[Vertebrobasilar stroke: recording of care times and factors related to early care]. / Ictus vertebrobasilar: registro de tiempos de asistencia y factores relacionados con la atención precoz.

AIM: To determine the state of the vertebrobasilar stroke care chain in our hospital reference area by evaluating the factors related to stroke code activation and management times. PATIENTS AND METHODS: Observational, analytical and retrospective study, carried out during the period 2017-2018, which includes patients admitted with a diagnosis of stroke confirmed by neuroimaging. Data were collected consecutively during assessment in the emergency department and admission to the stroke unit. Clinical factors, neurological signs and symptoms at the time of admission, detection of large-vessel occlusion and variables related to the care chain were evaluated, namely, basic medical attention, stroke code activation, onset-to-door time and door-to-imaging time. RESULTS: Altogether 954 patients were included in the study, 233 with vertebrobasilar stroke. The onset-to-door and door-to-imaging times registered were significantly higher for posterior circulation stroke. The factors related to a lower delay in onset-to-door time were: National Institutes of Health Stroke Scale > 4, dysarthria and loss of strength. A shorter delay in door-to-imaging time was observed for the variables basic attention by medical emergency service, dysarthria, loss of strength and presence of more than one symptom/sign. Predictive variables for stroke code activation were a history of smoking, clinical signs of dysarthria or loss of strength, and the presence of more than one clinical manifestation. CONCLUSIONS: In the pre-hospital phase is is difficult to identify vertebrobasilar stroke, which causes delays in care times. Training in knowledge of the clinical features of vertebrobasilar stroke could allow these times to be optimised.

TITLE: Ictus vertebrobasilar: registro de tiempos de asistencia y factores relacionados con la atención precoz.Objetivo. Conocer el estado de la cadena asistencial del ictus vertebrobasilar en el área de referencia de nuestro centro hospitalario, evaluando los factores relacionados con la activación del código ictus y tiempos de actuación. Pacientes y métodos. Estudio observacional, analítico y retrospectivo, realizado durante el período 2017-2018, que incluye a pacientes ingresados con diagnóstico de ictus confirmado por neuroimagen. Se recogieron los datos de manera consecutiva durante su valoración en urgencias e ingreso en la unidad de ictus. Se evaluaron factores clínicos, síntomas y signos neurológicos en el momento del ingreso, detección de oclusión de gran vaso y variables relacionadas con la cadena asistencial: primera asistencia, activación de código ictus, tiempo inicio-puerta y tiempo puerta-imagen. Resultados. Se incluyó a 954 pacientes, 233 con ictus vertebrobasilar. Los tiempos inicio-puerta y puerta-imagen registrados fueron significativamente mayores para el ictus de circulación posterior. Los factores relacionados con menor retraso en el tiempo inicio-puerta fueron: National Institute of Health Stroke Scale > 4, disartria y pérdida de fuerza. Se observó un menor retraso en el tiempo puerta-imagen para las variables: primera asistencia por servicio de emergencias médicas, disartria, pérdida de fuerza y presencia de más de un síntoma/signo. Fueron variables predictoras de activación del código ictus el antecedente de fumador, la clínica de disartria o pérdida de fuerza, y la presencia de más de una manifestación clínica. Conclusiones. Existen dificultades en la fase prehospitalaria para identificar el ictus vertebrobasilar, lo cual origina retrasos en los tiempos de asistencia. La formación en conocimientos sobre la clínica de ictus vertebrobasilar podría permitir la optimización de esos tiempos.

Dietary fiber and its interaction with drugs.

As the intake of purified dietary fibers is increasing in the society, it is necessary to know how these fibers interact with simultaneously administered drugs, in order to ensure adequate therapeutic effects, minimizing the risk for adverse effects. This paper reviews the literature on the interactions between different types of purified fibers and several drugs.

[Glucomannan: properties and therapeutic applications]. / Glucomanano: propiedades y aplicaciones terapéuticas.

Glucomannan is a dietary fiber employed quite frequently in the western countries since two decades now, as its ingestion plays an important role in human health. However, eastern people have used this fiber for more than a thousand years. This dietary fiber is the main polysaccharide obtain from the tubers of the Amorphophallus konjac plant, a member of the family Araceae found in east Asia. The chemical structure of glucomannan consists, mainly, in mannose and glucose in the ratio 8:5 linked by beta (1-->4) glycosidic bonds. This soluble fiber has a extraordinarily high waterholding capacity, forming highly viscous solutions when dissolved in water. It has the highest molecular weight and viscosity of any known dietary fiber. It has been demonstrated that this product is highly effective in the treatment of obesity due to the satiety sensation that it produces; as a remedy for constipation, because it increases the faeces volume; as hypocholesterolemic agent, interfering in the transport of cholesterol and of bile acids and as hypoglycemic and hypoinsulinemic agent, probably, by delaying gastric emptying and slowering glucose delivery to the intestinal mucosa. To the beneficial properties of this fiber, several disadvantages can be added as the production of flatulence, abdominal pain, esophageal obstruction, lower gastrointestinal obstruction or even the possible modification of the bioavailability of other drugs. This paper reviews the main characteristics of glucomannan, as well as its properties, physiologic effects and therapeutic uses.

[Effect of Ispaghula husks on postprandial glycemia in healthy female volunteers]. / Influencia de las cutículas de semillas de Plantago ovata (Ispaghula husk) en la glucemia posprandial en voluntarias sanas.

OBJECTIVES: To evaluate the influence of Ispaghula husk in the postprandial glucose concentrations in serum in healthy volunteers. MATERIAL AND METHODS: This study is divided in two assays and 7 healthy women with ages ranging from 35 to 45 years participated in both assays. Assay 1. Administration of 50 g of glucose dissolved in 125 ml of water (followed by other 150 ml of water). Assay 2. It was carried out one week later in the same women and conditions as assay 1 but adding 10.5 g of Ispaghula husk to the dissolution. In both assays, blood samples were obtained at 0, 10, 20, 30, 45, 60, 75, 90 and 120 minutes after administration and glucose concentration was determined in serum. RESULTS: The value of the area under the mean glucose concentration-time curve obtained in assay 2 (in the presence of fiber) was a 13.6% lower than that obtained in assay 1 (significant difference, p < or = 0.05). Individual concentration-time curves obtained in assay 1 can be considered as normal in 4 of the 7 volunteers. Abnormalities observed in the other 3 curves were due to: her history of prediabetic in one of them (glucose concentration values over 180 mg/100 ml); diabetic patients in her family in other of them (2 values over 180 mg/100 ml) and hypoglycaemia in two of the volunteers. When we administered glucose with fiber in assay 2, in all cases, the maximum concentration reached was lower, the variations in glycaemia values were also lower along the different sampling times (peaks disappear or are less marked) and no hypoglycaemia appeared.