ABSTRACT
Easter Island (Rapa Nui), Chile, is remote, located in the Polynesian Triangle in Oceania. The closest continental point is Chile, 3,512 km east. It has a population of 7,750 inhabitants, who are Chilean citizens, and receives more than 60,000 tourists a year. For this entire population, there is a medium complexity hospital without a neurology specialist. In 2019, local professionals were trained in a Telestroke program with remote clinical support conducted by neurologists located on mainland Chile. We present a 50-year-old native male, with unknown medical history, who suddenly presented right-half-body weakness and aphasia. He was evaluated via Telestroke consultation, and thrombolysis with tenecteplase was indicated. The patient improved rapidly and 45 min later the NIHSS score was 0 points. To our knowledge, this is the first reported case of Telestroke treatment in such a remote area, highlighting the importance of telemedicine to overcome geographical and technological stroke care barriers and to improve patients' outcome, no matter where they live.
Subject(s)
Neurology , Stroke , Telemedicine , Hospitals , Humans , Male , Middle Aged , Stroke/diagnosis , Stroke/drug therapy , Thrombolytic TherapyABSTRACT
BACKGROUND: The NIH Stroke Scale (NIHSS) is used to assess acute ischemic stroke severity and outcome. High NIHSS scores are usually associated with arterial occlusion but it is unknown what the effect of time to clinical evaluation (TTCE) in this association is. We tested the NIHSS scores as an instrument to determine vessel occlusion (VO) at different time points from symptom onset. METHODS: Patients were selected from our prospective stroke database if they had admission NIHSS scores and intracranial vessel neuroimaging studies. We dichotomized patients according to VO and TTCE. Receiver operating curves, c statistics, and odds ratios were calculated to study the validity of the NIHSS score. RESULTS: Among 463 patients (mean age 70.2 years, 53.1% male, median NIHSS 4, median TTCE 3.3 hours), 22.5% had arterial occlusion. Median NIHSS scores were higher in patients with VO, 10.5 (interquartile range 5-18) vs 3 (2-7), p<0.001, and in those with TTCE<6 hours, 15 (interquartile range 7-19) vs 4 (2-8) if ≥6 hours, p<0.001. Receiver operating characteristic curves showed that the validity of NIHSS in predicting VO was higher in patients with TTCE<6 hours, p=0.03. The best cutoff point in patients evaluated before 6 hours was an NIHSS of 7 (76.2% sensitivity, specificity 70.1%), while in patients evaluated after 6 hours the best cutoff point was 4 (sensitivity 65.4%, specificity 62.0%). CONCLUSIONS: Our study shows that the validity of NIHSS scores in predicting arterial occlusion is time-dependent, decreasing with increasing time from symptom onset to clinical evaluation.
Subject(s)
Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/etiology , Cerebral Infarction/complications , Severity of Illness Index , Aged , Aged, 80 and over , Brain/diagnostic imaging , Brain/pathology , Diffusion Magnetic Resonance Imaging/methods , Female , Humans , Magnetic Resonance Angiography , Male , Middle Aged , National Institutes of Health (U.S.) , Neurologic Examination , Predictive Value of Tests , ROC Curve , Reproducibility of Results , Retrospective Studies , Statistics, Nonparametric , Time Factors , Tomography Scanners, X-Ray Computed , Ultrasonography, Doppler, Transcranial , United StatesABSTRACT
This study aimed to cross-validate the capacity of a computer software program to detect and measure, using a measurement method applied to the content and form analysis of 5-minute speech samples, cognitive impairment and associated comorbid neuropsychiatric psychobiological dimensions in drug-abusing patients. At the University of California-Irvine (UCI) Neuropsychiatric Center, 28 drug-abusing inpatients using illegal drugs were clinically evaluated. Their scores for cognitive impairment derived by the computerized content analysis method were compared with scores derived from selected tests from the Halstead-Reitan Neuropsychological Test Battery, the computerized Automated Neuropsychological Assessment Metric Battery (ANAM), the Alzheimer's Disease Assessment Scale-Cognitive Portion, the Stroop Color and Word Test, the Symbol Digit Modalities Test, and the Controlled Oral Word Association Test. The statistical significance (P value) of the correlations of scores from these different measures with scores obtained from the computerized content analysis measures was less than .05 to .001. The comparative "hit rate," detecting cognitive impairment above the norms for each measure administered to these drug-abusing patients, for the computerized content analysis measures and some of the ANAM neuropsychological measures was 75% to 89%, and for the other neuropsychological measures, 25% to 64%. In conclusion, the computerized content analysis methodology applied to 5-minute verbal samples is a valid, rapid, easily administered measurement instrument for assessing the magnitude of cognitive impairment and comorbid neuropsychiatric dimensions.
Subject(s)
Cognition Disorders/diagnosis , Diagnosis, Computer-Assisted , Adolescent , Adult , Aged , Aged, 80 and over , Electronic Data Processing , Female , Humans , Male , Middle Aged , Neuropsychological TestsABSTRACT
Lead levels in samples of the groups at highest risk to the effects of lead exposure, pregnant women and their infants, are higher than levels known to produce developmental retardation in children in a considerable proportion of the sample tested in Mexico City. Modeling of prenatal factors predicting maternal lead during pregnancy shows the strong effect of the use of low-temperature ceramics on lead level. The data also suggests an important contribution from air lead. The downward trend in lead exposure in pregnant women in the Valley of Mexico over the last 10 years, concurrent with downward trends in air lead is encouraging. However, reducing the manufacture and use of leaded pottery could produce a significant further reduction of lead exposure with a modest program of public education, government regulation and subsidization of lead free pottery.
Subject(s)
Environmental Exposure/adverse effects , Lead/adverse effects , Pregnancy/drug effects , Suburban Population , Urban Population , Adolescent , Adult , Environmental Exposure/statistics & numerical data , Female , Humans , Infant , Infant, Newborn , Lead/blood , Male , Mexico/epidemiology , Pregnancy/blood , Suburban Population/statistics & numerical data , Urban Population/statistics & numerical dataABSTRACT
Análisis retrospectivo de 5 años (ene. 1984 a dic. 1988) de pacientes portadores de cuerpos extraños esofágicos (CEE) consultantes de Cirugía de Tórax y Otorrinolaringología del Hospital Regional Temuco, IX Región
Subject(s)
Infant, Newborn , Infant , Child, Preschool , Child , Middle Aged , Humans , Male , Female , Foreign Bodies , Esophagus , Esophageal Stenosis/etiology , Esophagoscopy , Foreign-Body MigrationABSTRACT
Se describre la experiencia de un equipo multidisciplinario de tratamiento para NF Labiopalatinos en la IX Región, entre 1980 y 1986, en 250 NF de ambos sexos, portadores de diversos tipos de fisuras en las que predominan las formas más complejas de lesión. Se expone un algo-ritmo de trabajo organizado integral el que es necesario para dar al NF la mejor atención. Se comenta el apoyo de gran valor de entidades comunitarias benéficas (local: COANIFIS e internacional: INTERPLAST) en el tratamiento completo, complejo y de alto costo en estas patologías
