Tasa de filtración glomerular como estimador de la hipertensión en enfermedades renales y cardiovasculares / Glomerular filtration rate as an estimator of renal and cardiovascular diseases such as hypertension

Introducción: Las fórmulas para la estimación de la tasa de filtración glomerular son fundamentales para estimar el curso de enfermedades renales; incluso ha sido de gran ayuda para obtener datos de prevalencia. Las ecuaciones comparadas con otros métodos son una forma económica y rápida para dar una estimación de la función renal. Objetivo: Describir la utilización de diferentes fórmulas para calcular la tasa de filtración glomerular relacionada con la hipertensión arterial y otras patologías renales y cardiovasculares. Metodología: Se realizó la búsqueda de artículos de investigación en bases de datos como PubMed, Science-Direct, Embase y otras, se estableció un tiempo de publicación entre los años 2018-2022 y se seleccionaron 42 artículos científicos relacionados con el tema. Resultados: La hipertensión arterial es una situación que incrementa el riesgo tanto de enfermedad cardiovascular como de deterioro de la función renal, por lo que en los pacientes hipertensos se espera una relación estrecha en la expresión de ambas patologías. Existen factores que alteran los valores de la creatinina sérica como la dieta, el ejercicio, la edad, el género, la masa muscular, enfermedades musculares y medicamentos. El impacto de la hipertensión en la función renal está descrito además de la relación entre el deterioro de la función renal y el incremento del riesgo cardiovascular; es por esto que en los últimos años la estimación de la función renal se ha incorporado como un marcador de morbilidad y mortalidad cardiovascular. Conclusiones: La estimación de la tasa de filtración glomerular es importante en varios contextos clínicos, en especial en aquellos pacientes con enfermedades que afectan la función glomerular, la creatinina es el biomarcador más usado a pesar de sus evidentes limitaciones.

Introduction: Formulas for estimating glomerular fil-tration rate are fundamental for estimating the course of renal diseases; they have even been of great help in obtaining prevalence data. Equations compared with other methods are an economical and fast way to give an estimation of renal function. Objective: Describe the use of different formulas to calculate the glomerular filtration rate related to high blood pressure and other kidney or cardiovascular pa-thologies. Methodology: Research articles were searched in da-tabases such as PubMed, Science-Direct, Embase and others, a publication time was established between the years 2018-2022 and 42 scientific articles related to the topic were selected. Results: Arterial hypertension is a situation that in-creases the risk of both cardiovascular disease and re-nal function deterioration, so in hypertensive patients a close relationship in the expression of both pathologies is expected. There are factors that alter serum creati-nine values such as diet, exercise, age, gender, muscle mass, muscle diseases and medications. The impact of hypertension on renal function has been described in addition to the relationship between the deterioration of renal function and the increase in cardiovascular risk; this is why in recent years the estimation of renal func-tion has been incorporated as a marker of cardiovascu-lar morbidity and mortality. Conclusions: The estimation of glomerular filtration rate is important in several clinical contexts, especia-lly in those patients with diseases that affect glomerular function; creatinine is the most widely used biomarker despite its obvious limitations

Diabetes Mellitus Y Su Manejo En Escenarios Difíciles / Diabetes mellitus and its management in difficult scenarios

Introducción: la diabetes mellitus se produce por la alteración en el metabolismo de los carbohidratos, su prevalencia viene en aumento debido al incremento en la tasa de obesidad y los cambios en los hábitos nutricionales. En Colombia, alrededor de 8,36 % de la población padece diabetes tipo 2 y menos del 1 % diabetes tipo 1. Metodología: se seleccionaron 51 artículos sobre diabetes y diferentes escenarios clínicos, publicados en su mayoría entre los años 2015-2021. Resultados: en los pacientes con enfermedad hepática crónica, se aumenta la resistencia a la insulina e intolerancia a la glucosa; por esto, deben ser tratados en primera instancia con metformina o insulinas. En los diabéticos el riesgo cardiovascular se incrementa tanto para infarto como para accidente cerebrovascular. En estos, se puede realizar tratamiento con metformina, empagliflozina, entre otros. Los pacientes con falla renal tienen mayor riesgo de hipoglicemia por el metabolismo prolongado de la insulina como consecuencia de la filtración glomerular, en estos son útiles medicamentos como liraglutide y sus similares. Conclusión: existen múltiples escenarios clínicos que se presentan en conjunto con la diabetes mellitus. Se deben tener en cuenta las múltiples comorbilidades de los pacientes al momento de instaurar un tratamiento y sus diferentes determinantes, para garantizar su efectividad.

Introduction: Diabetes mellitus is caused by alterations in carbohydrate metabolism and its prevalence is increasing due to the increase in the rate of obesity and changes in nutritional habits. In Colombia, about 8.36% of the population suffers from type 2 diabetes and less than 1% from type 1 diabetes. Methods: Fifty-one articles were selected, on diabetes and different clinical scenarios, mostly published between 2015-2021. Results: In patients with chronic liver disease, insulin resistance and glucose intolerance are increased; therefore, they should be treated in the first instance with Metformin or Insulin. In diabetics, cardiovascular risk is increased for both infarction and stroke. In these patients, treatment can be performed with Metformin, Empagliflozin, among others. Patients with renal failure have a higher risk of hypoglycemia due to prolonged insulin metabolism as a consequence of glomerular filtration; medications such as Liraglutide and similar drugs are useful in these patients. Conclusion: There are multiple clinical scenarios that occur in conjunction with diabetes mellitus. The multiple comorbidities of patients should be taken into account when instituting treatment and its different determinants to ensure the effectiveness of the treatment to be appropriate for the patients.

Tromboprofilaxis entrauma / Thromboprophylaxis in Trauma Santiago Castañeda Palacio1

Introducción: Las lesiones traumáticas son una de las principales causas de morbilidad y mortalidad en todo el mundo. Los pacientes que sufren traumatismos tienen riesgo de estados de hipercoagulación y aumentan el riesgo de sufrir enfermedad tromboembólica venosa. La tromboprofilaxis hace referencia a cualquier intervención usada para prevenir el desarrollo del tromboembolismo venoso como son la trombosis venosa profunda y el tromboembolismo pulmonar. Objetivo: Realizar una revisión sobre los principales mecanismos de tromboprofilaxis y sus principales esquemas en relación con el trauma ortopédico. Métodos: Se realizó una búsqueda de artículos de investigaciones originales en las bases de datos MEDLINE, EMBASE, Lilacs y Science Direct. Se seleccionaron palabras claves y términos del MeSH relacionados con anticoagulantes, tromboembolismo venoso, y embolismo pulmonar entre otros. La mayoría de bibliografía utilizada tuvo un rango de publicación no mayor a 5 años. Conclusiones: Los pacientes que sufren traumas tienen riesgo de sufrir estados de hipercoagulación y aumentan el riesgo de una enfermedad tromboembólica venosa. Con el fin de prevenirla se utilizan en la tromboprofilaxis distintos medicamentos, como heparinas de bajo peso molecular, y dispositivos de compresión(AU)

Introduction: Traumatic injuries are one of the leading causes of morbidity and mortality worldwide. Up to six million people die due to this cause. Trauma patients are at risk for hypercoagulable states and are at increased risk for venous thromboembolic disease. Thromboprophylaxis refers to any intervention used to prevent the development of venous thromboembolism such as deep vein thrombosis and pulmonary thromboembolism. Objective: To carry out a practical review of the main mechanisms of thromboprophylaxis and its main schemes in relation to orthopedic trauma. Methods: A search for original research articles was conducted in MEDLINE, EMBASE, Lilacs, and Science Direct databases. The keywords and MeSH terms related to anticoagulants, venous thromboembolism, and pulmonary embolism were selected among others. Most of the bibliography used had a publication range of no more than 5 years. Conclusions: Patients who suffer trauma are at risk of hypercoagulable states and these increase the risk of venous thromboembolic disease. In order to prevent it, different drugs are used in thromboprophylaxis, such as low molecular weight heparins, among others, as well as other compression devices(AU)

Anemia sideroblástica una enfermedad infrecuente de causas múltiples / Sideroblastic anemia, a rare disease of multiple causes

Introducción: La anemia sideroblástica es un trastorno hematológico que altera el proceso de la hematopoyesis, en la cual se ve afectada en mayor proporción la línea eritroide. Además, se presentan alteraciones en la síntesis del grupo hemo por disfunción mitocondrial en las células de la médula ósea. Objetivo: Indagar sobre la anemia sideroblástica, sus variables y los diferentes tipos de presentación que puede tener esta enfermedad. Métodos: Se llevó a cabo una revisión de la literatura en las bases de datos MEDLINE, EMBASE, Lilacs y ScienceDirect, con los descriptores: anemia sideroblástica, hematopoyesis, anomalías congénitas y 5-aminolevulinato sintetasa, en español e inglés. Se seleccionaron 26 artículos relacionados. Se hizo un análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: Es una enfermedad de origen congénito o secundario a otros procesos como el consumo de alcohol o inducido por algunos medicamentos. Se presenta con poca frecuencia y, en su mayoría, el diagnóstico se hace mediante estudios de laboratorio, como extendido de sangre periférica, estudio de médula ósea, a los que se les pueden aplicar diversas tinciones, realizar secuenciación o incluso realizar reacción en cadena de polimerasa. Conclusión: La anemia sideroblástica es una enfermedad puede relacionarse con otras alteraciones hematológicas que modifican el metabolismo del hierro. El tratamiento curativo es la trasfusión de hemocomponentes y debe hacerse un enfoque individualizado de cada paciente según el tipo de anemia sideroblástica(AU)

Introduction: Sideroblastic anemia is a hematological disorder that alters the hematopoiesis process. This condition affects, to a great extent, the erythroid line. In addition, alterations occur in the synthesis of the heme group due to mitochondrial dysfunction in the bone marrow cells. Objective: To investigate sideroblastic anemia, its variables and the different types of presentation of this disease. Methods: A literature review was carried out in the MEDLINE, EMBASE, Lilacs and ScienceDirect databases, using the descriptors anemia sideroblástica [sideroblastic anemia], hematopoyesis [hematopoiesis], anomalías congénitas [congenital anomalies] and 5-aminolevulinato sintetasa [5-aminolevulinate synthetase], in Spanish and English. Twety-six articles related to the topic were selected. An analysis and summary of the revised bibliography was carried out. Information analysis and synthesis: It is a disease of congenital origin or secondary to other processes such as alcohol consumption or induced by some medications. It occurs infrequently and its diagnosis is mostly made through laboratory studies, such as peripheral blood smear and bone marrow study, to which various stains can be applied, as well as sequencing or even polymerase chain reaction. Conclusion: Sideroblastic anemia is a disease that can be related to other hematological alterations that modify iron metabolism. The curative treatment is the transfusion of blood components. An individualized approach should be used according to the type of sideroblastic anemia(AU)

Comparative Study of 10 X-STR Markers in Populations of Northeast Argentina.

In northeast Argentina, different Amerindian communities share territory and history with settlers, mainly Europeans. Due to miscegenation, the current Argentinean population has a particular structure that can be described through X chromosome variation. The objectives of this study were to describe the variation of 10 X-chromosome short tandem repeats (X-STRs) in urban populations of the Argentinean regions known as Gran Chaco and Mesopotamia, report the forensic parameters of these STRs, and estimate the European and indigenous genetic components in these regions. Population and forensic parameters were estimated for 419 individuals from the analyzed populations, including two indigenous groups, Wichí and Mocoví, previously reported. Population structure was estimated through FST and RST distances and analysis of molecular variance. The indigenous American and European components were assessed with STRUCTURE. X-STRs showed a high level of genetic variability in urban and indigenous populations. Indigenous people of the Gran Chaco region showed significant differentiation from the urban samples (FST = 5.5%) and among themselves (FST = 5.3%). Genetic differentiation among urban groups was almost negligible, except that the population from Misión Nueva Pompeya differed from the rest of the city populations. Forensic parameters indicate that these X-STRs are useful as a complement to paternity tests. The set of 10 STRs could be a good tool for examining population differences.

Genetic Differentiation of North-East Argentina Populations Based on 30 Binary X Chromosome Markers.

Alu insertions, INDELs, and SNPs in the X chromosome can be useful not only for revealing relationships among populations but also for identification purposes. We present data of 10 Alu insertions, 5 INDELs, and 15 SNPs of X-chromosome from three Argentinian north-east cities in order to gain insight into the genetic diversity of the X chromosome within this region of the country. Data from 198 unrelated individuals belonging to Posadas, Corrientes, and Eldorado cities were genotyped for Ya5DP62, Yb8DP49, Ya5DP3, Ya5NBC37, Ya5DP77, Ya5NBC491, Ya5DP4, Ya5DP13, Yb8NBC634, and Yb8NBC102 Alu insertions, for MID193, MID1705, MID3754, MID3756 and MID1540 Indels and for rs6639398, rs5986751, rs5964206, rs9781645, rs2209420, rs1299087, rs318173, rs933315, rs1991961, rs4825889, rs1781116, rs1937193, rs1781104, rs149910, and rs652 SNPs. No deviations from Hardy-Weinberg equilibrium were observed for Posadas and Corrientes. However, Eldorado showed significant values, and it was found to have an internal substructuring with two groups of different origin, one showing higher similarity with European countries, and the other with more similarities to Posadas and Corrientes. Fst pairwise genetic distances emerged for some markers among the studied populations and also between our data and those from other countries and continents. Of particular interest, Alu insertions demonstrated the most differences, and could be of use in ancestry studies for these populations, while INDELs and SNPs variation were informative for differentiation within the country.

Palliative sedation in advanced cancer patients hospitalized in a specialized palliative care unit.

PURPOSE: To describe the practice of palliative sedation (PS) in patients with advanced cancer in a specialized palliative care (PC) unit in Colombia. METHODS: Descriptive prospective study including all adults with cancer hospitalized under PS in a cancer institute between January and July 2015 in Colombia. Variables examined were diagnosis, physical functioning, symptoms at the start of sedation, medications and dosages used, and type, level, and time of sedation. Descriptive and correlational statistics were obtained. RESULTS: Sixty-six patients were included, 70% of which were women. The patients had an average age of 61 years (range 24-87), and 74% had a Karnofsky Index (KI) of 50% or less. The most frequent diagnosis was breast cancer (22%), and 82% had metastatic cancer. The prevalence of palliative sedation was 2% and the most common symptoms indicating it were dyspnea (59%), delirium (45%), and pain (32%). All patients received midazolam as a sedative. The average time between the interval start and culmination of sedation was 44 h. There was a significant and inverse relationship between functionality and time under sedation. CONCLUSIONS: Palliative sedation is a valid therapeutic option for refractory symptoms causing suffering. The results correspond to international reports and guidelines, which suggests that PS is tailored to the needs of the individual patient while maintaining a high scientific standard, even in a context where PC is under development. However, further development of strategies and clear indications towards the use of PS in Colombia are needed, given its still scarce use.

Older Stroke Patients with High Stroke Scores Have Delayed Door-To-Needle Times.

INTRODUCTION: The timely administration of intravenous (IV) tissue plasminogen activator (t-PA) to acute ischemic stroke patients from the period of symptom presentation to treatment, door-to-needle (DTN) time, is an important focus for quality improvement and best clinical practice. METHODS: A retrospective review of our Get With The Guidelines database was performed for a 5-hospital telestroke network for the period between January 2010 and January 2015. All acute ischemic stroke patients who were triaged in the emergency departments connected to the telestroke network and received IV t-PA were included. Optimal DTN time was defined as less than 60 minutes. Logistic regression was performed with clinical variables associated with DTN time. Age and National Institutes of Health Stroke Scale (NIHSS) score were categorized based on clinically significant cutoffs. RESULTS: Six-hundred and fifty-two patients (51% women, 46% White, 45% Hispanic, and 8% Black) were included in this study. The mean age was 70 years (range 29-98). Of the variables analyzed, only arrival mode, initial NIHSS score, and the interaction between age and initial NIHSS score were significant. DTN time more than or equal to 60 minutes was most common in patients aged more than 80 years with NIHSS score higher than 10. CONCLUSIONS: The cause of DTN time delay for older patients with higher NIHSS score is unclear but was not related to presenting blood pressure or arrival mode. Further study of this subgroup is important to reduce overall DTN times.

Cannabis Use and Outcomes in Patients With Aneurysmal Subarachnoid Hemorrhage.

BACKGROUND AND PURPOSE: The incidence of cannabis use in patients with aneurysmal subarachnoid hemorrhage (aSAH) and its impact on morbidity, mortality, and outcomes are unknown. Our objective was to evaluate the relationship between cannabis use and outcomes in patients with aSAH. METHODS: Records of consecutive patients admitted with aSAH between 2010 and 2015 were reviewed. Clinical features and outcomes of aSAH patients with negative urine drug screen and cannabinoids-positive (CB+) were compared. Regression analyses were used to assess for associations. RESULTS: The study group consisted of 108 patients; 25.9% with CB+. Delayed cerebral ischemia was diagnosed in 50% of CB+ and 23.8% of urine drug screen negative patients (P=0.01). CB+ was independently associated with development of delayed cerebral ischemia (odds ratio, 2.68; 95% confidence interval, 1.03-6.99; P=0.01). A significantly higher number of CB+ than urine drug screen negative patients had poor outcome (35.7% versus 13.8%; P=0.01). In univariate analysis, CB+ was associated with the composite end point of hospital mortality/severe disability (odds ratio, 2.93; 95% confidence interval, 1.07-8.01; P=0.04). However, after adjusting for other predictors, this effect was no longer significant. CONCLUSIONS: We offer preliminary data that CB+ is independently associated with delayed cerebral ischemia and possibly poor outcome in patients with aSAH. Our findings add to the growing evidence on the association of cannabis with cerebrovascular risk.

Effect of addition of clopidogrel to aspirin on stroke incidence: Meta-analysis of randomized trials.

BACKGROUND: It remains controversial whether dual antiplatelet therapy reduces stroke more than aspirin alone. AIM: We aimed to assess the effects of adding clopidogrel to aspirin on the occurrence of stroke and major haemorrhage in patients with vascular disease. METHODS: Meta-analysis of published randomized trials comparing the combination of clopidogrel and aspirin vs. aspirin alone that reported stroke and major bleeding. RESULTS: Thirteen randomized trials were included with a total of 90 433 participants (mean age 63 years; 63% male) with a mean follow-up of 1·0 years and 2011 strokes. Stroke was reduced 19% by dual antiplatelet therapy (odds ratio = 0·81, 95% confidence interval 0·74-0·89) with no evidence of heterogeneity of effect across different trial populations (I(2) index = 5%, P = 0·4 for heterogeneity). Dual antiplatelet therapy reduced ischemic stroke by 23% (odds ratio = 0·77; 95% confidence interval 0·70-0·85); there was a nonsignificant 12% increase in intracerebral haemorrhage (odds ratio = 1·12, 95% confidence interval 0·86-1·46). Among 1930 participants with recent (<30 days) brain ischemia from four trials, stroke was reduced by 33% (odds ratio = 0·67, 95% confidence interval 0·46-0·97) by dual antiplatelet therapy vs. aspirin alone. The risk of major bleeding was increased by 40% (odds ratio = 1·40, 95% confidence interval 1·26-1·55) by dual antiplatelet therapy. CONCLUSIONS: This meta-analysis demonstrates a substantial relative risk reduction in stroke by clopidogrel plus aspirin vs. aspirin alone that is consistent across different trial cohorts. Major haemorrhage is increased by dual antiplatelet therapy.

Predictors of mortality in patients with lacunar stroke in the secondary prevention of small subcortical strokes trial.

BACKGROUND AND PURPOSE: The Secondary Prevention of Small Subcortical Stroke trial (SPS3) recruited participants meeting clinical and radiological criteria for symptomatic lacunes. Individuals randomized to dual antiplatelet therapy with clopidogrel and aspirin had an unanticipated increase in all-cause mortality compared with those assigned to aspirin. We investigated the factors associated with mortality in this well-characterized population. METHODS: We identified independent predictors of mortality among baseline demographic and clinical factors by Cox regression analysis in participants of the SPS3 trial. Separately, we examined the effect on mortality of nonfatal bleeding during the trial. RESULTS: During a mean follow-up of 3.6 years, the mortality rate was 1.78% per year for the 3020 participants (mean age, 63 years). Significant independent predictors of mortality at study entry were age, diabetes mellitus, history of hypertension, systolic blood pressure (hazard ratio [HR], 1.3 per 20 mm Hg increase), serum hemoglobin<13 g/dL (HR, 1.6), renal function (HR, 1.3 per estimated glomerular filtration rate decrease of 20 mL/min), and body mass index (HR, 1.8 per 10 kg/m2 decrease). Participants with ischemic heart disease (P=0.01 for interaction) and normotensive/prehypertensive participants (P=0.03 for interaction) were at increased risk if assigned to dual antiplatelet therapy. Nonfatal major hemorrhage increased mortality in both treatment arms (HR, 4.5; 95% confidence interval, 3.1-6.6; P<0.001). CONCLUSIONS: Unexpected interactions between assigned antiplatelet therapy and each of ischemic heart disease and normal/prehypertensive status accounted for increased mortality among patients with recent lacunar stroke given dual antiplatelet therapy. Despite extensive exploratory analyses, the mechanisms underlying these interactions are uncertain. CLINICAL TRIAL REGISTRATION URL: http://www.SPS3ClinicalTrials.gov. Unique identifier: NCT00059306.

Lacunar strokes in patients with diabetes mellitus: risk factors, infarct location, and prognosis: the secondary prevention of small subcortical strokes study.

BACKGROUND AND PURPOSE: Diabetes mellitus is an independent risk factor for lacunar strokes. Few data are available regarding patient features, infarct location, and recurrent vascular events for patients with diabetes mellitus with lacunar stroke. METHODS: We compared features at study entry and prognosis during 3.6 years of follow-up of patients with diabetes mellitus versus patients without diabetes mellitus with recent lacunar stroke participating in the Secondary Prevention of Small Subcortical Strokes (SPS3) randomized trial. RESULTS: Among the 3020 participants, the prevalence of diabetes mellitus was 37% with a mean duration of 11 years. Diabetes mellitus was independently associated with slightly younger age (63 versus 64 years; P<0.001), Hispanic ethnicity (36% versus 28%; P<0.0001), ischemic heart disease (11% versus 6%; P=0.002), and peripheral vascular disease (5% versus 2%; P<0.001). Patients with diabetes mellitus more frequently had intracranial stenosis ≥50% (P<0.001), infarcts involving the brain stem or cerebellum (P<0.001), and more extensive white matter abnormalities (P<0.001). Patients with diabetes mellitus were almost twice as likely to have a recurrent stroke (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.4-2.3), recurrent ischemic stroke (HR, 1.8; 95% CI, 1.4-2.4), disabling/fatal stroke (HR, 1.8; 95% CI, 1.2-2.9), myocardial infarction (HR, 1.7; 95% CI, 1.0-2.8), and death (HR, 2.1 95% CI, 1.6-2.8) compared with patients without diabetes mellitus. CONCLUSIONS: Patients with diabetes mellitus with lacunar stroke have a distinctive clinical profile that includes double the prevalence of systemic and intracranial atherosclerosis, preferential involvement of the posterior circulation, and a poor prognosis for recurrent stroke and death. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00059306.

Effect of addition of clopidogrel to aspirin on mortality: systematic review of randomized trials.

BACKGROUND AND PURPOSE: In the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, addition of clopidogrel to aspirin was associated with an unexpected increase in mortality in patients with lacunar strokes. We assessed the effect of the addition of clopidogrel to aspirin on mortality in a meta-analysis of published randomized trials. METHODS: Randomized trials in which clopidogrel was added to aspirin in subjects with vascular disease or vascular risk factors were identified. Trials were restricted to those with a mean follow-up of ≥14 days in which both the combination of aspirin and clopidogrel was tested and mortality was reported. RESULTS: Twelve trials included 90 934 participants (mean age, 63 years; 70% men; median follow-up, 1 year) with 6849 observed deaths. There was no significant increase in mortality with the combination therapy either in 4 short-term (14 days-3 months; OR, 0.93; 95% CI, 0.87-0.99) or in 7 long-term (>3 months; hazard ratio, 0.97; 95% CI, 0.91-1.04) trials after 1 long-term trial (the SPS3 trial) was excluded because of heterogeneity. Addition of clopidogrel was associated with an increase in fatal hemorrhage (OR, 1.35; 95% CI, 0.97-1.90) and a reduction in myocardial infarction (OR, 0.82; 95% CI, 0.74-0.91). CONCLUSIONS: The addition of clopidogrel to aspirin has no overall effect on mortality. The SPS3 trial results are outliers, possibly because of a lower prevalence of coronary artery ischemia. Addition of clopidogrel to aspirin increases fatal bleeding and reduces myocardial infarction. CLINICAL TRIAL REGISTRATION: URL: http//www.clinicaltrials.gov. Unique identifier: NCT00059306.

Thrombolysis for acute stroke in hemodialysis: international survey of expert opinion.

BACKGROUND AND OBJECTIVES: Although data are absent, it has been stated that thrombolysis is probably not safe in the treatment of acute stroke in patients undergoing hemodialysis. The objective of this study was for stroke experts to define the range of management concerning thrombolytic treatment of acute stroke in hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Sixty-five stroke experts in thrombolytic therapy of acute ischemic stroke were queried regarding their personal experience in the use of thrombolysis in hemodialysis patients. Hypothetical case scenarios were presented. RESULTS: Of the 65 stroke experts who were queried, 40 (62%) responded. One-third of the responders had previously treated hemodialysis patients with recombinant tissue-type plasminogen activator (rt-PA). Most favored use of intravenous rt-PA for hemodialysis patients with acute ischemic stroke. When presented with a case of a patient who had recently undergone dialysis with a mildly prolonged activated partial thromboplastin time (aPTT), 50% favored immediate intravenous thrombolysis. Seventy-eight percent of the experts would have considered an intra-arterial approach and would have preferred mechanical clot retrieval to thrombolysis. CONCLUSIONS: Despite the acknowledged absence of data and prevalent concerns about bleeding risk, most surveyed experts favored its use. One-third reported treating hemodialysis patients with this therapy. Although these results do not substitute for data, they usefully define the range of current practice of stroke experts.

[Animal models of injury and repair in developing brain]. / Modelos animales de lesion y reparacion del cerebro en desarrollo.

Animal models of injury and repair in developing brain. Brain injury is a major contributor to neonatal morbidity and mortality, a considerable group of these children will develop long term neurological sequels. Despite the great clinical and social significance and the advances in neonatal medicine, no therapy yet does exist that prevent or decrease detrimental effects in cases of neonatal brain injury. Our objective was to review recent research in relation to the hypothesis for repair mechanism in the developing brain, based in animal models that show developmental compensatory mechanisms that promote neural and functional plasticity. A better understanding of these adaptive mechanisms will help clinicians to apply knowledge derived from animals to human clinical situations.

Modelos animales de lesión y reparación del cerebro en desarrollo / Animal models of injury and repair in developing brain

Gran parte de la morbilidad y mortalidad neonatal están determinadas por la lesión del cerebro en desarrollo. Un considerable número de los niños afectados presentarán secuelas neurológicas a largo plazo. A pesar de la importancia médica y social que presenta el problema, los avances alcanzados por la medicina neonatal no cuentan aún con una terapéutica eficaz para prevenir o aminorar las consecuencias de la lesión del cerebro en desarrollo. En la siguiente revisión nos proponemos actualizar las investigaciones más recientes en relación a los mecanismos de lesión y reparación del cerebro en desarrollo, basados en modelos animales que ilustran sobre los mecanismos plásticos de adaptación neuronal y funcional; el fin es un mejor conocimiento de los citados procesos que ayude al clínico en la práctica cotidiana de la neonatología.(AU)

Brain injury is a major contributor to neonatal morbidity and mortality, a considerable group of these children will develop long term neurological sequels. Despite the great clinical and social significance and the advances in neonatal medicine, no therapy yet does exist that prevent or decrease detrimental effects in cases of neonatal brain injury. Our objective was to review recent research in relation to the hypothesis for repair mechanism in the developing brain, based in animal models that show developmental compensatory mechanisms that promote neural and functional plasticity. A better understanding of these adaptive mechanisms will help clinicians to apply knowledge derived from animals to human clinical situations.(AU)

Modelos animales de lesión y reparación del cerebro en desarrollo / Animal models of injury and repair in developing brain

Gran parte de la morbilidad y mortalidad neonatal están determinadas por la lesión del cerebro en desarrollo. Un considerable número de los niños afectados presentarán secuelas neurológicas a largo plazo. A pesar de la importancia médica y social que presenta el problema, los avances alcanzados por la medicina neonatal no cuentan aún con una terapéutica eficaz para prevenir o aminorar las consecuencias de la lesión del cerebro en desarrollo. En la siguiente revisión nos proponemos actualizar las investigaciones más recientes en relación a los mecanismos de lesión y reparación del cerebro en desarrollo, basados en modelos animales que ilustran sobre los mecanismos plásticos de adaptación neuronal y funcional; el fin es un mejor conocimiento de los citados procesos que ayude al clínico en la práctica cotidiana de la neonatología.

Brain injury is a major contributor to neonatal morbidity and mortality, a considerable group of these children will develop long term neurological sequels. Despite the great clinical and social significance and the advances in neonatal medicine, no therapy yet does exist that prevent or decrease detrimental effects in cases of neonatal brain injury. Our objective was to review recent research in relation to the hypothesis for repair mechanism in the developing brain, based in animal models that show developmental compensatory mechanisms that promote neural and functional plasticity. A better understanding of these adaptive mechanisms will help clinicians to apply knowledge derived from animals to human clinical situations.

Late-developing cerebral arteropathy after pyogenic meningitis.

BACKGROUND: Although vasculopathy is a recognized complication during acute meningitis, to our knowledge, no previous reports have been published of this phenomenon developing months after successful treatment. OBJECTIVE: To report a unique case of a late-developing vasculopathy after pyogenic meningitis in an adult. REPORT OF A CASE: A 51-year-old woman was seen with severe headache 2 months after treatment of Haemophilus influenzae type C meningitis. Initial arteriography showed no abnormality; a second arteriogram showed progressive multifocal intracranial stenosis affecting mainly the internal carotid arteries. Findings from pathologic examination disclosed diffuse collagenosis consistent with chronic vascular injury from meningitis. The arterial lesions stabilized, and the patient remained asymptomatic. CONCLUSION: Progressive intracranial arterial stenosis can evolve months after meningitis and should be added to the list of recognized vascular complications.