Tendencia de egresos hospitalarios con diagnóstico de accidente cerebrovascular agudo entre los años 2018-2021 en Chile: análisis descriptivo / Hospital discharge trend with diagnosis of acute stroke between the years 2018 and 2021 in Chile: descriptive analysis

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

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

Estudio Transversal: Riesgo Cardiovascular en Diabetes Mellitus II según Score UKPDS en pacientes del Hospital José Carrasco Arteaga / Cross-Sectional Study: Cardiovascular Risk in Diabetes Mellitus II using UKPDS Score in Hospital José Carrasco Arteaga patients

INTRODUCCIÓN: La Diabetes Mellitus Tipo 2 (DM2) es una enfermedad de gran impacto sanitarionitario y socioeconómico. Las complicaciones cardiovasculares son su principal causa de muerte, por este motivo es de gran importancia la aplicación de estrategias de prevención. El objetivo de este estudio fue determinar el Riesgo Cardiovascular según el Score UKPDS en pacientes con Diabetes Mellitus Tipo 2 atendidos en del Hospital José Carrasco Arteaga de Cuenca-Ecuador, durante el periodo noviembre 2018 a agosto 2019. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo, de corte transversal, con una muestra de 118 pacientes con diagnóstico de DM2 atendidos en el Hospital José Carrasco Arteaga, entre noviembre 2018 a agosto 2019. Se revisaron los registros clínicos, se recopilo la información en un formulario con todas las variables del Score UKPDS. La estimación del Riesgo Cardiovascular (RCV) se llevó a cabo con ayuda de la Calculadora Risk Engine versión 2.0 del Score UKPDS. RESULTADOS: En la población de estudio predominó el sexo femenino. La edad se encontró en un rango de 32 a 95 años, el grupo etario de mayor frecuencia fue el de 55 a 59 años con el 16.1%. En el 40% de la muestra la duración de la enfermedad fue de >10 años. El 42.4% (n=50) presentó valores ≥130mmHg de PAS. El 75.4% de la muestra tenían un mal control glucémico, con hemoglobina glicosilada mayor al rango normal para el grupo de edad. El RCV estimado a 5 años se mantuvo dentro de "Riesgo Bajo" para la mayoría de la muestra; mientras que a los 10 años se encontró que aumenta el riesgo sobre todo para ECV no Fatal (Riesgo alto: 21.25%) y para IAM Fatal (6.8%) y no Fatal (6.8%). CONCLUSIÓN: La mayoría de pacientes tenían más de 10 años de evolución de DMII. Más de la mitad de la muestra tenían un control glicémico inadecuado. El riesgo cardiovascular a los 5 años fue "bajo" para la mayoría de la población, tanto para IAM como para ECV. El riesgo cardiovascular a los 10 años fue ligeramente mayor para todas las entidades, sobre todo aumenta para ECV no fatal, a "riesgo muy alto" del 21.2%, el riesgo de IAM también aumenta a riesgo muy alto del 6.8%.

BACKGROUND: Type 2 Diabetes Mellitus (DM2) is a disease of great health and socioeconomic impact. Cardiovascular complications are the main cause of death in diabetic patients, for this reason the application of prevention strategies is important. The aim of the research was to determine the cardiovascular risk according to UKPDS Score in patients diagnosed with DM2, treated at Hospital José Carrasco Arteaga, Cuenca-Ecuador, from November 2918 to August 2019. METHODS: A descriptive, cross-sectional study was conducted with a sample of 118 patients diagnosed with DM2, treated at Hospital José Carrasco Arteaga, between November 2018 and August 2019. Clinical records were reviewed, information was collected on a form with all the variables of the UKPDS Score. Cardiovascular Risk Estimation (RCV) was carried out with the Risk Engine Calculator version 2.0 of the UKPDS Score. RESULTS: The female sex predominated in the study population. The age range went from 32 to 95 years old, the most frequent range of age was 55 to 59 years old (16.1%). The disease duration in 40% of the population was higher than 10 years. 42.4 %(n=50) presented SBP values ≥130mmHg. 75.4% of the sample had poor glycemic control, with glycosylated hemoglobin levels higher than the normal range for each age group. The estimated 5-year CVR was low for most of the sample; while the 10 year CVR increased, especially for non-fatal CVD(high risk:21.25%) and for fatal (6.8%) and non-fatal(6.8%) AMI. CONCLUSION: Most of the patients had more than 10 years with DMII diagnosis. More than half of the sample had inadequate glycemic control. The CVR at 5 years was "low" for the majority of the population, both for AMI and CVD. The cardiovascular risk at 10 years was slightly higher for all entities, especially it increases for non-fatal CVD, to a "very high risk" of 21.2%, and the risk of AMI also increases to a "very high risk" of 6.8%.

Clinical Profile of Acute Ischemic Cerebrovascular Stroke.

Introduction: Stroke is the common cause of severe disabilityand death worldwide. Study aimed to evaluate etiological,demographic, clinical course and identification of risk factorsin acute ischemic cerebrovascular stroke.Material and methods: A prospective study of 46 patientsof Ischemic cerebrovascular stroke conducted at MedicalCollege, Vadodara during January 2014 to November 2014.All Patients were subjected to Personal biodata and detailedclinical assessment with written consent. All were sent forroutine blood investigations including Lipid profile, chest xray PA view, Electrocardiography, 2D Echo and CT Scan. AllData were analysed by using Microsoft excel software.Results: In our study, most common age group was 55 to64 yrs (mean age 55.5yrs) with males predominance wasobserved (52%). Among males, 26 (56.53%) patients weresmokers while 18 (39.13%) males were alcoholic. Amongst46 patients, 55% and 35% found to be hypertensive andDiabetic respectively. 24% Patients had positive familyhistory of Hypertension. In our study, 54.3% had normalserum cholesterol level between 150 to 199 mg/dl whileHypertriglyceridemia and low HDL was found in 17.4% and26% respectively. Most common documented risk factors forstroke were age, smoking, hypertension and Diabetes Mellitus.Most of Patients presented with limb/motor weakness (86.9%)followed by speech disturbance and loss of consciousness at41.3% and 34.7% respectively. Hospital outcome was good.Conclusion: Ischemic stroke entails high socioeconomicburden due to increased morbidity and mortality. Age,Smoking, Hypertension and Diabetes are importantatherosclerotic risk factors in our study. Early Identification,treatment and prevention of risk factors can decline theincidence, complications and related mortality. So Physicianhave a important role in stroke prevention by encouraging thereduction in risk factors.

An observational study of clinicoetiological profile of stroke patients in a new tertiary care hospital in North Odisha, India

Background: Stroke is one of the leading causes of morbidity and mortality in India. The objective was to study the clinical profile, risk factors, neurological characters, pattern of brain stroke, areas of brain affected as per CT scan findings in patients with stroke.Methods: This observational study was carried out from June 2018 to Jan 2019 of all new patients admitted with stroke in Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, India.Results: The incidence of stroke is maximum in 46-60 years of age group. The average age+SD was 59.3+13.5 in our study. 274 (46.52%) patients had ischemic stroke and 315 (53.48%) patients had hemorrhagic stroke. The male to female ratio was 1.46:1. Anterior circulation (86.42%) was the most common territory involved in the brain. The most common risk factor was hypertension with 77.76% followed by dyslipidemia (53.99%). The most common clinical presentation was hemiplegia (85.23%).Conclusions: The incidence of stroke is maximum in 46-60 years of age group. The average age+SD was 59.3+13.5 in our study. 274 (46.52%) patients had ischemic stroke and 315 (53.48%) patients had hemorrhagic stroke. The male to female ratio was 1.46:1. Anterior circulation (86.42%) was the most common territory involved in the brain. The most common risk factor was hypertension with 77.76% followed by dyslipidemia (53.99%). The most common clinical presentation was hemiplegia (85.23%).

A study of 50 cases of seizures in adults and its clinical profile

Background: Seizure disorder is a one of major health problem in adults mostly in late adulthood in which chances of seizures are increased especially due to comorbidities like cerebrovascular stroke, CNS infection (tuberculoma, viral encephalitis), degenerative disease of brain, and brain tumor Materials and methods: We studied 50 adult patients to identify various etiology of seizures We checked for various parameters like complete blood count, blood sugar level, renal function tests with electrolytes, liver function tests, brain imaging and Electroencephalogram (EEG) Results: With the help of this study, we identify that most common cause for seizure was idiopathic in less than 50 years of age and post stroke epilepsy in more than 50 years of age Generalized tonic clonic seizure was most common type of seizure With the help of newer neuro-imaging modalities and EEG it was possible to find out specific etiology of seizure, so EEG and imaging study should be integral part of investigation work of patient with seizure disorder Conclusion: The present study was an effort to find out the various etiology and type of seizures in adult its types and clinical profile and response to antiepileptic drugs Every patient should be investigated thoroughly and diagnosed and best suitable drug given depending upon type of seizures to the patient for proper control of seizures and also improve morbidity and mortality due to seizures

Serum enzymes in cerebrovascular accident

Background: Brain is a rich source of a variety of enzymes and any injury like stroke to brain tissue could similarly result in an increase in activity of these enzymes in cerebrospinal fluid and serum. It was in this context that the present study was done to assess the levels of enzymes like aspartate aminotransferase (AST), creatine kinase (CK) and Isoenzyme of creatine kinase (CK-MB) in serum. Evaluation of enzyme levels in serum has involved keen interest as a simple, economical, reliable and easily available method for the evaluation of severity, course, prognosis, and to some extent in the differential diagnosis of various types of cerebrovascular accidents. Aim: To study the serum enzymes in cerebrovascular accidents. Materials and methods: The present study was done in Fathima Institute of Medical Sciences, Kadapa, by taking 50 of samples and 30 are controls. Creatine Kinase (Total), Creatine Kinase-MB, Aspartate Transaminase, lipid profile, Fasting Blood Sugar were estimated in patients and control group also. Results: The biochemical parameters studied were fasting blood glucose, total cholesterol, triglycerides, LDL, VLDL, HDL, SGOT, CPK and CPK-MB. Serum CPK was grossly elevated in patients with stroke compared to controls which is statistically significant (P Value < 0.001). Conclusion: In the present study, all the parameters were elevated, for better understanding of serum enzymes in cerebrovascular accidents further investigations are needed

A study on clinical profile of stroke in young and elderly in GMERS Medical College and Hospital, Gandhinagar, Gujarat.

Background: The cerebrovascular stroke is one of the leading causes of morbidity & mortality in adult life. Indian studies have shown a stroke prevalence of 471.58/100000 population. Stroke mostly occurs in elderly people. Risk factors for stroke differ between young and elderly patients. The aim was to study the clinical presentation, risk factors, types, topography as per CT scan findings in ≤45 years and >45 years patients from GMERS medical college and hospital Gandhinagar. Methods: This is a retrospective study of all new patients managed for stroke in the medical ward of GMERS medical college and hospital, Gandhinagar, Gujarat from January1, 2012 to December 31, 2013. Results: Incidence of stroke in elderly (≥45 years) was than young (<45 years) patients with male predominance in both the groups. Most common clinical presentation from both age groups was hemiplegia (75% in young vs. 72.1% in elderly). Common risk factors in were HT and past h/o CVD (25%) and smoking (16.6%) in young and HT (37.1%), dyslipidemia and smoking (14.3%) in elderly. Most common type of stroke in both age groups was ischemic (83.3% in young vs. 73.2% in elderly), followed by Hemorrhagic. Common sites of hemorrhage in young and elderly were lobar and thalamoganglionic. Most common infarction site in both age groups is MCA territory. Conclusion: The cerebrovascular stroke was more in elderly with hypertension and smoking was the most common risk factor in both age groups and most common type was ischemic.

A retrospective study of clinical profile of stroke patients from GMERS Medical College and Hospital, Gandhinagar, Gujarat.

The cerebrovascular stroke is one of the leading causes of morbidity & mortality in adult life. After coronary heart disease & cancer of all types, stroke is the third commonest cause of death worldwide. Indian studies have shown a stroke prevalence of 471.58/100000 population. The objective was to study the clinical presentation, risk factors, neurological presentation, pattern of brain strokes, areas of brain affected as per CT scan findings in pts GMERS medical college and hospital Gandhinagar. Methods: This is a retrospective study of all new patients managed for stroke in the medical ward of GMERS medical college and hospital, Gandhinagar, Gujarat from January1, 2012 to December 31, 2013. Results: The cerebrovascular strokes are more common in males (59.7%) than females (40.3%). Most common age group was 61-70 years (32.8%). Most common clinical feature was hemiplegia (72.6%). Most common risk factor was Hypertension (34%) followed by past h/o cerebrovascular stroke (15%), smoking (14%), dyslipidemia (13%). Most common type of stroke was ischemic (74.6%) & hemorrhagic was 2nd (22.9%). In ischemic stroke most common involved areas were parietal (33.7%), frontal (16.7%). In hemorrhagic stroke most common site was thalamus (24.7%) followed by ventricular (17.5%). Conclusions: The cerebrovascular stroke cases were having male predominance with Hypertension was the most common risk factor and most common type of stroke was ischemic.

Preliminary survey on blood homocystein level in cerebrovascular stroke

The concentration of blood homocystein (Hcy) in 26 patients with cerebrovascular accident (CVA) was determined preliminarily in Central Hospital in Hue city. 57.69% was the incidence of CVA in male and 42.31% in female patients (in male it was 1.36 fold higher than in female). Hcy concentration increased in 80.77% CVA patient. The rate of increase of blood level of Hcy was 66.67% in brain hemorrhage, 92.86% in brain infarctus. The incidence of CVA enhanced with the age, especially after the age of 55. High blood pressure accounted for 76.92% in CVA. 17/26 (65.38%) was the ratio of tobacco smoler.