Valores de normalidad de sensibilidad retiniana y fijación foveal mediante microperimetría fotópica y escotópica en población sana / Fotopic and scotopic retinal sensitivity and foveal fixation normal values using microperimetry in healthy population

Objetivo Analizar los valores de sensibilidad retiniana y fijación foveal, en población sana, en condiciones fotópicas y escotópicas usando el microperímetro MP3-S (Nidek, Gamagori, Japón). Métodos Estudio observacional, transversal, unicéntrico. Se realizó una microperimetría (MP) fotópica y escotópica con una rejilla de estímulos personalizada de 13 puntos centrada en fóvea de 4,5×4,5mm en voluntarios sanos, sin enfermedad ocular. Se utilizó el ICC para evaluar la fiabilidad de la MP fotópica y escotópica. Resultados Se evaluaron 102 ojos de 54 voluntarios sanos (edad media: 49,8±15 años). La sensibilidad retiniana media (SRM) en la prueba fotópica y escotópica fue de 28,87±3,3 y 15,72±1,9dB, respectivamente. No se hallaron diferencias al comparar la SRM por grupo de sexos. Sin embargo, al analizar la SRM por grupos de edad se encontraron diferencias estadísticamente significativas en ambas modalidades de la prueba, siendo mayor la SRM en el grupo de sujetos menores de 35 años, con 30,3±1,7dB en la fotópica y 16,3±1,3dB en la escotópica, y menor en el grupo de mayores de 65 años, con 26,7±2,2dB en la fotópica y 13,8±1,8dB en la escotópica, con p=0,0001. En el análisis de fiabilidad, el coeficiente alfa de Cronbach reveló una excelente fiabilidad de la MP fotópica (0,958) y una buena fiabilidad de la MP escotópica (0,841). Conclusión La MP es un test con buena fiabilidad tanto en condiciones fotópicas como escotópicas. La SRM en condiciones fotópicas y escotópicas no difiere según el sexo, pero sí disminuye con la edad. Existe una correlación positiva entre la SRM fotópica y la escotópica (AU)

Purpose To determine normal values of fotopic and scotopic retinal sensitivity and foveal fixation obtained by microperimetry, using MP3-S microperimeter (Nidek, Gamagori, Japan), in a healthy population. Methods Observational, cros-sectional, single centre study. Fotopic and scotopic microperimetry (MP) was performed using with a customized 13-point fovea-centered pattern in healthy volunteers without ocular pathology. A intraclass correlation coefficient was performed to evaluate fotopic and scotopic MP reliability. Results We analyzed 102 eyes of 54 healthy volunteers (mean age 49.8±15 years old). The fotopic and scotopic mean retinal sensitivity (MRS) was 28.87±3.3dB and 15.72±1.9dB (95% CI 15.35-16.09), respectively, showing a significant statistical difference (P<.05). No differences were found when comparing MRS by gender group. However, when analyzing the MRS by age groups, statistically significant differences were found in both modalities of the test, MRS being higher in the group of subjects under 35 years of age, with 30.3±1.7dB in the photopic and 16.3±1.3dB in the scotopic, and lower in the group of older than 65 years, with 26.7±2.2dB in the photopic and 13.8±1.8dB in the scotopic, with P=.0001. The reliability analysis of both tests revealed an excellent reliability of the fotopic MP with a Cronbach alpha of 0.958 and a good reliability of 0.841 in scotopic MP. Conclusion MP is a test with good reliability both under photopic and scotopic conditons. MRS and fixation stability under photopic and scotopic conditions do not differ according to sex, but it does decrease with age. There is a positive correlation between photopic and scotopic MRS (AU)

Fotopic and scotopic retinal sensitivity and foveal fixation normal values using microperimetry in healthy population.

PURPOSE: To determine normal values of fotopic and scotopic retinal sensitivity and foveal fixation obtained by microperimetry, using MP3-S microperimeter (Nidek, Gamagori, Japan), in a healthy population. METHODS: Observational, crossectional, single centre study. Fotopic and scotopic microperimetry was performed using with a customized 13-point fovea-centered pattern in healthy volunteers without ocular pathology. A intraclass correlation coefficient (ICC) was performed to evaluate fotopic and scotopic microperimetry reliability. RESULTS: We analyzed 102 eyes of 54 patients with a mean age of 49.8 +/- 15 years old. The fotopic and scotopic mean retinal sensitivity (MRS) was 28.55±3.3dB (95% CI=[27.87-29.23]) and 15.72±1.9dB (95% CI=[15.35-16.09]) respectively, showing a significant statistical difference (p<0.05). No differences were found when comparing SRM by gender group. However, when analyzing the SRM by age groups, statistically significant differences were found in both modalities of the test; SRM being higher in the group of subjects under 35 years of age with 30.3±1.7dB in the photopic and 16.3±1.3dB in the scotopic; and lower in the group of older than 65 years with 26.7±2.2dB in the photopic and 13.8±1.8dB in the scotopic with p=0.0001. The reliability analysis of both tests, revealed an excellent reliability of the fotopic microperimetry with a Crombach alpha of 0.958 and a good reliability of 0.841 in scotopic microperimetry. CONCLUSIONS: Microperimetry is a test with good reliability both under photopic and scotopic conditions. SRM and fixation stability under photopic and scotopic conditions do not differ according to sex, but it does decrease with age. There is a positive correlation between photopic and scotopic SRM.

Epidemiología y características del ictus isquémico en el adulto joven en Aragón / Epidemiology and characteristics of ischaemic stroke in young adults in Aragon

Introducción: Alrededor de 15 millones de personas sufren un ictus cada año, de los que un 10-15% ocurre en menores de 50 años (ictus en el adulto joven). La prevalencia de los distintos factores de riesgo vascular y las estrategias sanitarias para el manejo del ictus varían a nivel mundial, siendo interesante conocer la epidemiología y las características específicas de cada región. El objetivo de este estudio fue determinar la prevalencia de los diferentes factores de riesgo vascular, la etiología y las características de los ictus isquémicos en el adulto joven en la comunidad autónoma de Aragón. Métodos: Estudio multicéntrico, de corte transversal, realizado por los Servicios de Neurología de todos los hospitales del Servicio Aragonés de Salud (SALUD). Se identificó a todos los pacientes entre 18 y 50 años que ingresaron en cualquiera de estos hospitales con el diagnóstico de ictus isquémico o AIT entre enero del 2005 y diciembre del 2015. Se recogieron variables demográficas, factores de riesgo vascular y tipo de ictus isquémico entre otras. Resultados: En el periodo de estudio, 786 pacientes entre 18 y 50 años ingresaron con el diagnóstico de ictus isquémico o AIT en algún hospital del SALUD, con una tasa anual promedio de 12,3 por 100.000 habitantes. La mediana de su edad fue de 45 años (RIQ: 40-48 años). El factor de riesgo vascular más prevalente fue el tabaquismo, 404 (51,4%). La mayoría fue de causa indeterminada (36,2%), seguida por «otras causas» (26,5%). La mediana de puntuación en la escala NIHSS fue de 3,5 (RIQ: 2,07,0). En total, 211 (26,8%) de los ingresos fueron por AIT. De los pacientes que ingresaron con el diagnóstico de ictus isquémico, 59 (10,3%) se fibrinolizaron. Conclusiones: El ictus isquémico en el adulto joven no es infrecuente en Aragón y en un importante número de casos es de etiología indeterminada, por lo que es necesario implementar medidas que nos permitan mejorar su estudio, disminuir su incidencia y prevenir su recurrencia. (AU)

Introduction: Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. Methods: A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. Results: During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. Conclusions: Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence. (AU)

Epidemiology and characteristics of ischaemic stroke in young adults in Aragon.

INTRODUCTION: Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. METHODS: A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. RESULTS: During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. CONCLUSIONS: Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.

Pronóstico funcional a 3 meses de pacientes hospitalizados por ictus isquémico agudo en Aragón: análisis regional de la repercusión de la COVID-19 / Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: Rregional analysis of the impact of COVID-19

Introducción: La pandemia por COVID-19 ha tenido un impacto en el manejo del ictus isquémico; se ha descrito una disminución de los ingresos hospitalarios e incluso una interrupción en la cadena de atención y un aumento de la mortalidad intrahospitalaria. Sin embargo, falta evidencia sobre su impacto en el pronóstico funcional. El objetivo de este estudio es analizar el efecto de la pandemia por COVID-19 en el pronóstico funcional a 3 meses de los pacientes con ictus isquémico agudo hospitalizados en Aragón.Material y métodosRevisamos los datos de todos los pacientes ingresados por ictus isquémico en todos los hospitales de nuestro sistema sanitario entre el 30 de diciembre del 2019 y el 3 de mayo del 2020. Comparamos su mRS y la mortalidad a 3 meses de los hospitalizados antes y después de haberse establecido el estado de emergencia secundario a la pandemia por COVID-19.ResultadosEn total, 318 pacientes con ictus isquémico agudo cumplieron nuestros criterios de inclusión. No hubo diferencias en las características globales y específicas de cada periodo, excepto por una mayor proporción de pacientes mayores de 80 años de edad durante el periodo pre-CoV (42,2% vs. 29,0%, p = 0,028). En el análisis comparativo, no encontramos una diferencia significativa en la mortalidad (12,3 vs. 7,9, p = 0,465) o la proporción de pacientes con mRS ≤ 2 (57,7% vs. 57,1%, p = 0,425) a los 3 meses.ConclusiónHasta donde sabemos, este es el primer estudio que analiza el impacto de la pandemia por COVID-19 en el pronóstico funcional a 3 meses de pacientes con ictus isquémico. En nuestra comunidad autónoma, no ha habido un incremento en la mortalidad o discapacidad a 3 meses de pacientes hospitalizados por ictus isquémico durante el periodo de COVID-19. (AU)

Introduction: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain).Materil and methodsWe reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic.ResultsIn total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs. 29.0%, P=.028). In the comparative analysis, we found no significant differences in mortality (12.3 vs. 7.9, P=.465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs. 57.1%, P=.425) at 3 months.ConclusionTo our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic. (AU)

Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: regional analysis of the impact of COVID-19.

INTRODUCTION: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). METHODS: We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. RESULTS: In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs 29.0%, P = .028). In the comparative analysis, we found no significant differences in mortality (12.3 vs 7.9, P = .465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs 57.1%, P = .425) at 3 months. CONCLUSION: To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.

Grado de cumplimiento terapéutico a los tres meses en pacientes con migraña / Degree of compliance with treatment at three months in migraine patients

Introducción: La adhesión al tratamiento preventivo oral (TPO) en la migraña se ve frecuentemente comprometida. El objetivo fue conocer el grado de adhesión al TPO en pacientes con migraña a los tres meses. Pacientes y métodos: Estudio multicéntrico observacional de pacientes diagnosticados de migraña episódica o crónica (criterios de la Clasificación Internacional de Cefaleas, tercera edición) en los que se iniciaba TPO. Se recogieron datos demográficos (edad, género, nivel estudios, estado civil) y de enfermedad (número de ataques, puntuación en las escalas Headache Impact Test-6 y Migraine Disability Assessment Scale). A los tres meses se pasó la escala de Morisky Green, que diferencia niveles de adhesión: excelente (0), moderada (1-2) y baja (3-4). Resultados: Participaron 100 pacientes, un 87% mujeres de 42 ± 13 años, el 14% con migraña crónica. El 53,2% comenzaba su primer TPO. Se iniciaron betabloqueantes en el 23,2%, antidepresivos tricíclicos en el 35,4%, flunaricina en el 21,2%, neuromoduladores en el 19,2% y antihipertensivos en el 1%. El 56% presentaba discapacidad grave y el 79,5%, impacto muy grave. La adhesión a los tres meses fue excelente en el 41,8%, moderada en el 28,6% y baja en el 29,6%. El motivo más frecuente de discontinuación fueron los efectos adversos (44%). Se encontró una relación significativa entre adhesión excelente y estado civil soltero (p = 0,046), y entre adhesión baja y efectos adversos (p = 0,009). No se encontraron diferencias significativas entre los TPO empleados y el grado de adhesión ni con el resto de variables estudiadas. Conclusiones: Aunque nuestros resultados son mejores que los publicados en la bibliografía, consideramos que la adhesión terapéutica en nuestro medio es baja y es prioritario educar a nuestros pacientes en este sentido.(AU)

Introduction: Adherence to oral preventive treatment (OPT) in migraine is often compromised. The aim was to determine the degree of adherence to OPT in migraine patients at three months. Patients and methods: We conducted a multicentre observational study of patients diagnosed with episodic or chronic migraine (criteria of the International Headache Classification, third edition) in whom OPT was initiated. Demographic data (age, gender, educational level, marital status) and disease data (number of attacks, Headache Impact Test-6 and Migraine Disability Assessment Scale scores) were collected. At three months, the Morisky-Green scale was administered, which differentiates levels of adherence: excellent (0), moderate (1-2) and low (3-4). Results: Altogether 100 patients participated in the study: 87% women aged 42 ± 13 years, 14% with chronic migraine; 53.2% of them were beginning their first OPT. Beta-blockers were initiated in 23.2%, tricyclic antidepressants in 35.4%, flunarizine in 21.2%, neuromodulators in 19.2% and antihypertensives in 1%. Severe disability was observed in 56%, and the impact was very severe in 79.5%. Adhesion at three months was excellent in 41.8%, moderate in 28.6% and low in 29.6%. The most frequent reason for discontinuing was the occurrence of adverse effects (44%). A significant relationship was found between excellent adherence and being single (p = 0.046), and between low adherence and adverse effects (p = 0.009). No significant differences were found between the OPT used and the degree of adherence or the other variables studied. Conclusions: Although our results are better than those published in the literature, we consider that therapeutic adherence in our setting is low and educating our patients in this regard is a priority.(AU)

[Degree of compliance with treatment at three months in migraine patients]. / Grado de cumplimiento terapéutico a los tres meses en pacientes con migraña.

INTRODUCTION: Adherence to oral preventive treatment (OPT) in migraine is often compromised. The aim was to determine the degree of adherence to OPT in migraine patients at three months. PATIENTS AND METHODS: We conducted a multicentre observational study of patients diagnosed with episodic or chronic migraine (criteria of the International Headache Classification, third edition) in whom OPT was initiated. Demographic data (age, gender, educational level, marital status) and disease data (number of attacks, Headache Impact Test-6 and Migraine Disability Assessment Scale scores) were collected. At three months, the Morisky-Green scale was administered, which differentiates levels of adherence: excellent (0), moderate (1-2) and low (3-4). RESULTS: Altogether 100 patients participated in the study: 87% women aged 42 ± 13 years, 14% with chronic migraine; 53.2% of them were beginning their first OPT. Beta-blockers were initiated in 23.2%, tricyclic antidepressants in 35.4%, flunarizine in 21.2%, neuromodulators in 19.2% and antihypertensives in 1%. Severe disability was observed in 56%, and the impact was very severe in 79.5%. Adhesion at three months was excellent in 41.8%, moderate in 28.6% and low in 29.6%. The most frequent reason for discontinuing was the occurrence of adverse effects (44%). A significant relationship was found between excellent adherence and being single (p = 0.046), and between low adherence and adverse effects (p = 0.009). No significant differences were found between the OPT used and the degree of adherence or the other variables studied. CONCLUSIONS: Although our results are better than those published in the literature, we consider that therapeutic adherence in our setting is low and educating our patients in this regard is a priority.

TITLE: Grado de cumplimiento terapéutico a los tres meses en pacientes con migraña.Introducción. La adhesión al tratamiento preventivo oral (TPO) en la migraña se ve frecuentemente comprometida. El objetivo fue conocer el grado de adhesión al TPO en pacientes con migraña a los tres meses. Pacientes y métodos. Estudio multicéntrico observacional de pacientes diagnosticados de migraña episódica o crónica (criterios de la Clasificación Internacional de Cefaleas, tercera edición) en los que se iniciaba TPO. Se recogieron datos demográficos (edad, género, nivel estudios, estado civil) y de enfermedad (número de ataques, puntuación en las escalas Headache Impact Test-6 y Migraine Disability Assessment Scale). A los tres meses se pasó la escala de Morisky Green, que diferencia niveles de adhesión: excelente (0), moderada (1-2) y baja (3-4). Resultados. Participaron 100 pacientes, un 87% mujeres de 42 ± 13 años, el 14% con migraña crónica. El 53,2% comenzaba su primer TPO. Se iniciaron betabloqueantes en el 23,2%, antidepresivos tricíclicos en el 35,4%, flunaricina en el 21,2%, neuromoduladores en el 19,2% y antihipertensivos en el 1%. El 56% presentaba discapacidad grave y el 79,5%, impacto muy grave. La adhesión a los tres meses fue excelente en el 41,8%, moderada en el 28,6% y baja en el 29,6%. El motivo más frecuente de discontinuación fueron los efectos adversos (44%). Se encontró una relación significativa entre adhesión excelente y estado civil soltero (p = 0,046), y entre adhesión baja y efectos adversos (p = 0,009). No se encontraron diferencias significativas entre los TPO empleados y el grado de adhesión ni con el resto de variables estudiadas. Conclusiones. Aunque nuestros resultados son mejores que los publicados en la bibliografía, consideramos que la adhesión terapéutica en nuestro medio es baja y es prioritario educar a nuestros pacientes en este sentido.

El rol actual de los trombolíticos en el tratamiento de la obstrucción de arteria central de la retina / The actual role of thrombolytic treatment in central retinal artery occlusion

Objetivo El propósito de este estudio es determinar la aplicación del tratamiento trombolítico en la obstrucción de la arteria central de la retina (OACR), sus beneficios reales, su seguridad y sus posibles indicaciones. Métodos Realizamos una investigación en las bases de datos de Pubmed, Cochrane y Google Scholar, primero en búsqueda de la efectividad del tratamiento tradicional para la OACR y luego llevamos a cabo una comparación con las nuevas estrategias de terapia que involucran fibrinolíticos intravenosos e intraarteriales. Resultados Mientras que pequeños estudios retrospectivos u observacionales proponen el uso del tratamiento trombolítico, estudios multicéntricos randomizados no pudieron demostrar mejorías visuales significativas con esta nueva terapia. Además, se observó un mayor riesgo de efectos adversos potencialmente amenazantes para la vida de los pacientes que utilizaron el tratamiento trombolítico. Conclusiones Hasta que no existan estudios bien diseñados que demuestren un claro beneficio de la terapia trombolítica para la mejoría visual, y que este beneficio sea contrastado con la frecuencia y severidad de los efectos adversos, no podemos recomendar el tratamiento fibrinolítico para la OACR (AU)

Objective The purpose of this study is to determine the application of thrombolytic treatment in central retinal artery occlusion (CRAO), its real benefit, safety and possible indications for treatment. Methods We searched the PubMed, Cochrane and Google Scholar databases delving first into the effectiveness of the traditional treatment for CRAO, and then comparing them with new treatment strategies with intra venous or intra arterial fibrinolysis. Results Whereas small retrospective and open-label observational trials support the use of thrombolytic therapy, multicenter randomized trials failed to demonstrate a significant visual improvement with this new strategy. Besides that, a greater risk of life threatening adverse event was observed in patients using thrombolytic treatment. Conclusion Until well-conducted clinical trials demonstrate a clear benefit of thrombolytic therapy for improving visual acuity and their benefit are weighted against the frequency and severity of adverse events, we could not recommend fibrinolysis for treating CRAO (AU)

The actual role of thrombolytic treatment in central retinal artery occlusion. / El rol actual de los trombolíticos en el tratamiento de la obstrucción de arteria central de la retina.

OBJECTIVE: The purpose of this study is to determine the application of thrombolytic treatment in central retinal artery occlusion (CRAO), its real benefit, safety and possible indications for treatment. METHODS: We searched the PubMed, Cochrane and Google Scholar databases delving first into the effectiveness of the traditional treatment for CRAO, and then comparing them with new treatment strategies with intra venous or intra arterial fibrinolysis. RESULTS: Whereas small retrospective and open-label observational trials support the use of thrombolytic therapy, multicenter randomized trials failed to demonstrate a significant visual improvement with this new strategy. Besides that, a greater risk of life threatening adverse event was observed in patients using thrombolytic treatment. CONCLUSION: Until well-conducted clinical trials demonstrate a clear benefit of thrombolytic therapy for improving visual acuity and their benefit are weighted against the frequency and severity of adverse events, we could not recommend fibrinolysis for treating CRAO.

[Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: Rregional analysis of the impact of COVID-19]. / Pronóstico funcional a 3 meses de pacientes hospitalizados por ictus isquémico agudo en Aragón: análisis regional de la repercusión de la COVID-19.

Introduction: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). Materil and methods: We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. Results: In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs. 29.0%, P=.028). In the comparative analysis, we found no significant differences in mortality (12.3 vs. 7.9, P=.465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs. 57.1%, P=.425) at 3 months. Conclusion: To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.

Epidemiology and characteristics of ischaemic stroke in young adults in Aragon. / Epidemiología y características del ictus isquémico en el adulto joven en Aragón.

INTRODUCTION: Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. METHODS: A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. RESULTS: During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. CONCLUSIONS: Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.

Seed Cryostorage Enhances Subsequent Plant Productivity in the Forage Species Teramnus Labialis (L.F.) Spreng.

BACKGROUND: Teramnus labialis is an herbaceous legume that serves as a source of carbohydrates and proteins for animals and humans, and is valued for its nitrogen contribution to soil. The benefits of this species are, however, limited by low seed availability, small seed size and low in situ seed germination levels, due to physical dormancy. Cryostorage has been shown to be beneficial for both seed storage and breaking physical dormancy in seeds of various species. However, its potential effects on subsequent seedling emergence, plant growth and seed production need to be studied before large-scale implementation for T. labialis. OBJECTIVE: To record agricultural traits of T. labialis after seed exposure to liquid nitrogen. MATERIALS AND METHODS: Seeds were maintained at 5 degree C (control) or stored in LN before sowing. Seedling emergence percentage and traits related to plant growth and seed production were evaluated for 6 months. RESULTS: Except for seed weight, all traits differed significantly between seedlings generated from cryostored and control seeds. Except for pod number, seedling emergence and plant growth traits were enhanced by cryostorage to a greater extent than seed production traits. Cryostorage resulted in cracks and breaks in the seed coat which were absent in control seeds (scanning electron microscopy), and in breaking physical dormancy may have facilitated more rapid seedling emergence than for control seeds. CONCLUSION: Seed cryostorage enhances subsequent plant productivity in terms of growth and to a lesser extent seed production in Teramnus labialis, validating its use for commercial growth of this species.

Depth versus subdural temporal electrodes revisited: Impact on surgical outcome after resective surgery for epilepsy.

OBJECTIVE: To study retrospectively the impact of electrode modality (subdural or depth electrodes) during presurgical assessment on surgical outcome after temporal lobectomy. METHODS: The study included 17 patients assessed with depth electrodes and 57 with bitemporal subdural strips. RESULTS: MRI showed a larger proportion of bilateral pathology in patients undergoing depth recordings (29.41% versus 3.5%, p=0.00069). Among the operated patients, those undergoing depth electrode recordings showed better outcome at one year after surgery (11/12 versus 22/33; p=0.046). This difference disappears at longest follow up (10/12 versus 22/33; p=0.138). Moreover, the probability of undergoing surgery and having good outcome after assessment with intracranial recordings is higher for the depth electrode group at one-year follow up (11/17 versus 22/57; p=0.029) but statistical differences decrease to a trend for the longest follow up (10/17 versus 22/57; p=0.069). No other statistical differences were noted between subdural and depth electrodes. Depth electrodes showed lower complication rates than subdural electrodes. CONCLUSION: Both depth and subdural electrodes are effective for presurgical assessment of temporal lobe epilepsy. SIGNIFICANCE: Assessment with depth electrodes is associated with slightly increased likelihood of surgery and marginally better surgical outcome at one year follow up which disappears for longer follow up periods. Initial assessment with depth electrodes would have avoided a second implantation in 15% of patients.

Corea secundaria a encefalitis estriatal por anticuerpos CV2/CRMP5. Descripción de un caso y revisión de la literatura / Chorea secondary to striatal encephalitis due to anti-CV2/CRMP5 antibodies. Case description and review of the literature

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[Does medication abuse in patients with chronic migraine influence the effectiveness of preventive treatment with topiramate?]. / ¿El abuso de farmacos en pacientes con migraña cronica influye en la efectividad del tratamiento preventivo con topiramato?

INTRODUCTION: Patients with chronic migraine (CM) and medication abuse are difficult to treat, and have a greater tendency towards chronification and a poorer quality of life than those with other types of headache. AIM: To evaluate whether the presence of medication abuse lowers the effectiveness of topiramate. PATIENTS AND METHODS: A series of patients with CM were grouped according to whether they met abuse criteria or not. They were advised to stop taking the drug that they were abusing. Treatment was adjusted to match their crises and preventive treatment with topiramate was established from the beginning. The number of days with headache and intense migraine in the previous month and at four months of treatment was evaluated. RESULTS: In all, 262 patients with CM criteria were selected and 167 (63.7%) of them fulfilled abuse criteria. In both groups there was a significant reduction in the number of days with headache/month and number of migraine attacks/month at the fourth month of treatment with topiramate. The percentage of reduction in the number of days with headache/month in CM without abuse was 59.3 ± 36.1%, and with abuse, 48.7 ± 41.7% (p = 0.0574). The percentage of reduction in the number of days with intense migraine/month in CM without abuse was 61.2%, and with abuse, 50% (p = 0.0224). Response rate according to the number of days with headache/month in CM without abuse was 69%, and with abuse, 57%. Response rate according to the number of intense migraines/month in CM without abuse was 76.8%, and in CM with abuse, 61% (p = 0.0097). CONCLUSIONS: Topiramate was effective in patients with CM with and without medication abuse, although effectiveness is lower in the latter case.

TITLE: El abuso de farmacos en pacientes con migraña cronica influye en la efectividad del tratamiento preventivo con topiramato?Introduccion. Los pacientes con migraña cronica (MC) y abuso de medicacion son dificiles de tratar y tienen peor calidad de vida que otros pacientes con migrañas. Objetivo. Valorar si la presencia de abuso de farmacos disminuye la efectividad del topiramato. Pacientes y metodos. Una serie de pacientes con MC fueron agrupados segun presentasen criterios de abuso o no abuso de farmacos. Se les aconsejo la supresion del farmaco del cual abusaban. Se ajusto el tratamiento de sus crisis y se inicio tratamiento preventivo desde el principio con topiramato. Se valoro el numero dias con cefalea y migrañas intensas en el mes previo y al cuarto mes de tratamiento. Resultados. Fueron seleccionados 262 pacientes con criterios de MC, y de ellos 167 (63,7%) cumplieron criterios de abuso. En ambos grupos hubo una reduccion significativa del numero de dias con cefalea/mes y numero de crisis de migraña/mes al cuarto mes de tratamiento con topiramato. Porcentaje de reduccion de dias con cefalea/mes en MC sin abuso, 59,3 ± 36,1%; y con abuso, 48,7 ± 41,7% (p = 0,0574). Porcentaje de reduccion de migrañas intensas/mes en MC sin abuso, 61,2%; y con abuso, 50% (p = 0,0224). Tasa de respondedores segun numero de dias con cefalea/mes en MC sin abuso, 69%; y con abuso, 57%. Tasa de respondedores segun numero de migrañas intensas/mes en MC sin abuso, 76,8%; y en MC con abuso, 61% (p = 0,0097). Conclusiones. El topiramato fue efectivo en pacientes con MC sin y con abuso de farmacos, aunque con menor efectividad en estos ultimos.

[Clinical and therapeutic differences in neuro-ophthalmological involvement secondary to syphilis]. / Diferencias clinicas y terapeuticas de la afectacion neurooftalmologica secundaria a sifilis.

INTRODUCTION. There are many forms of neuro-ophthalmological involvement secondary to syphilis, and not all of them are well known. Our aim is to determine the clinical and therapeutic differences in these patients. CASE REPORTS. Our sample included eight patients diagnosed with an ocular and neuro-ophthalmological disorder due to syphilis over the years 2012 and 2013. Five of them presented uveitis, pan-eveitis being the most frequent, with three cases. Two cases presented papilloedema and another displayed retrobulbar optic neuropathy. A total of 62.5% were diagnosed with neurosyphilis, the presence of which was related with compromise of the optic nerve (p = 0.035). None of them gave positive for VDRL in cerebrospinal fluid and they were diagnosed by the presence of FTA antibodies together with high protein levels in cerebrospinal fluid, lymphocytic pleocytosis or intrathecal synthesis of antibodies. In the absence of uveitis, diagnosis was delayed by a mean time of 2.6 months (p = 0.047). All the patients, except one who required a vitrectomy, progressed favourably with intravenous antibiotic therapy. CONCLUSIONS. In cases of neuro-ophthalmological compromise, whether inflammatory or non-inflammatory, the physician must bear syphilis in mind as a potential causation in order to avoid delays in the diagnosis, since early well-tailored treatment can prevent permanent loss of sight.

TITLE: Diferencias clinicas y terapeuticas de la afectacion neurooftalmologica secundaria a sifilis.Introduccion. Existen multiples formas de afectacion neurooftalmologica secundaria a sifilis, no siempre bien conocidas. Nuestro objetivo es conocer las diferencias clinicas y de tratamiento en estos pacientes. Casos clinicos. Se incluyeron ocho pacientes diagnosticados de afectacion ocular y neurooftalmologica por sifilis durante los años 2012 y 2013. Cinco presentaron uveitis, siendo la panuveitis la forma mas frecuente, con tres casos. Dos casos presentaron papiledema, y otro, neuropatia optica retrobulbar. Un 62,5% fue diagnosticado de neurosifilis, cuya presencia se relaciono con la afectacion del nervio optico (p = 0,035). Ninguno de ellos presento positividad para VDRL en el liquido cefalorraquideo, y se diagnosticaron por la presencia de anticuerpos FTA junto con hiperproteinorraquia, pleocitosis linfocitaria o sintesis intratecal de anticuerpos. En ausencia de uveitis, se produjo un retraso diagnostico medio de 2,6 meses (p = 0,047). Todos los pacientes, salvo uno que preciso vitrectomia, evolucionaron favorablemente con antibioterapia intravenosa. Conclusiones. En casos de afectacion neurooftalmologica, inflamatoria y no inflamatoria, el clinico debe tener en cuenta la sifilis como potencial etiologia para evitar un retraso diagnostico, puesto que un adecuado tratamiento precoz puede evitar una perdida de vision permanente.

Sustained virological response to peginterferon plus ribavirin in chronic hepatitis C genotype 1 patients is associated with a persistent Th1 immune response.

BACKGROUND: An impairment of cellular immune response may contribute to the persistency of hepatitis C virus infection. AIM: To analyse the Th1/Th2 cytokine profile in peripheral blood CD4(+) and CD8(+) T cells from patients with chronic hepatitis C (CHC) during treatment with pegylated interferon-alpha2a plus ribavirin and to correlate the Th1/Th2 balance with virological response (SVR). METHODS: Prospective longitudinal study: 44 naïve genotype 1 CHC patients received PEG-IFNalpha2a plus ribavirin for 48 weeks: 26 (59.1%) achieved a SVR, 13 relapsed (29.5%) and 5 (11.4%) were non-responders. Sixteen healthy controls were analysed. The production of IL-4, IFNgamma and TNFalpha by CD4(+) and CD8(+) T cells was measured using flow cytometry, both in resting and phorbol-ester-stimulated cells. RESULTS: First three months of treatment: the synthesis of TNFalpha by phorbol-ester-stimulated-CD4(+) T cells was higher in patients with SVR (P < 0.01). At the end of treatment, SVR was associated with higher intracellular expression of IFNgamma by stimulated-CD4(+) and CD8(+) T cells (P < 0.05). At the end of follow-up, a higher intracellular expression of IFNgamma by CD4(+) T cells was associated with a SVR. CONCLUSIONS: A Th1-type immune response was associated with achievement of a SVR, as indicated by the persistent elevation of intracellular IFNgamma and TNFalpha.