ABSTRACT
Introducción. La hemorragia intracerebral espontánea (HIC) es una entidad neurológica con una elevada tasa de mortalidad. Desde la aparición de las primeras guías de manejo en 1999, se han probado nuevas terapias sin éxito sustancial. Objetivo. Describir los cambios en el tratamiento de la HIC de un hospital regional mexicano y evaluar su posible impacto en la evolución clínica. Pacientes y métodos. Es un estudio retrospectivo entre 2000 y 2006 con pacientes mayores de 15 años y diagnóstico tomográficamente confirmado de HIC. Excluimos pacientes con trauma craneoencefálico en las cuatro semanas previas o puntuación inicial de la National Institute of Health Stroke Scale (NIHSS) indeterminada. Se estudiaron características epidemiológicas, clínicas y tipo de tratamiento. Resultados. Analizamos 175 pacientes con edad promedio de 62 años. La etiología y localización más frecuente fueron hipertensión arterial y lobar, respectivamente. Más del 20% requirió intubación al ingreso y sólo la mitad fue admitida en la unidad de terapia intensiva. NIHSS > 15 o Glasgow < 9 iniciales se asociaron con pobre resultado. Los inhibidores de la enzima conversora de angiotensina se usaron más frecuentemente para el control de la tensión arterial. El uso de antagonistas del calcio, estatinas y descompresión quirúrgica se asoció con un mejor resultado funcional. Conclusiones. El uso de salas de terapia intensiva es una medida fuertemente sugerida como eje del manejo de la HIC. En nuestro centro, esto no se realizó regularmente por un déficit infraestructural. Este problema podría generarse en otros hospitales mexicanos. La revisión de este fenómeno urge. Se requiere la evaluación de nuevas medidas terapéuticas (AU)
Introduction. The spontaneous intracerebral hemorrhage (ICH) shows a high lethal rate. In 1999 appeared the first therapeutic guidelines, after that new therapies have been assessed without substantial success. Aim. To describe treatment changes for ICH in a regional Mexican hospital and to assess their impact on clinical evolution. Patients and methods. We accomplished a retrospective study of patients admitted between 2000 and 2006. We included those elder than 15 years with tomographyc diagnostic of ICH. Patients with head injury four weeks before or undetermined initial National Institute of Health Stroke Scale (NIHSS) were excluded. Epidemiological, clinical characteristics and kind of therapy were studied. Results. We analyzed 175 patients with mean age of 62 years. Etiology and localization more frequently were arterial hypertension and lobar, respectively. More than 20% were intubated and approximately one half of these admitted in intensive care unit. Angiotensin converter enzyme inhibitors were the medicaments more usually used for controlling blood pressure. An initial NIHSS > 15 or Glasgow < 9 were associated to poor outcome. Additional administration of calcium antagonist, statins and surgical decompression was associated to a better outcome. Conclusions. Use of intensive care units is a measure highly suggested as standard for ICH-therapy. In our center it was not regularly accomplished because of infrastructural deficiencies. This problem could be generated in other Mexican hospitals; attention to that phenomenon is urgently required. Evaluation of new therapeutic strategies is required (AU)
Subject(s)
Humans , Cerebral Hemorrhage/epidemiology , Hypertension/epidemiology , Cerebral Hemorrhage/therapy , Retrospective Studies , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Calcium Channel Blockers/therapeutic use , /therapeutic use , Decompression, Surgical , Critical CareABSTRACT
BACKGROUND: There are no data on Mexican population referring to frequency and prognosis of transient ischemic attacks (TIA). The purpose of the present study was to: (1) estimate the prevalence, vascular risk factors and short-term outcome in patients with TIA included in the first Mexican registry of cerebrovascular disease, and (2) analyze the acute care provided in these patients. PATIENTS AND METHODS: This national registry of cerebrovascular diseases is a multicenter, observational, and hospital-based registry that was conducted from November 2002 to October 2004. The registry was developed to improve our knowledge in Mexico regarding risk factors profile, outcome, current diagnostic and treatment strategies, and short-term follow-up in patients with acute cerebral ischemia. Standardized data assessment was used by all centers which included information on demographics, pre-hospital events (including stroke onset and arrival to hospital), emergency department triage and workup. Short-term outcome was evaluated at day 30. Of this registry, TIA cases were selected and associated risk factors, clinical characteristics, diagnosis and treatment were analyzed. RESULTS: During the study time period, 2,000 patients were enrolled; 97 (5%) with diagnosis of TIA; 51 women and 46 men, mean age 69.3 +/- 11.4 years. Among these 97 patients; 51 (52.6%) were admitted to the hospital for evaluation. The main risk factors were; age > or = 65 years in 74%, hypertension in 64%, diabetes in 45%, and dislipidemia in 36% and obesity in 31%. The affected arterial territory was carotid TIA in 74% and vertebrobasilar in 26%. TIA was attributed to atherosclerosis in 63% of the patients, cardioembolism in 17%, and small vessels disease in 5%. At 30 days follow-up; three patients died during the initial evaluation (two secondary to cardiac arrhythmia, and one secondary to pneumonia). Among 14 of the 94 survivors (14.9%) we documented an early stroke recurrence, including cerebral infarction in nine patients (9.6%) and new TIA in five cases (5.3%). Considering death and cerebral infarction, the frequency of unfavorable major events was 12.4%. There were only three cases treated with carotid endarterectomy. CONCLUSIONS: The short-term risk of ischemic stroke, death or recurrent in TIA patients is high. These findings emphasize that all patients with TIA should undergo rapid investigation and management to prevent a major stroke and other vascular events.
Subject(s)
Ischemic Attack, Transient , Aged , Aged, 80 and over , Female , Humans , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/therapy , Male , Mexico , Middle Aged , Prognosis , Registries , Time FactorsABSTRACT
The aim of the present study was to determinate the factors affecting carbamazepine (CBZ) clearance (CL) in adults with epilepsy using a mixed-effect model and sparse data collected during routine clinical care. The patient population comprised 104 adults receiving CBZ. A total of 161 CBZ steady state serum concentration samples were analyzed. Population CL was calculated by using NONMEM with a one compartment model with first-order absorption and elimination. The following covariates were tested for their influence on clearance (CL): total body weight, age, dose/day, sex, surface area (SA) and comedication with primidone (PRIM), ualproic acid or phenytoin (DFH). The final regression model for carbamazepine clearance found best to describe the data was: CL = (0.614 SA + 0.0016 dose/day)(1 + 0.278 DFH)(1 + 0.326 PRIM).
Subject(s)
Carbamazepine/pharmacokinetics , Epilepsy/metabolism , Adolescent , Adult , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
The aim of the present study was to determinate the factors affecting carbamazepine (CBZ) clearance (CL) in adults with epilepsy using a mixed-effect model and sparse data collected during routine clinical care. The patient population comprised 104 adults receiving CBZ. A total of 161 CBZ steady state serum concentration samples were analyzed. Population CL was calculated by using NONMEM with a one compartment model with first-order absorption and elimination. The following covariates were tested for their influence on clearance (CL): total body weight, age, dose/day, sex, surface area (SA) and comedication with primidone (PRIM), valproic acid or phenytoin (DFH). The final regression model for carbamazepine clearance found best to describe the data was: CL = (0.614 SA + 0.0016 dose/day)(1 + 0.278 DFH)(1 + 0.326 PRIM).
El objetivo de este trabajo es determinar los factores que influyen en el aclaramiento (CL) de carbamacepina (CBZ) en pacientes epilépticos adultos usando un modelo de efectos mixtos y datos de concentraciones séricas de CBZ generados del cuidado rutinario de los pacientes. El número de pacientes incluidos en el estudio fue de 104. Se analizaron un total de 161 concentraciones séricas de CBZ en el estado estacionario. El aclaramiento poblacional se determinó con el programa NONMEM aplicando un modelo monocompartimental con absorción y eliminación de primer orden. Se analizó la influencia de las siguientes covariables sobre el CL: peso corporal total, edad, dosis/día, sexo, superficie corporal (SC) y la comedicación con primidona (PRIM), ácido valproico o difenilhidantoína (DFH). El modelo final de regresión obtenido es el siguiente: CL = (0.614 SC + 0.0016 dosis/día)( 1+ 0.278 DFH)(1 + 0.326 PRIM).
