nervoso central, porém não exclusivas. O diagnóstico da vasculopatia cerebral falciforme necessita auxílio neurorradiológico. O tratamento se faz basicamente com transfusões de eritrócitos contendo hemoglobina A. O objetivo deste trabalho é rever a literatura médica, procurando selecionar a melhor conduta em diagnóstico e tratamento que seja possível empregar de imediato, para reduzir a morbidade e mortalidade da vasculopatia cerebral e elevar a qualidade de vida dos pacientes, principalmente na infância. Os fatores de risco clínicos e laboratoriais, incluindo a triagem por ultra-sonografia Doppler das artérias cerebrais e imagens de ressonância magnética, devem influenciar a decisão de instituir transfusões crônicas e a quelação do ferro transfusional deve acompanhar este tratamento.

In children with sickle cell disease, cerebral arteries are prone to lesions that may cause deficiencies and poor quality of life. After the age of 20, new lesions may also occur. Besides stroke and silent cerebral ischemia, other lesions may occur. Radiologic images are necessary to diagnose and blood transfusions to treat. We reviewed the literature to choose best practices and guidelines to reduce morbidity and mortality and improve the quality of life of children with sickle cell disease. Risk factors identified from clinical and laboratory data and screening by Doppler ultrasonography and magnetic resonance must be used in order to make decisions about transfusion and iron chelation therapy.

Lenticulostriate Vasculopathy of Brain Ultrasonography

PURPOSE: To describe the associated conditions and clinical significance of lenticulostriate uasculopathy (LSV) as demonstrated by cranial sonography. MATERIALS AND METHODS: We retrospectively studied 77 LSV cases who between January 1994 and January 1996 had undergone cranial sonography for neonatal asphyxia, seizure, or bulging of anterior fontanel. Cranial sonography was performed with 7 MHz real-time linear and sector transducers using an Acuson computed sonography unit ; examinations were performed in sagittal and coronal planes. Twenty-six LSV patients underwent color Doppler studies, and in 24 of these, color signal and arterial pulse spectral wave were detected. LSV was grouped as one of three types, according to echogenicity : type I (less echogenic than sylvian fissure), type II (similar to sylvian fissure), and type III (more echogenic than sylvian fissures). We retrospectively evaluated associated sonographic abnormalities of the brain, and reviewed medical records for associated conditions and neurologic sequelae. Follow-up sonographic examinations were performed in 23 patients. RESULTS: There were 56 type I cases (73 %), 17 of type II (22 %) and 4 of type III (5 %). Cranial sonographic results were normal in 36 cases (47 %) and abnormal in 41(53 %). Forty-eight cases of nonspecific causes and 29 cases of perinatal and acquired causes accounted for associated conditions. The echogenicity of LSV had not changed in 21 of 23 follow-up cases. Neurologic examinations were performed in 18 cases and in 14 of these (78 %) there was no neurologic sequela. CONCLUSION: LSV in basal ganglia may be associated with nonspecific neonatal conditions, in addition to well known perinatal causes.