Association between Early Ischemic Changes and Collaterals in Acute Stroke: A Retrospective Study.

BACKGROUND AND PURPOSE: The quality of leptomeningeal collaterals may influence the speed of infarct progression in acute stroke. Our main objective was to evaluate the association of leptomeningeal collateral score and its interaction with time with ischemic changes on CT in patients with acute stroke. MATERIALS AND METHODS: Adult patients with acute stroke symptoms and anterior circulation large-vessel occlusion on CTA from 2015 to 2019 were included. Routinely performed NCCT and multiphase CTA were reviewed to assess ASPECTS and the leptomeningeal collateral score. We built multivariate regression models to assess the association between leptomeningeal collateral score and its interaction with time and ASPECTS. Performance measures to predict poor ASPECTS at different time thresholds (identified with receiver operating characteristic curve analysis) were estimated in a subgroup of patients with poor leptomeningeal collateral scores. RESULTS: Leptomeningeal collateral scores 0-1 were associated with lower ASPECTS, and the model with dichotomized and trichotomized leptomeningeal collateral score showed a significant multiplicative interaction between time and the leptomeningeal collateral score. The negative predictive value for poor ASPECTS was >0.9 for at least the first 3 hours from stroke onset to imaging, and the positive predictive value was <0.5 for every time threshold tested in the subgroup of patients with leptomeningeal collateral scores 0-3. CONCLUSIONS: Poor (0-1) leptomeningeal collateral scores were associated with lower ASPECTS, and an increase in time has a multiplicative interaction with the leptomeningeal collateral score on ASPECTS.

Competencias profesionales de los bibliotecarios de ciencias de la salud en el siglo XXI / Professional competences of the health sciences librarians in the XXI century

El siglo XXI impone al bibliotecario grandes retos como consecuencia del desarrollo de nuevas tecnologías y la incorporación a diversos escenarios donde la información asume formas que van más allá de los productos y servicios tradicionales de una biblioteca. Se realiza una panorámica de los cambios que han marcado el tránsito hacia un paradigma diferente para la actividad científica-informativa. Se analiza la necesidad de desarrollar nuevas capacidades y conocimientos entre los bibliotecarios como parte de un proceso de alfabetización informacional. Se establecen las diferencias entre el modelo del bibliotecario tradicional y el modelo del bibliotecario gestor. Asimismo se describen algunas de las competencias profesionales que deben desarrollar los bibliotecarios para asumir las nuevas funciones que le impone la sociedad de la información.

The XXI Century faces librarians with great challenges, as a consequence of the development of new technologies and their incorporation to different scenarios where information takes forms beyond the traditional products and services of a library. The changes that have characterized the transit towards a different paradigm for the scientific information activity are approached. An analysis is made of the need of developing new abilities and knowledge among librarians, as part of a process of informational literacy. The differences between the traditional librarian model and the model of the management librarian are stated, and some of the professional competences librarians should develop to deal with the new functions imposed to them by the information society are established.

[Rheological and expander effect of hydroxyethyl-starch in intradural anesthesia]. / Efecto reológico y expansor del hidroxietilalmidón en anestesia intradural.

We have evaluated the effect of the infusion of hydroxyethylstarch (HES) on blood viscosity and its usefulness to prevent hypotension associated with intradural anesthetic blockade. The sample consisted of 20 healthy patients scheduled for elective surgery with intradural anesthesia (0.5% hyperbaric bupivacaine), in whom 500 ml of HES were infused in 20 minutes. Blood samples were taken before lumbar puncture and 20 minutes after it and once HES infusion had been finished. Blood viscosity, the erythrocyte and leukocyte mass parameters and biochemical values (total protein, BUN, creatinine, glucose) were measured. Blood pressure (systolic, diastolic, mean) and heart rate were monitored every 5 minutes. During the study time, systolic blood pressure did not show significant changes. Mean and diastolic blood pressure in the minutes 15 and 20 were reduced in less than 10 mmHg (p less than 0.01). Packed red cell volume diminished in 5.7% and the blood viscosity in 0.5-2.3 mPas. It was concluded that HES is a good option for intradural anesthesia because of its plasma volume expanding effect and the hemodilution it induces.

Intraosseous fluid administration in emergencies.

15 patients who needed prompt administration of fluids and in whom cannulation of a vein proved difficult were given various solutions and drugs by the intraosseous route. The results of this therapy were rewarding and no serious complications were attributed to the procedure.