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1.
AJNR Am J Neuroradiol ; 43(9): 1304-1310, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35981762

RESUMO

BACKGROUND AND PURPOSE: The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis. MATERIALS AND METHODS: We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-four-month clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared. RESULTS: One hundred forty-one patients were included. Forty-four carotid artery stent placement and 23 carotid endarterectomy procedures were performed within 6 months after the event. Complete revascularization was achieved in 83.6%, 81.8% in the carotid artery stent placement group and 87% with carotid endarterectomy (P = .360). Periprocedural stroke or death occurred in 6% (carotid artery stent placement = 2.3%; carotid endarterectomy = 13%; P = .077) and was not related to revascularization failure. The carotid restenosis or occlusion rate was 8.3% (5% restenosis, 3.3% occlusion); with carotid artery stent placement it was 10.5%; and with carotid endarterectomy it was 4.5% (P = .419). The 24-month cumulative rate of ipsilateral stroke was 4.8% in the carotid artery stent placement group, 17.4% for carotid endarterectomy, and 13.1% for medical treatment (P = .223). Mortality was 12%, 4.5%, and 5.6%, respectively (P = .422). Revascularization failure and restenosis occurred more frequently in patients with full collapse compared with patients without full collapse (33.3% versus 5.6%, P = .009; 21.4% versus 2.9%, P = .032, respectively). CONCLUSIONS: Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment.


Assuntos
Doenças das Artérias Carótidas , Estenose das Carótidas , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Humanos , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Estenose das Carótidas/complicações , Estudos Prospectivos , Endarterectomia das Carótidas/efeitos adversos , Acidente Vascular Cerebral/complicações , Doenças das Artérias Carótidas/complicações , Stents/efeitos adversos , Sistema de Registros , Resultado do Tratamento , Fatores de Risco
2.
Bol. pediatr ; 62(260): 103-110, 2022. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-213412

RESUMO

Antecedentes y objetivos. La COVID-19 es una enfermedad producida por el virus SARS-CoV-2. En España,entre el mes de marzo y junio de 2020 se declaró el primer Estado de Alarma con el fin de contener la pandemia.Nuestro objetivo es evaluar la demanda asistencial y lasenfermedades que acudieron a Urgencias Pediátricas y quefueron ingresadas durante el tiempo que duró el primer Estado de Alarma, comparando con los mismos meses delos años 2018 y 2019.Resultados. Existe una reducción del número de ingresosde 345 a 141, un incremento de la complejidad demostrada por una mayor duración de los ingresos hasta 7,3±12,4 días(6,2±8,6 días en 2018 y 4,8±6,9 en 2019). Las enfermedades infecciosas (principalmente las respiratorias) descendieron, permaneciendo estables los ingresos por neoplasias, patología psiquiátrica, apendicitis y enfermedades circulatorias. EnUrgencias Pediátricas, en los años 2018 y 2019 (de 1 marzoa 30 junio) se atendieron 9.075 y 8.525 pacientes, mientras que en el 2020 se atendieron 2.215, aumentando el porcentajede ingresos procedentes de urgencias del 3,6% y 3,4% al 6%en 2020. Las enfermedades que aumentaron de forma más importante fueron las lesiones traumáticas y las intoxicaciones. Tanto en los ingresos como en urgencias existe unincremento en la edad de los pacientes. Conclusiones. El Estado de Alarma influyó en la presión asistencial y en el tipo de enfermedades atendidas enel Servicio de Pediatría, con una disminución del número de Urgencias y de ingresos, un incremento de la edad y unamodificación del tipo de enfermedades atendidas.


Introduction and objectives. COVID-19 is a disease caused by the SARS-CoV-2 virus. In Spain, between March and June 2020, the first State of Alarm was declared in order to contain the pandemic. Our objective is to evaluate the health care demand and the diseases that came to the Pediatric Emergency Department and were admitted during the time that the first State of Alarm lasted, comparing with the same months of the years 2018 and 2019.Results. There is a reduction in the number of admissions from 345 to 141, an increase in complexity demonstrated by a longer duration of admissions to 7.3±12.4 days (6.2 ± 8.6 days in 2018 and 4, 8±6.9 in 2019). Infectious diseases (mainly respiratory) decreased, with admissions for neoplasms, psychiatric pathology, appendicitis and circulatory diseases remaining stable. In Pediatric Emergencies, in the years 2018 and 2019 (from March 1 to June 30), 9,075 and 8,525 patients were attended, while in 2020, 2,215 were attended, increasing the percentage of admissions from the emergency room of 3.6% and 3.4% to 6% in 2020. The diseases that increased most significantly were traumatic injuries and poisonings. Both in admissions and in emergencies there is an increase in the age of the patients. Conclusions. The State of Alarm influenced the care pressure and the type of diseases treated in the Pediatric Service, with a decrease in the number of Emergencies and admissions, an increase in age and a modification of the type of diseases treated (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Cuidado da Criança/provisão & distribuição , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Estudos Retrospectivos , Espanha/epidemiologia
3.
Rev Neurol ; 72(10): 352-356, 2021 May 16.
Artigo em Espanhol | MEDLINE | ID: mdl-33978229

RESUMO

INTRODUCTION: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. PATIENTS AND METHODS: We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types. RESULTS: Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital. CONCLUSIONS: The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.


TITLE: Retraso en la administración de tratamiento trombolítico en el ictus minor.Introducción. Se considera ictus minor a aquel que se presenta con escasos síntomas; sin embargo, hasta un 40% presenta discapacidad a largo plazo. La tasa de trombólisis en estos pacientes también es inferior a la del resto de ictus. En este estudio se pretende explorar si existen diferencias en los tiempos de atención en la trombólisis intravenosa en los pacientes con ictus minor. Material y métodos. Revisión retrospectiva de los ictus tratados con trombólisis intravenosa en nuestro centro y análisis comparativo de los tiempos de asistencia entre ictus minor y el resto. Resultados. Se encontraron tiempos más alargados en los casos de ictus minor en cuanto al tiempo puerta-tomografía computarizada y puerta-aguja. No fue así, sin embargo, para el tiempo desde el inicio de los síntomas hasta la llegada al hospital. Conclusiones. La presencia de escasos síntomas en el ictus minor puede hacer difícil su reconocimiento y podría ser un motivo de retraso en el tratamiento. La formación entre el personal que atiende a estos pacientes es fundamental para mejorar este aspecto.


Assuntos
Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Tempo para o Tratamento , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
4.
Neuroradiology ; 63(5): 705-711, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33025041

RESUMO

PURPOSE: The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO. METHODS: A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)-confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR). RESULTS: One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (p < 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s, p < 0.001; 0.80 vs 1.00, p < 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%, p = 0.051). CONCLUSION: The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.


Assuntos
Doenças das Artérias Carótidas , Estenose das Carótidas , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Circulação Cerebrovascular , Circulação Colateral , Hemodinâmica , Humanos , Estudos Prospectivos , Sistema de Registros , Ultrassonografia Doppler Transcraniana
5.
Eur J Neurol ; 26(11): 1391-1398, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31126001

RESUMO

BACKGROUND AND PURPOSE: The risk of recurrent stroke amongst patients with symptomatic carotid near-occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24-month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO. METHODS: A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography-confirmed SCNO were included. The primary end-point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted. RESULTS: The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24-month cumulative incidence of the primary end-point was 11.1% (95% confidence interval 5.8-16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log-rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively. CONCLUSIONS: The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near-occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure.


Assuntos
Estenose das Carótidas/complicações , Estenose das Carótidas/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Estenose das Carótidas/cirurgia , Angiografia Cerebral , Revascularização Cerebral , Endarterectomia das Carótidas , Determinação de Ponto Final , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Prospectivos , Sistema de Registros , Espanha/epidemiologia , Acidente Vascular Cerebral/mortalidade
6.
Pediatr. aten. prim ; 12(45): 53-65, ene.-mar. 2010. tab
Artigo em Espanhol | IBECS | ID: ibc-79210

RESUMO

Objetivos: conocer la prevalencia del sobrepeso y la obesidad en la población infantil,las características de sus hábitos dietéticos, su estilo de vida y otros determinantes asociados. Material y métodos: diseño: estudio descriptivo transversal. Emplazamiento: Centro de Atención Primaria, ámbito urbano. Participantes: niños > 6 y < 10 años del ABS El Carmel (Barcelona) (n = 716). Criterios de selección: muestra aleatoria –n = 340; prevalencia: 15%; intervalo deconfianza (IC): 95%; precisión: 3%– de la base de datos SIAP (Sistema de Informaciónen Atención Primaria). No se establecieron criterios de exclusión. Sin respuesta: n = 63(95%: errores de filiación; 5%: falta de interés). Mediciones principales: peso y talla –para el índice de masa corporal (IMC)–, test rápido Krece Plus y test corto de actividad física Krece Plus (para hábitos dietéticos y estilode vida). Análisis descriptivo y bivariado: chi al cuadrado, test de la t de Student, test deAnova, test de correlación y regresión logística. Resultados: 276 encuestas (81,4%). Prevalencia del sobrepeso: 11,59% (IC 95%:7,81%-15,32%); prevalencia de la obesidad: 10,14% (IC 95%: 6,58%-13,7%). Hábitos alimentarios: 52,3% tiene una alimentación óptima y 4,4% presenta hábitos inadecuados. Estilo de vida: malo: 58,7%; bueno: 3,6%. La media del IMC es superior (p < 0,05) en los niños más inactivos, cuando el nivel de estudios de la madre es bajo o si nacieron fuera de España. El sobrepeso y la obesidad infantiles son 3,6 veces superiores (IC 95%: 1,37-8,05) si el padre es obeso y 3,1 veces superiores (IC 95%: 1,19-7,31) si lo es la madre. Conclusiones: el estudio proporciona una línea de base para establecer las directricesy actividades del programa de intervención comunitaria para la prevención de la obesidad infantil (AU)


Objectives: to determine the prevalence of overweight and obesity in children, characteristicsof their dietary habits, lifestyle and other associated determinants. Material and method: design: cross-sectional study. Location: Primary Health Center, urbanarea. Participants: children > 6 and < 10 years of ABS El Carmel (Barcelona) (n = 716).Selection criteria: random sample (n = 340; prevalence: 15%; CI: 95%; accuracy: 3%)from the database SIAP (System for Information in Primary Care), no exclusion criteria were established. No answer: n = 63 (95%: address error; 5%: lack of interest). Measurements: weight, height (for BMI), Quick Test and Short Test from Krece Plus (fordiet and lifestyle). Descriptive and bivariate analysis: Chi-square, t-test, ANOVA test, correlationtest and logistic regression. Results: two hundred and seventy-six surveys (81.4%). Overweight prevalence: 11.59%(95% CI: 7.81%-15.32%); obesity prevalence: 10.14% (95% CI: 6.58%-13.7%). Food habits:52.3% optimal feeding habits and 4.4% inadequate. Lifestyle: 58.7% bad lifestyle and 3.6% goodlifestyle. The BMI mean was higher (p < 0.05) in inactive children, in low education level of mothers, or in born outside Spain. Overweight and obesity in children is 3.6 times higher (95% CI:1.37-8.05) if the father is obese and 3.1 times higher (95% CI: 1.19-7.31) if the mother is obese. Conclusions: the study provides a baseline for establishing the guidelines and activities ofthe community intervention program for preventing childhood obesity (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Sobrepeso/epidemiologia , Obesidade/epidemiologia , Comportamento Alimentar , Estilo de Vida , Índice de Massa Corporal , Peso-Estatura , Escolaridade , Exercício Físico , Atenção Primária à Saúde , Epidemiologia Descritiva
7.
Rev Neurol ; 39(1): 1-6, 2004.
Artigo em Espanhol | MEDLINE | ID: mdl-15257519

RESUMO

INTRODUCTION: The availability of the interferon beta in its three forms at the moment available in our country and of glatiramer acetate has marked a point of flexion in the natural history of multiple sclerosis (MS), but the high cost of these treatments cause that its use is questioned. In this work we have studied the effectiveness and efficiency of the processing with interferon beta, and the cost-utility of these treatments in MS in Spain has been also analyzed. PATIENTS AND METHODS: For this work we studied 102 patients affected of RR MS, treated with the three interferons beta which we have available in our country. We used as control 330 patients who had participated in the pivotal clinical interferon trials with both interferon beta 1a. In these patients in addition to effectiveness data, we have studied the disability measured as area below curve and the quality of life (AVACs). We also calculated the economical costs, considering the relation cost-utility in our country. RESULTS: Besides to confirm the data of effectiveness of three interferons, in this study a saving of 23 days/year is demonstrated what corresponds to 0.063 AVACs. The additional cost of interferons is greater than the avoided cost until the fifth year of treatment in which the tendency is reversed in favor of the group of treated patients, if we assume that the same effectiveness that we found in the first years is maintained in the long term. CONCLUSION: The use of the treatment with interferon beta is justified by its effectiveness, efficacy and efficiency. The additional cost of the treatment will be compensated in the long term if the effectiveness of the interferon beta is maintained.


Assuntos
Análise Custo-Benefício , Interferon beta/economia , Interferon beta/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/economia , Adulto , Área Sob a Curva , Avaliação da Deficiência , Feminino , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Espanha , Resultado do Tratamento
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