Use of statins for the treatment of spontaneous intracerebral hemorrhage: results of a pilot study.

BACKGROUND AND STUDY AIMS: Spontaneous intracerebral hemorrhage (ICH) represents the most fatal kind of stroke, and there is still no treatment available that improves the outcome. Statins are cholesterol reducers, and during the last few years many additional effects have been demonstrated that might be neuroprotective. We designed a pilot clinical study in order to evaluate whether the administration of statins is associated with a better outcome. PATIENTS AND METHODS: From August to December 2006 we carried out a prospective/retrospective non-randomized clinical study. The prospective group was treated with rosuvastatin (20 mg) and the retrospective control group was taken from our clinical records with a relation of 1:3. We included patients of both sexes, aged > or =15 years with proven ICH in CT-scan. Exclusion criteria were a history of neoplasm, head injury four weeks before admission, non-hypertensive reasons, brainstem hemorrhage, steroid administration, cranial surgery, initial hydrocephalus, and NIHSS > or =30. RESULTS: We analyzed 18 patients treated with rosuvastatin and 57 controls with similar basic characteristics. The mortality rate during hospitalization was 1 (5.6%) patient in the statin group and 9 (15.8%) in the control group; the hazard ratio adjusted by the initial Glasgow Coma Scale (GCS), intubation, admission in intensive care unit, disruption into the subarachnoid space was 0.20 (95% CI 0.02-1.67). The odds ratio for NIHSS > or =15 at release was 0.04 (95% CI 0.003-0.93). CONCLUSIONS: The use of statins during the acute phase of ICH could be associated with a better outcome. Further clinical trials are necessary to confirm a possible therapeutic effect and evaluate the toxicity of statins.

[A clinical-epidemiological approximation to intracerebral hemorrhage in a Mexican hospital: analysis of factors associated to mortality]. / Aproximacion clinicoepidemiológica de la hemorragia intracerebral en un hospital mexicano: analisis de factores asociados a la mortalidad.

INTRODUCTION: Intracerebral hemorrhage (ICH) is the most lethal type of stroke. There are some clinical and radiological factors related to mortality. The time for obtaining medical care could be related with poor prognosis, but there are not available studies in Hispanics that evaluated this one. AIM: To determinate the association between epidemiological factors, time to obtain medical care, origin, and clinical characteristics with hospital mortality due to ICH. SUBJECTS AND METHODS: Study of cases and controls in a regional third level center, between January 2000 and December 2006 with patients of both sexes, older than 15 years with tomographic diagnosis of ICH. We excluded patients with NIHSS undetermined or traumatic head injury 4 weeks before. We studied demographic variables, time between beginning of symptoms and medical care, origin in kilometers until hospital, clinical characteristics at admission, including Glasgow and NIHSS. RESULTS: We analyzed 74 men and 101 women with mean age of 65 years. The etiology was hypertension in 77.4% and localization lobar in 39.4%. Eighty-five percent receipt medical care after 3 hours and 75.4% came from a radius < 100 km. Mortality in hospital was 16.6% with an explicative model of regression that included blood pressure < 130/80 mmHg, intubation, Glasgow < 9 at admission or NIHSS > 15, and hospitalization days. CONCLUSIONS: Demographic characteristics, causes, and localization are similar to previously informed series. The time for obtaining medical care is far from ideal, this could delay treatment; allow progression of disease, and then worse prognosis.

Aproximación clinicoepidemiológica de la hemorragia intracerebral en un hospital mexicano: análisis de factores asociados a la mortalidad / Clinical-epidemiological approximation to intracerebral hemorrhage in a Mexican hospital: analysis of factors associated to mortality

La hemorragia intracerebral (HIC) espontánea es la forma más letal de enfermedad cerebrovascular.Existen factores clínicos y radiológicos descritos asociados a mortalidad. El tiempo en recibir atención podría relacionarse con peor pronóstico; sin embargo, no existen estudios en la población latina que hayan analizado esta asociación. Objetivo.Determinar la asociación entre factores epidemiológicos, el tiempo de atención, la procedencia y características clínicas con la mortalidad hospitalaria por HIC. Sujetos y métodos. Es un estudio de casos y controles en un centro regional de tercer nivel,entre enero de 2000 y diciembre de 2006, con pacientes de ambos sexos, mayores de 15 años, con diagnóstico tomográfico de HIC. Se excluyeron aquéllos con la escala del Instituto Nacional de Salud para enfermedades cardiovasculares (NIHSS) basal indeterminada o traumatismo craneal en las cuatro semanas previas. Se estudiaron variables demográficas, tiempo entre inicio de síntomas y atención médica, lugar de procedencia en kilómetros y características clínicas en el momento del ingreso, incluyendo la puntuación de Glasgow y NIHSS. Resultados. Analizamos 74 hombres y 101 mujeres con edad promediode 65 años. La etiología fue hipertensión arterial en el 77,3% y localización lobar en el 39,4%. El 84,5% recibió atención despuésde tres horas y el 75,4% procedía de un radio menor de 100 km. La mortalidad hospitalaria fue del 16,6%, con un modeloexplicativo de regresión logística que incluyó: tensión arterial < 130/80 mmHg, intubación, Glasgow < 9 o NIHSS >15en el momento del ingreso y los días de hospitalización. Conclusiones. Las características demográficas, causas y localizaciónse asemejan a lo descrito en la bibliografía. El tiempo de atención dista de lo ideal, lo que puede retrasar el tratamiento,permitir la progresión de la enfermedad y empeorar el pronóstico

Intracerebral hemorrhage (ICH) is the most lethal type of stroke. There are some clinical andradiological factors related to mortality. The time for obtaining medical care could be related with poor prognosis, but there are not available studies in Hispanics that evaluated this one. Aim. To determinate the association between epidemiologicalfactors, time to obtain medical care, origin, and clinical characteristics with hospital mortality due to ICH. Subjects and methods. Study of cases and controls in a regional third level center, between January 2000 and December 2006 with patients of both sexes, older than 15 years with tomographic diagnosis of ICH. We excluded patients with NIHSS undetermined or traumatic head injury 4 weeks before. We studied demographic variables, time between beginning of symptoms and medicalcare, origin in kilometers until hospital, clinical characteristics at admission, including Glasgow and NIHSS. Results. We analyzed 74 men and 101 women with mean age of 65 years. The etiology was hypertension in 77.4% and localization lobar in 39.4%. Eighty-five percent receipt medical care after 3 hours and 75.4% came from a radius < 100 km. Mortality inhospital was 16.6% with an explicative model of regression that included blood pressure < 130/80 mmHg, intubation, Glasgow < 9 at admission or NIHSS > 15, and hospitalization days. Conclusions. Demographic characteristics, causes, and localization are similar to previously informed series. The time for obtaining medical care is far from ideal, this could delaytreatment; allow progression of disease, and then worse prognosis

[Statins and brain protection mechanisms]. / Estatinas y mecanismos de proteccion cerebral.

INTRODUCTION: The 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA) inhibitors or statins are drugs used in the treatment of dyslipidemies. The clinical trials performed for evaluation of the efficacy observed a reduced incidence of stroke and other trials have demonstrated a better outcome after stroke and subrachnoid hemorrhage. DEVELOPMENT: In the last years, new actions of statins have been described (pleiotropics). The statins seem to originate neuroprotector effects, such as up-regulation of endothelial nitric oxide synthase; creation of a fibrinolytic profile with suppression of the intravascular stability of the clot; immunomodulation by regulation of cytokines and cellular adhesion molecules; anti-oxidation by reduction of lipidic peroxidation; induction of neuroplasticity by increment of neurotrophic factors and protection of neuroexcitotoxicity, maybe by regulation of intracellular calcium or depletion of intracellular sterols. All these actions can be explained by decreament of isoprenoids synthesis. CONCLUSION: The pleiotropic properties of the statins offer the possibility to consider them as possible neuroprotectors, which should be evaluated in pathologies where the molecular ways interfered are involved, for example head injury and stroke.

Estatinas y mecanismos de protección cerebral / Statins and brain protection mechanisms

Los inhibidores de la 3-hidroxi-3-metilglutaril coenzima A reductasa (HMG-CoA) o estatinas son medicamentosutilizados en el tratamiento de las dislipidemias. En los estudios clínicos realizados para evaluar su eficacia y seguridad se observó una menor incidencia de eventos isquémicos cerebrales y otros estudios han demostrado un mejor resultado funcional posterior a isquemia y hemorragia subaracnoidea. Desarrollo. En los últimos años se han descrito nuevas acciones delas estatinas (pleiotrópicas), las cuales podrían originar un efecto neuroprotector, como la suprarregulación de la sintasa de óxido nítrico en su isoforma endotelial, la creación de un perfil fibrinolítico por desestabilización de trombos intravasculares, la inmunomodulación por la regulación de citocinas y moléculas de adhesión, la antioxidación por reducción de la peroxidación lípidica, la inducción de neuroplasticidad por aumento de factores neurotróficos y la protección de neuroexcitotoxicidad, probablemente mediadas por modulación del ingreso de calcio intracelular o disminución de los esteroles intracelulares. Todo lo anterior podría explicarse por la disminución en la formación de isoprenoides. Conclusión. Las propiedades pleiotrópicas de lasestatinas abren la posibilidad de considerarlas como posibles neuroprotectores a evaluar en patologías que impliquen las vías que interfieren, como en el traumatismo craneal y la enfermedad vascular cerebral (AU)

The 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA) inhibitors or statins are drugsused in the treatment of dyslipidemies. The clinical trials performed for evaluation of the efficacy observed a reduced incidence of stroke and other trials have demonstrated a better outcome after stroke and subrachnoid hemorrhage. Development. In thelast years, new actions of statins have been described (pleiotropics). The statins seem to originate neuroprotector effects, such as up-regulation of endothelial nitric oxide synthase; creation of a fibrinolytic profile with suppression of the intravascular stability of the clot; immunomodulation by regulation of cytokines and cellular adhesion molecules; anti-oxidation by reduction of lipidic peroxidation; induction of neuroplasticity by increment of neurotrophic factors and protection ofneuroexcitotoxicity, maybe by regulation of intracellular calcium or depletion of intracellular sterols. All these actions can be explained by decreament of isoprenoids synthesis. Conclusion. The pleiotropic properties of the statins offer the possibility to consider them as possible neuroprotectors, which should be evaluated in pathologies where the molecular ways interfered areinvolved, for example head injury and stroke (AU)

Exposure to arsenic and lead and neuropsychological development in Mexican children.

This cross-sectional study examined the effects of chronic exposure to lead (Pb), arsenic (AS) and undernutrition on the neuropsychological development of children. Two populations chronically exposed to either high (41 children) or low (39 children) levels of As and Pb were analyzed using the Wechsler Intelligence Scale for Children, Revised Version, for México (WISC-RM). Geometric means of urinary arsenic (AsU) and lead in blood (PbB) were 62.9+/-0.03 (microgAs/g creatinine) and 8.9+/-0.03 (microg/dl) for the exposed group and 40.2+/-0.03 (microgAs/g creatinine) and 9.7+/-0.02 (microg/dl) for the reference group. The height for age index (HAI) was used as an indicator of chronic malnutrition and sociodemographic information was obtained with a questionnaire. Lead and arsenic were measured by atomic absorption spectrophotometry. Data on full, verbal, and performance intelligence quotients (IQ) scores, long-term memory, linguistic abstraction, attention span, and visuospatial organization were obtained through the WISC-RM. After controlling for significant potential confounders verbal IQ (P<0.01) decreased with increasing concentrations of AsU. The HAI correlated positively with full-scale and performance IQ (P<0.01). Higher levels of AsU were significantly related to poorer performance on WISC-RM factors examining long-term memory and linguistic abstraction, while lower scores in WISC-RM factors measuring attention were obtained at increasing values of PbB. Our results suggest that exposure to As and chronic malnutrition could have an influence on verbal abilities and long-term memory, while Pb exposure could affect the attention process even at low levels.

Somatosensory evoked potentials in chronic spinal cord compression.

Os A.A. analisam o valor dos potenciais evocados na compressao medular