Pilot Study Assessing the Safety and Acceptance of a Novel Virtual Reality System to Improve Visual Function.

PURPOSE: To assess the feasibility of the clinical use of a novel Virtual Reality (VR) training software designed to be used for active vision therapy in amblyopic patients by determining its preliminary safety and acceptance on the visual function of healthy adults. METHODS: Pilot study enrolling 10 individuals (3 men, 7 women, mean age: 31.8 ± 6.5 years) with a best-corrected visual acuity (BCVA) of ≥ .90 (decimal) in both eyes were evaluated before and after 20 minutes of exposure to the NEIVATECH VR system using the HTC Vive Pro Eye head mounted display. Visual function assessment included near (40 cm) and distance (6 m) cover test (CT), stereopsis, binocular accommodative facility (BAF), near point of convergence (NPC), near point of accommodation (NPA), accommodative-convergence over accommodation (AC/A) ratio and positive and negative fusional vergences. Safety was assessed using the VR Sickness Questionnaire (VRSQ) and acceptance using the Technology Acceptance Model ;(TAM). Changes in all these variables after VR exposure were analyzed. RESULTS: Short-term exposure to the NEIVATECH VR system only induced statistically significant changes in distance phoria (p = .016), but these changes were not clinically relevant. No significant changes were observed in VRSQ oculo-motricity and disorientation scores after exposure (p = .197 and .317, respectively). TAM scores showed a good acceptance of the system in terms of perceived enjoyment and perceived ease of use, although some concerns were raised in relation to the intention-to-use domain. CONCLUSION: Exposure to the NEIVATECH VR system does not seem to adversely affect the visual function in healthy adults and its safety and acceptance profile seems to be adequate for supporting its potential use in other populations, such as amblyopic patients.

Visual perception alterations in COVID-19: a preliminary study.

AIM: To compare the visual perception (color and chromatic-achromatic contrast vision) of a small cohort of COVID-19 patients at the time of infection and after 6mo with that of a healthy population matched for sex and age. METHODS: A total of 25 patients (9 females, 16 males, mean age: 54±10y) with COVID-19 hospitalized in the COVID-19 Unit of the University Clinical Hospital of Valladolid were recruited for this preliminary study. Visual perception, as determined by monocular measurement of contrast sensitivity function (CSF) and color vision was assessed in each patient using the Optopad test. The results obtained were then compared with those of a sample of 16 age- and sex-matched healthy controls (5 females, 11 males, mean age: 50±6y) in which the same measurement procedure was repeated. Statistically significant differences between groups were assessed using the Mann-Whitney U test. Measurements were repeated after a minimum follow-up period of 6mo and statistically significant differences between the two time points in each group were assessed using the Wilcoxon signed rank test. RESULTS: Discrimination thresholds (color and chromatic-achromatic contrast vision) and their corresponding sensitivity, calculated as the inverse of the discrimination threshold, were evaluated. Analysis of the data revealed higher contrast threshold results (i.e., worse contrast sensitivity) in the COVID-19 group than in the control group for all spatial frequencies studied in the Optopad-CSF achromatic test and most of the spatial frequencies studied in the Optopad-CSF chromatic test for the red-green and blue-yellow mechanisms. In addition, color threshold results in the COVID-19 group were also significantly higher (i.e., worse color sensitivity) for almost all color mechanisms studied in the Optopad-Color test. At 6mo, most of the differences found between the groups were maintained despite COVID-19 recovery. CONCLUSION: The present results provide preliminary evidence that visual perception may be impaired in COVID-19, even when the infection has passed. Although further research is needed to determine the precise causes of this finding, analysis of CSF and color vision could provide valuable information on the visual impact of COVID-19.

Neutrophil-Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19.

BACKGROUND: The neutrophil-lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19. OBJECTIVE: We sought to describe the role of NLR in predicting poor outcome in COVID-19 patients undergoing mechanical thrombectomy for acute ischemic stroke. METHODS: We analyzed NLR in COVID-19 patients with large vessel occlusion (LVO) strokes enrolled into an international 12-center retrospective study of laboratory-confirmed COVID-19, consecutively admitted between March 1, 2020 and May 1, 2020. Increased NLR was defined as ≥7.2. Logistic regression models were generated. RESULTS: Incidence of LVO stroke was 38/6698 (.57%). Mean age of patients was 62 years (range 27-87), and mortality rate was 30%. Age, sex, and ethnicity were not predictive of mortality. Elevated NLR and poor vessel recanalization (Thrombolysis in Cerebral Infarction (TICI) score of 1 or 2a) synergistically predicted poor outcome (likelihood ratio 11.65, p = .003). Patients with NLR > 7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2-38.6, p = .03) and almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2-52.4, p = .03). In a multivariate analysis, NLR > 7.2 predicted poor outcome even when controlling for the effect of low TICI score on poor outcome (NLR p = .043, TICI p = .070). CONCLUSIONS: We show elevated NLR in LVO patients with COVID-19 portends significantly worse outcomes and increased mortality regardless of recanalization status. Severe neuro-inflammatory stress response related to COVID-19 may negate the potential benefits of successful thrombectomy.

Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study.

BACKGROUND: While there are reports of acute ischemic stroke (AIS) in coronavirus disease 2019 (COVID-19) patients, the overall incidence of AIS and clinical characteristics of large vessel occlusion (LVO) remain unclear. OBJECTIVE: To attempt to establish incidence of AIS in COVID-19 patients in an international cohort. METHODS: A cross-sectional retrospective, multicenter study of consecutive patients admitted with AIS and COVID-19 was undertaken from March 1 to May 1, 2020 at 12 stroke centers from 4 countries. Out of those 12 centers, 9 centers admitted all types of strokes and data from those were used to calculate the incidence rate of AIS. Three centers exclusively transferred LVO stroke (LVOs) patients and were excluded only for the purposes of calculating the incidence of AIS. Detailed data were collected on consecutive LVOs in hospitalized patients who underwent mechanical thrombectomy (MT) across all 12 centers. RESULTS: Out of 6698 COVID-19 patients admitted to 9 stroke centers, the incidence of stroke was found to be 1.3% (interquartile range [IQR] 0.75%-1.7%). The median age of LVOs patients was 51 yr (IQR 50-75 yr), and in the US centers, African Americans comprised 28% of patients. Out of 66 LVOs, 10 patients (16%) were less than 50 yr of age. Among the LVOs eligible for MT, the average time from symptom onset to presentation was 558 min (IQR 82-695 min). A total of 21 (50%) patients were either discharged to home or discharged to acute rehabilitation facilities. CONCLUSION: LVO was predominant in patients with AIS and COVID-19 across 2 continents, occurring at a significantly younger age and affecting African Americans disproportionately in the USA.

[Analysis of factors associated with the comprehensive recovery of stroke patients at acute hospital discharge]. / Análisis de factores asociados a la recuperación integral de pacientes de ictus al alta de hospital de agudos.

OBJECTIVE: Stroke is a public health problem of the first magnitude, being the first cause of disability in Spain. Although the fundamental role of psychophysical rehabilitation is known in patients suffering from this pathology, little is known about the integral and functional recovery of this type of patient. The Public Health Systems pay for or manage part of the treatment, but never its entirety. The aim of our study was to identify the factors that hinder access to the different treatments and care that allow the functional recovery of stroke patients. METHODS: Bivariate correlational descriptive analysis was performed on a sample of 102 stroke patients, over 30 years of age, admitted to the University Clinical Hospital of Valladolid, who required comprehensive rehabilitation upon discharge from hospital. Additionally, a multivariable analysis (logistic regression) was carried out to adjust results and eliminate confusing variables. RESULTS: The study showed that the factors initially associated with access to total rehabilitation were age (p<0.001), place of residence (p<0.001), marital status (p=0.007) and the existence of family support (p=0.01). Sex (p=0.18) and income (p=0.62) were not statistically significant. Age and place of residence (rural or urban) were the explanatory factors for access to comprehensive rehabilitation (values adjusted for all other variables p<0.001 were obtained). CONCLUSIONS: The results show the existence of very unequal access variables to comprehensive rehabilitation, with the consequences of loss of quality of life and impossibility of functional recovery that this implies, both for stroke patients of advanced age and for patients residing in rural areas.

OBJETIVO: El ictus es un problema de Salud Pública de primera magnitud, siendo la primera causa de discapacidad en España. A pesar de que se conoce el papel fundamental de la rehabilitación psicofísica en los pacientes que sufren esta patología, poco se conoce sobre la recuperación integral y funcional de este tipo de pacientes. Los Sistemas Públicos de Salud costean o gestionan parte del tratamiento, pero nunca su totalidad. El objetivo de nuestro estudio fue identificar los factores que dificultan el acceso a los diferentes tratamientos y cuidados que permiten la recuperación funcional del paciente con ictus. METODOS: Se realizó análisis descriptivo correlacional bivariable de una muestra de 102 pacientes con ictus, mayores de 30 años, ingresados en el Hospital Clínico Universitario de Valladolid, que precisaban una rehabilitación integral al alta hospitalaria. Adicionalmente, se realizó un análisis multivariable (regresión logística) para ajustar resultados y eliminar variables confusoras. RESULTADOS: El estudio evidenció que los factores inicialmente asociados al acceso a la rehabilitación total fueron la edad (p<0,001), el lugar de residencia (p<0,001), el estado civil (p=0,007) y la existencia de apoyo familiar (p=0,01). El sexo (p=0,18) y los ingresos económicos (p=0,62) no presentaron asociación estadísticamente significativa. La edad y el lugar de residencia (rural o urbano) fueron los factores explicativos del acceso a la rehabilitación integral (se obtuvieron valores ajustados al resto de variables de p<0,001). CONCLUSIONES: Los resultados muestran la existencia de variables de acceso muy desigual a la rehabilitación integral, con las consecuencias de pérdida de calidad de vida e imposibilidad de recuperación funcional que ello implica, tanto para pacientes de ictus de edad avanzada como para pacientes que residen en el medio rural.

Análisis de factores asociados a la recuperación integral de pacientes de ictus al alta de hospital de agudos / Analysis of factors associated with the comprehensive recovery of stroke patients at acute hospital discharge

OBJETIVO: El ictus es un problema de Salud Pública de primera magnitud, siendo la primera causa de discapacidad en España. A pesar de que se conoce el papel fundamental de la rehabilitación psicofísica en los pacientes que sufren esta patología, poco se conoce sobre la recuperación integral y funcional de este tipo de pacientes. Los Sistemas Públicos de Salud costean o gestionan parte del tratamiento, pero nunca su totalidad. El objetivo de nuestro estudio fue identificar los factores que dificultan el acceso a los diferentes tratamientos y cuidados que permiten la recuperación funcional del paciente con ictus. MÉTODOS: Se realizó análisis descriptivo correlacional bivariable de una muestra de 102 pacientes con ictus, mayores de 30 años, ingresados en el Hospital Clínico Universitario de Valladolid, que precisaban una rehabilitación integral al alta hospitalaria. Adicionalmente, se realizó un análisis multivariable (regresión logística) para ajustar resultados y eliminar variables confusoras. RESULTADOS: El estudio evidenció que los factores inicialmente asociados al acceso a la rehabilitación total fueron la edad (p < 0,001), el lugar de residencia (p < 0,001), el estado civil (p = 0,007) y la existencia de apoyo familiar (p = 0,01). El sexo (p = 0,18) y los ingresos económicos (p = 0,62) no presentaron asociación estadísticamente significativa. La edad y el lugar de residencia (rural o urbano) fueron los factores explicativos del acceso a la rehabilitación integral (se obtuvieron valores ajustados al resto de variables de p < 0,001). CONCLUSIONES: Los resultados muestran la existencia de variables de acceso muy desigual a la rehabilitación integral, con las consecuencias de pérdida de calidad de vida e imposibilidad de recuperación funcional que ello implica, tanto para pacientes de ictus de edad avanzada como para pacientes que residen en el medio rural

OBJECTIVE: Stroke is a public health problem of the first magnitude, being the first cause of disability in Spain. Although the fundamental role of psychophysical rehabilitation is known in patients suffering from this pathology, little is known about the integral and functional recovery of this type of patient. The Public Health Systems pay for or manage part of the treatment, but never its entirety. The aim of our study was to identify the factors that hinder access to the different treatments and care that allow the functional recovery of stroke patients. METHODS: Bivariate correlational descriptive analysis was performed on a sample of 102 stroke patients, over 30 years of age, admitted to the University Clinical Hospital of Valladolid, who required comprehensive rehabilitation upon discharge from hospital. Additionally, a multivariable analysis (logistic regression) was carried out to adjust results and eliminate confusing variables. RESULTS: The study showed that the factors initially associated with access to total rehabilitation were age (p < 0.001), place of residence (p < 0.001), marital status (p = 0.007) and the existence of family support (p = 0.01). Sex (p = 0.18) and income (p = 0.62) were not statistically significant. Age and place of residence (rural or urban) were the explanatory factors for access to comprehensive rehabilitation (values adjusted for all other variables p < 0.001 were obtained). CONCLUSIONS: The results show the existence of very unequal access variables to comprehensive rehabilitation, with the consequences of loss of quality of life and impossibility of functional recovery that this implies, both for stroke patients of advanced age and for patients residing in rural areas

Diasquisis transcallosa: a propósito de un caso de afasia cruzada / Interhemispheric diaschisis: a case of crossed aphasia

No disponible

[Intracranial atherosclerosis]. / Ateromatosis intracraneal.

Until recently, intracranial atheromatosis was a probably underdiagnosed clinicopathological entity that was rarely studied in depth. In the last years the advance and expansion in the use of non-invasive diagnostic tools have led intracranial atheromatosis to the front page among the most prevalent causes of stroke worldwide. Important efforts have been accomplished with the aim of identifying markers of poor outcome, which, besides the underlying mechanisms of cerebral ischemia in these patients, are the most important factors on which clinical and therapeutic decisions should be based. To date, the therapeutic armamentarium is scarce and far from optimun, regarding medical and endovascular measures. In this review we address the most important aspects of the natural history and cure treatment of intracranial atheromatosis.

Ateromatosis intracraneal / Intracranial atherosclerosis

Hasta hace relativamente poco tiempo la ateromatosis intracraneal había permanecido como una entidad probablemente infradiagnosticada y poco estudiada. En los últimos años el avance y la generalización del uso de herramientas diagnósticas no invasivas la han situado como una de las causas más prevalentes de ictus en todo el mundo. Se han realizado importantes esfuerzos para identificar los factores indicadores de peor pronóstico, que, junto con la identificación del mecanismo patológico subyacente de la isquemia en estos pacientes,representan los elementos más importantes para guiar las decisiones terapéuticas en este trastorno. Las medidas terapéuticas médicas e intervencionistas disponibles son insuficientes o están poco optimizadas. Abordaremos en esta revisión los aspectos más importantes de lahistoria natural y terapéutica de este trastorno

Until recently, intracranial atheromatosis was a probably underdiagnosed clinicopathological entity that was rarely studied in depth. In the last years the advance and expansion in the use of non-invasive diagnostic tools have led intracranial atheromatosis to the front page among the most prevalent causes of stroke worldwide. Important efforts have been accomplished with the aim of identifying markers of poor outcome, which, besides the underlying mechanisms of cerebralischemia in these patients, are the most important factors on which clinical and therapeutic decisions should be based. To date, the therapeutic armamentarium is scarce and far from optimun, regarding medical and endovascular measures. In this review we address the most important aspects of the natural history and cure treatment of intracranial atheromatosis