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Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/diagnóstico por imagem , Imageamento por Ressonância MagnéticaRESUMO
INTRODUCTION: Management of cerebral vascular pathologies by means of clinical pathways allows us to make cost effective use of resources, to enhance health care quality and to obtain a greater degree of satisfaction in patients. AIMS: To assess the efficiency of applying a clinical pathway designed for the treatment of transient ischemic attacks (TIA) by monitoring a series of indicators that enable us to detect existing problems, to introduce any corrections that are needed and to draw conclusions that can be useful in the future. PATIENTS AND METHODS: To this end, a clinical pathway was drawn up with the general agreement of the members of our service and the different professionals involved in caring for these patients. Analyses were performed to study the data from 1998 to 2001, prior to implementation of the pathway, and from 2002 and 2003, which were the first years in which it was being applied. Altogether 1,433 patients with a diagnosis of TIA were hospitalised during this period, 554 of whom were admitted during the years 2002 and 2003. RESULTS: Of this group, the pathway was initially applied in 123 cases and 62 completed it. The mean stay in hospital was reduced from 9.2 days in 2000 to 5.7 days in 2003. The mean stay of patients who fulfilled all the requirements of the pathway was only 2.9 days. As far as the survey on satisfaction is concerned, 97% of patients said they were satisfied or very satisfied with the care they had received. CONCLUSIONS: The application of a clinical pathway in the treatment of TIA resulted in a high degree of satisfaction among the patients who were treated and a notable reduction in the mean stay in hospital.
Assuntos
Procedimentos Clínicos , Ataque Isquêmico Transitório/terapia , Algoritmos , Custos e Análise de Custo , Custos de Cuidados de Saúde , Hospitais Universitários , Humanos , Tempo de Internação , Satisfação do Paciente , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
Introducción. El manejo de la patología vascular cerebral a través de vías clínicas permite rentabilizar los recursos, potenciar la calidad asistencial y obtener una mayor satisfacción del paciente. Objetivo. Valorar la eficacia de la aplicación de una vía clínica diseñada para la atención de los accidentes isquémicos transitorios (AIT), mediante la monitorización de una serie de indicadores que permitieran detectar los problemas existentes, introducir las oportunas correcciones y extraer conclusiones válidas para el futuro. Pacientes y métodos. A tal efecto, se confeccionó una vía clínica de forma consensuada entre los miembros de nuestro servicio y los diversos profesionales implicados en la atención a dichos pacientes. Se analizaron los datos de 1998 a 2001, previos a la implantación de la vía, y de los años 2002 y 2003, primeros del funcionamiento de ésta. Resultados. Un total de 1.433 pacientes ingresaron con el diagnóstico de AIT en este período, de los cuales, 554 lo hicieron en los años 2002 y 2003. De este grupo, en 123 casos se aplicó inicialmente la vía y la completaron 62. La estancia media se redujo de 9,2 días en 2000 a 5,7 días en 2003. La estancia media de los pacientes que cumplieron todos los requisitos de la vía fue de tan sólo 2,9 días. En cuanto a la encuesta de satisfacción, el 97% de los pacientes se mostraron satisfechos o muy satisfechos con la atención recibida. Conclusión. La aplicación de una vía clínica en el tratamiento de los AIT implicó un alto grado de satisfacción en los pacientes atendidos y un notable descenso de la estancia media
Introduction. Management of cerebral vascular pathologies by means of clinical pathways allows us to make cost effective use of resources, to enhance health care quality and to obtain a greater degree of satisfaction in patients. Aims. To assess the efficiency of applying a clinical pathway designed for the treatment of transient ischemic attacks (TIA) by monitoring a series of indicators that enable us to detect existing problems, to introduce any corrections that are needed and to draw conclusions that can be useful in the future. Patients and methods. To this end, a clinical pathway was drawn up with the general agreement of the members of our service and the different professionals involved in caring for these patients. Analyses were performed to study the data from 1998 to 2001, prior to implementation of the pathway, and from 2002 and 2003, which were the first years in which it was being applied. Altogether 1,433 patients with a diagnosis of TIA were hospitalised during this period, 554 of whom were admitted during the years 2002 and 2003. Results. Of this group, the pathway was initially applied in 123 cases and 62 completed it. The mean stay in hospital was reduced from 9.2 days in 2000 to 5.7 days in 2003. The mean stay of patients who fulfilled all the requirements of the pathway was only 2.9 days. As far as the survey on satisfaction is concerned, 97% of patients said they were satisfied or very satisfied with the care they had received. Conclusions. The application of a clinical pathway in the treatment of TIA resulted in a high degree of satisfaction among the patients who were treated and a notable reduction in the mean stay in hospital
Assuntos
Humanos , Ataque Isquêmico Transitório/tratamento farmacológico , Ataque Isquêmico Transitório/cirurgia , Garantia da Qualidade dos Cuidados de Saúde , Satisfação do Paciente , Tempo de InternaçãoRESUMO
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Feminino , Idoso , Humanos , Alucinações/fisiopatologia , Transtornos da Visão/fisiopatologia , Diagnóstico Diferencial , Síndrome , Percepção Visual/fisiologiaRESUMO
AIM: Genetic and metabolism of C677T methylenetetrahydrofolate reductase (MTHFR) mutation and its relationship with ischemic vascular disease are revised. DEVELOPMENT: Homocygotes for C677T MTHFR mutation, 10-15% of general population, develop a thermolabil variant of the MTHFR enzyme which has a reduced functional activity. Because of this lower activity, is more likely for these patients to have mild hyperhomocysteinemia, a potential vascular risk factor, through their lives. A correct intake of folates and group B vitamins can help to compensate this genetic trend caused by the mutation. CONCLUSION: Molecular finding of C677T MTHFR mutation allow us to identify a part of population with a potential risk factor for ischemic vascular disease, with the advantage that is an easily revertible factor by modulation of the diet.
Assuntos
Isquemia Encefálica/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Polimorfismo Genético , Homocisteína/genética , Humanos , Fatores de RiscoRESUMO
Objetivo. Se analizan las características genéticas y metabólicasde la mutación C677T del gen de la metilentetrahidrofolatoreductasa (MTHFR) y su relación con la enfermedad isquémicavascular a través de una revisión de la bibliografía. Desarrollo.Los homocigotos para la mutación C677T MTHFR, que constituyenel 10-15% de la población general, desarrollan una variedadtermolábil de la enzima MTHFR con una actividad funcional reducida,que hace que tengan una tendencia sostenida a lo largo de suvida a padecer hiperhomocisteinemia moderada, que es candidataa ser un factor de riesgo vascular. El aporte adecuado de folatos yvitaminas del grupo B contribuye a revertir el condicionamientogenético que sobre el metabolismo de los folatos y de la metioninadetermina la mutación. Conclusión. La determinación molecularde la mutación C677T MTHFR permitirá identificar a un gruponotable de la población con tendencia a desarrollar un factor deriesgo potencial y fácilmente prevenible
Aim. Genetic and metabolism of C677T methylenetetrahydrofolate reductase (MTHFR) mutation and its relationshipwith ischemic vascular disease are revised. Development. Homocygotes for C677T MTHFR mutation, 10-15% of generalpopulation, develop a thermolabil variant of the MTHFR enzyme which has a reduced functional activity. Because of thislower activity, is more likely for these patients to have mild hyperhomocysteinemia, a potential vascular risk factor, throughtheir lives. A correct intake of folates and group B vitamins can help to compensate this genetic trend caused by the mutation.Conclusion. Molecular finding of C677T MTHFR mutation allow us to identify a part of population with a potential risk factorfor ischemic vascular disease, with the advantage that is an easily revertible factor by modulation of the diet
Assuntos
Humanos , Acidente Vascular Cerebral/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Acidente Vascular Cerebral/prevenção & controle , Homocisteína/sangue , Predisposição Genética para Doença , Mutação , Dieta , Fatores de Risco , Ácido Fólico/sangueRESUMO
BACKGROUND: Mutation C677T of the methylenetetrahydrofolate reductase (MTHFR) is the main cause of mild hyperhomocysteinemia. Hyperhomocysteinemia is a recognized risk factor for aterothrombosis. MTHFR C677T patients have higher levels of homocysteine in absence of dietary folates. METHODS: Retrospective study over data from patients studied for MTHFR C677T diagnosed of ischemic stroke (IS) younger 50 or older 50 without classic vascular risk factors or with familiar or personal history suggesting thrombophilia in a period of 3 years. MTHFR C677T was screened in 90 healthy blood donors as a control group. Computer database was used for descriptive statistics. RESULTS: Blood samples from 99 patients and from 90 donors (control). Mean age: 44.3 with Standard deviation (SD) 13.9 years in IS group and 39.1 with SD 8.3 years in control group. We found 19 (19.19%) homozygotes for MTHFR C677T in IS group and 14 (15.55%) in control group. CONCLUSIONS: Homozygosis for MTHFR C667T is more frequent in the IS group than in the control one, although there is no significant differences. Anyway, we suggest that, because of the high prevalence of the mutation MTHFR C677T found, screening should be made in the thombophilia studies, so that we could find patients with a risk factor that could be lowered by folates in the diet.
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Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Acidente Vascular Cerebral/genética , Adulto , Feminino , Humanos , Hiper-Homocisteinemia/genética , Masculino , Pessoa de Meia-Idade , Mutação , Prevalência , Estudos Retrospectivos , Fatores de Risco , Espanha , Trombofilia/genéticaRESUMO
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Humanos , Doenças da Glândula Tireoide/epidemiologia , Testes de Função Tireóidea/métodos , Doenças da Glândula Tireoide/diagnóstico , Programas de RastreamentoRESUMO
Fundamentos: La mutación C677T de la metilentetrahidrofolato reductasa (MTHFR) es la principal causa de hiperhomocisteinemia moderada en nuestro medio. La hiperhomocisteinemia es un factor reconocido de riesgo para aterotrombosis. Los pacientes con la mutación MTHFR C677T padecen hiperhomocisteinemia moderada en situaciones de carencia de folatos. Métodos: Se revisaron retrospectivamente resultados de los estudios de la mutación C677T MTHFR en pacientes con accidentes cerebrovasculares isquémicos agudos (ACVA) menores de 50 años y mayores de 50 años sin factores clásicos de riesgo vascular o historia familiar o personal sugerente de trombofilia, en un periodo de 3 años. Se realizaron estudios de la misma mutación en 90 donantes de sangre voluntarios sanos, como grupo control. Se realizó estadística descriptiva en base de datos informatizada. Resultados: Se recogieron muestras de 99 pacientes y de 90 controles. Edad media: 44,3 con desviación estándar de 13,9 años en pacientes y 39,1 con DS de 8,3 años en controles. Encontramos 19 (19,19%) homocigosis MTHFR C677T en el grupo de pacientes y 14 (15,55%) en el grupo de controles . Conclusiones: La homocigosis MTHFR C667T es más frecuente en el grupo de pacientes con ACVA que en los controles, si bien no encontramos diferencias significativas. Sin embargo, sugerimos que, dada la alta prevalencia poblacional encontrada en nuestro medio para la mutación MTHFR C677T, su estudio debe realizarse dentro de los estudios de trombofilia, pues es capaz de identificar pacientes con un factor de riesgo reversible mediante la administración de folatos
Background: Mutation C677T of the methylenetetrahydrofolate reductase (MTHFR) is the main cause of mild hyperhomocysteinemia. Hyperhomocysteinemia is a recognized risk factor for aterothrombosis. MTHFR C677T patients have higher levels of homocysteine in absence of dietary folates. Methods: Retrospective study over data from patients studied for MTHFR C677T diagnosed of ischemic stroke (IS) younger 50 or older 50 without classic vascular risk factors or with familiar or personal history suggesting thrombophilia in a period of 3 years. MTHFR C677T was screened in 90 healthy blood donors as a control group. Computer database was used for descriptive statistics. Results: Blood simples from 99 patients and from 90 donors (control). Mean age: 44.3 with Standard desviation (SD) 13.9 years in IS group and 39.1 with SD 8.3 years in control group. We found 19 (19.19%) homozygotes for MTHFR C677T in IS group and 14 (15.55%) in control group. Conclusions: Homozygosis for MTHFR C667T is more frequent in the IS group than in the control one, although there is no significant differences. Anyway, we suggest that, because of the high prevalence of the mutation MTHFR C677T found, screening should be made in the thombophilia studies, so that we could find patients with a risk factor that could be lowered by folates in the diet
Assuntos
Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Humanos , Mutação/genética , Hiper-Homocisteinemia/complicações , Hiper-Homocisteinemia/diagnóstico , Trombose/diagnóstico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Trombofilia/complicações , Trombofilia/diagnóstico , Homocisteína , Ácidos Pteroilpoliglutâmicos/deficiência , Estudos Retrospectivos , Inquéritos e Questionários , Acidente Vascular Cerebral/complicações , Trombose/complicações , DietaRESUMO
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Humanos , Sistema Imunitário/fisiopatologia , Epilepsia/complicações , Epilepsia/etiologia , Doenças do Sistema Imunitário/fisiopatologia , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/diagnóstico , Técnicas Citológicas/métodos , Citometria de Fluxo , Convulsões/psicologiaAssuntos
Arterite/tratamento farmacológico , Doenças Arteriais Cerebrais/tratamento farmacológico , Neurossífilis/tratamento farmacológico , Penicilina G/uso terapêutico , Vasculite do Sistema Nervoso Central/tratamento farmacológico , Adolescente , Arterite/etiologia , Isquemia Encefálica/etiologia , Doenças Arteriais Cerebrais/etiologia , Hemorragia Cerebral/etiologia , Transtornos da Consciência/etiologia , Guiné Equatorial/etnologia , Feminino , Humanos , Angiografia por Ressonância Magnética , Neurossífilis/complicações , Neurossífilis/diagnóstico , Indução de Remissão , Convulsões/etiologia , Vasculite do Sistema Nervoso Central/etiologiaRESUMO
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Recém-Nascido , Humanos , Veias Cerebrais , Trombose Venosa , Fatores de Tempo , Mesalamina , Aleitamento Materno , Transaminases , Asfixia Neonatal , Amônia , Anti-Inflamatórios não EsteroidesRESUMO
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