Rol comunicativo del cuidador en pacientes con accidente cerebrovascular, Sincelejo, Colombia / The communicative role of caregivers assisting stroke patients from Sincelejo, Colombia / Papel comunicativo do cuidador em pacientes com acidente vascular cerebral, Sincelejo, Colômbia

Introducción: Las enfermedades cerebrovasculares son consideradas un problema de salud pública que afectan muchas capacidades en el individuo, entre ellas la comunicación; de esta manera el cuidador cumple un papel fundamental en su recuperación. Objetivo: Describir el rol comunicativo del cuidador en la atención a pacientes con secuelas de accidente cerebrovascular en la ciudad de Sincelejo, Colombia. Materiales y métodos: Paradigma positivista, enfoque cuantitativo y estudio descriptivo de corte transversal realizado con 40 cuidadores, seleccionados según muestreo por criterios y reclutamiento en cadena. Se utilizó una encuesta sociodemográfica, una sobre favorecimiento y bienestar comunicativo y Escala Likert, se realizó análisis de fiabilidad y consistencia interna del instrumento. Resultados: Predominaron cuidadores de sexo femenino, sobresale el cuidador informal, con estudios de secundaria y estrato socioeconómico bajo. Se encontró una actitud favorable en la competencia del ser y saber hacer, prima el buen trato, justicia y respeto. La competencia del saber evidenció actitud desfavorable, caracterizada por un conocimiento limitado frente a la patología, insuficientes destrezas, técnicas y habilidades para cumplir sus funciones y estrategias empleadas. Conclusión: Es necesario cualificar al cuidador en la atención del paciente con accidente cerebrovascular, mediante programas de que dinamicen la competencia del ser, saber y saber hacer

Introduction: Cerebrovascular diseases are a public health problem affecting the different capabilities of patients, including communication. Thus, caregivers play a fundamental role in their recovery. Objective: To describe the communicative role of caregivers in the support of patients with stroke sequelae in the city of Sincelejo, Colombia. Materials and methods: A positivist paradigm, quantitative approach, and descriptive cross-sectional study was carried out with 40 caregivers, who were selected according to criteria sampling and chain recruitment. A sociodemographic survey about favorability and communicative well-being as well as the Likert Scale were applied. A reliability and internal consistency analysis was conducted. Results: The majority of caregivers were women. Informal caregivers, with high school education, and belonging to low socioeconomic status were also predominant. A positive attitude regarding competences such as being and knowing what to do; appropriate treatment of patients, with justice and respect, were observed as common features. The knowledge competence was considered unfavorable, which was characterized by limited understanding regarding pathology, strategies used, and insufficient skills, techniques, and abilities to fulfill their functions. Conclusions: Caregivers of stroke patients should be qualified through programs that improve the being, knowing, and knowing how to do competencies.

Introdução: As doenças cerebrovasculares são consideradas um problema de saúde pública que afeta diversas capacidades do indivíduo, incluindo a comunicação; desta forma, o cuidador desempenha um papel fundamental na sua recuperação. Objetivo: Descrever o papel comunicativo do cuidador no cuidado de pacientes com sequelas de acidente vascular cerebral na cidade de Sincelejo, Colômbia. Materiais e métodos: Paradigma positivista, abordagem quantitativa e estudo transversal descritivo realizado com 40 cuidadores, selecionados segundo critérios de amostragem e recrutamento em cadeia. Foi utilizado um inquérito sociodemográfico, um de favorabilidade e bem-estar comunicativo e uma Escala Likert, foi realizada uma análise da fiabilidade e consistência interna do instrumento. Resultados: Predominaram cuidadores do sexo feminino, destacando-se os cuidadores informais, com escolaridade média e baixo nível socioeconômico. Encontrou-se na competição uma atitude favorável por ser e saber fazer, prevalecendo o bom tratamento, a justiça e o respeito. A competência conhecimento apresentou atitude desfavorável, caracterizada por conhecimento limitado sobre a patologia, habilidades, técnicas e habilidades insuficientes para cumprir suas funções e estratégias utilizadas. Conclusões: É necessário qualificar o cuidador no cuidado ao paciente com AVC, por meio de programas que potencializem a competência de ser, saber e saber fazer.

Competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica / Competencias de enfermería en el cuidado de personas con accidente cerebrovascular elegibles para terapia trombolítica / Nursing competencies in the care of patients with stroke who are eligible for thrombolytic therapy

Resumo Introdução: O acidente vascular cerebral isquêmico tem como tratamento a terapia trombolítica, aplicada ainda na fase aguda, promovendo melhora importante nas sequelas acarretadas por este agravo. Considerando a complexidade da terapia trombolítica, torna-se necessário que os enfermeiros compreendam suas competências para auxiliar no cuidado. Objetivo: Identificar evidências científicas acerca das competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica. Metodologia: Revisão integrativa composta por seis etapas em seis etapas (elaboração da questão, busca na literatura, coleta de dados, análise, discussão e apresentação da revisão), realizada nas bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase e CINAHL. A busca foi realizada entre agosto e setembro de 2022 adotando como critérios de inclusão estudos primários; gratuitos, disponíveis eletronicamente na íntegra; nos idiomas inglês, português e espanhol. Foram obtidos inicialmente 2.830 estudos, os quais passaram por uma seleção, onde foram incluídos aqueles que atendiam os critérios previamente estabelecidos. Resultados: Com base nos doze estudos incluídos nesta revisão identificaram-se competências voltadas à três atividades do cuidado: gestão do cuidado como trabalho em equipe, códigos, fluxos e protocolos, assistência ao paciente antes, durante e após a utilização da terapia trombolítica e educação em saúde para equipe, pacientes e familiares. Conclusão: Os achados desta revisão puderam evidenciar as competências do enfermeiro no cuidado aos pacientes elegíveis a terapia trombolítica, as quais perpassam diferentes áreas de atuação do enfermeiro. Para este estudo prevaleceram as competências assistências, seguida por competências gerenciais.

Resumen Introducción: El accidente cerebrovascular isquémico se trata con terapia trombolítica, aplicada incluso en la fase aguda, que promueve una mejoría significativa de las secuelas provocadas por este padecimiento. Considerando la complejidad de la terapia trombolítica, es necesario que las personas profesionales de enfermería comprendan sus competencias para ayudar en el cuidado. Objetivo: Identificar evidencias científicas sobre las competencias del personal de enfermería en el cuidado de pacientes con accidente cerebrovascular elegibles para terapia trombolítica. Metodología: Revisión integradora que consta de seis etapas (elaboración de la pregunta, búsqueda bibliográfica, recolección de datos, análisis, discusión y presentación de la revisión), realizada en las bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase y CINAHL. La búsqueda se realizó entre agosto y septiembre de 2022. Los criterio de inclusión fueron: estudios primarios, gratuito, disponible electrónicamente en su totalidad, en inglés, portugués y español. Inicialmente se obtuvieron 2830 estudios, los cuales fueron sometidos a un proceso de selección, que incluyó aquellos que cumplían con los criterios previamente establecidos. Resultados: A partir de los doce estudios incluidos en esta revisión, se identificaron competencias centradas en tres actividades asistenciales: gestión del cuidado como trabajo en equipo, códigos, flujos y protocolos, atención a pacientes antes, durante y después del uso de la terapia trombolítica y educación en salud para personal, pacientes y familias. Conclusión: Los hallazgos de esta revisión pudieron resaltar las competencias de las personas profesionales en enfermería en el cuidado de personas elegibles para terapia trombolítica, que abarcan diferentes áreas de actuación del personal de enfermería. Para este estudio, prevalecieron las habilidades asistenciales, seguidas de las competencias gerenciales.

ABSTRACT Introduction: Ischemic stroke is treated with thrombolytic therapy, applied even in the acute phase, promoting a significant improvement in the after-effects caused by this condition. Considering the complexity of thrombolytic therapy, it is necessary for nurses to understand the skills required to assist in care. Objective: To identify scientific evidence about the competencies of nurses in the care of patients with stroke who are eligible for thrombolytic therapy. Methodology: An integrative review consisting of six stages (elaboration of the question, literature review, data collection, analysis, discussion, and presentation), conducted in MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase, and CINAHL databases. The search was carried out between August and September 2022 using primary studies as the inclusion criteria: free of charge, fully available electronically, published in English, Portuguese, or Spanish. Initially, 2.830 studies were obtained, which underwent a selection process that included only those studies that met the previously established criteria. Results: Based on the twelve studies included in this review, competencies focused on three care activities were identified: care management such as teamwork; codes; flows and protocols; patient care before, during, and after the use of thrombolytic therapy; and education health education for staff, patients, and families. Conclusion: The findings of this review highlighted the nurses' competencies in the care of patients eligible for thrombolytic therapy, which encompass different areas of the nurse's work. For this study, assistance competencies prevailed, followed by management competencies.

[Psychometric properties of performance outcome tools to assess sensitivity in subjects with stroke sequela: A systematic review]. / Propiedades psicométricas de herramientas de resultados de desempeño para evaluar la sensibilidad en sujetos con secuela de accidente cerebrovascular: revisión sistemática.

The objective was to perform a systematic review of those performance outcomes (HRD) tools that assess sensitivity in post-stroke subjects, as well as to know which of all is the most reliable and viable. The design was a systematic review. The following were included: HRD, developed in post-stroke subjects, of any etiology and period of evolution; 18 years of age or older and testing for sensitivity; results on psychometric properties. Excluded: self-reported results, the report of cross-cultural adaptation, designed through computerized means. 19 HRD were acquired. The psychometric properties analyzed were reliability, internal consistency, measurement error, construct validity, content validity, and sensitivity to change, the first being the most studied. Psychometric properties were identified, assessed, compared, and summarized. Of all of them, we recommend the use of the modified Erasmus Nottingham Sensory Assessment, as it presents the best degree of confidence in the evidence.

Assessment of pain relief after four botulinum toxin A injection cycles in patients with post-stroke lower limb spasticity: A prospective, observational study.

INTRODUCTION: Spasticity is common after a stroke and is an independent risk factor for developing pain. BotulinumtoxinA injection is the treatment of choice for focal spasticity. We examined the effect of intramuscular botulinumtoxinA on pain relief in patients in routine clinical practice who were experiencing pain as a primary complaint associated with post-stroke lower limb spasticity. METHODS: Prospective, multicentre, post-marketing observational study. The study period was 16 months. The primary effectiveness variable was the mean change from baseline on the pain 0-10 Numerical Rating Scale after four botulinumtoxinA injection cycles. Secondary endpoints included changes from baseline on the pain 0-100 Visual Analogue Scale, Goal Attainment Scale, modified Ashworth Scale, 10-Meter Walk Test, Penn Spasm Frequency Scale, and 36-item Short-Form Health Survey. RESULTS: Of 186 enrolled patients, 180 (96.8%) received botulinumtoxinA at least once. The mean (standard deviation) pain 0-10 Numerical Rating Scale score decreased significantly (p<0.0001) from 4.9 (2.2) at baseline to 2.5 (2.1) at study end, representing a 50% decrease in pain severity. Relief of pain due to spasticity was supported by improvement from baseline in all secondary variables except the 10-Meter Walk Test. Two adverse events (erysipelas and phlebitis) in one patient were considered likely to be related to botulinumtoxinA injection. CONCLUSION: BotulinumtoxinA appears to provide pain relief as an additional benefit of local treatment in patients with post-stroke lower limb spasticity for whom pain relief is a primary therapeutic goal (a Lay Abstract has been provided as Appendix A).

Aplicación clinicorradiológica del uso de la tomografía computarizada craneal de tecnología espectral en el manejo del ictus isquémico agudo tras trombectomía mecánica / Clinicoradiological application of the use of spectral cranial computed tomography in the management of acute ischemic stroke after mechanical thrombectomy

Introducción El ictus isquémico agudo es una de las principales causas globales de morbimortalidad. La trombectomía mecánica ha mejorado el pronóstico funcional de esta patología; sin embargo, la transformación hemorrágica es una complicación frecuente. La tomografía computarizada (TC) de tecnología espectral, como prueba de neuroimagen de control, diferencia la extravasación de contraste de la transformación hemorrágica gracias al diferente comportamiento de los materiales a la energía dual, y esta distinción es de utilidad en su manejo clinicoterapéutico. Material y métodos. Estudio unicéntrico, observacional y retrospectivo, en el cual se investigó, mediante el acceso a una base de datos disociada y a la historia clínica, la presencia de una serie de variables clínicas, radiológicas y terapéuticas en los pacientes con ictus isquémico agudo que fueron tratados con trombectomía mecánica en nuestro hospital entre julio de 2022 y marzo de 2023.ResultadosDe los 155 pacientes incluidos, se realizó una TC craneal espectral en 63 y convencional en 75. En el grupo de TC espectral se detectaron 21 imágenes hiperdensas y en el grupo de TC convencional fueron 28. En el 42,8% de los casos en los que se detectó una hiperdensidad en el grupo de TC convencional no se pudo distinguir entre extravasación de contraste y transformación hemorrágica, en comparación con el 4,8% del grupo de TC espectral (p < 0,001).ConclusionesLa TC espectral confiere una gran confianza diagnóstica al radiólogo para establecer el tipo de hiperdensidad detectada y, por ello, proporciona también una gran confianza terapéutica al neurólogo para reiniciar precozmente la anticoagulación. (AU)

Introduction. Acute ischemic stroke is one of the leading global causes of morbidity and mortality. Mechanical thrombectomy has improved the functional prognosis of this condition; however, hemorrhagic transformation is a common complication. Spectral computed tomography (CT) imaging, as a neuroimaging control test, distinguishes contrast extravasation from hemorrhagic transformation due to the differential behavior of materials at dual energy levels. This distinction is valuable in its clinical therapeutic management.Material and methods. A single-center, observational, retrospective study was conducted in which the presence of various clinical, radiological, and therapeutic variables in patients with acute ischemic stroke treated with mechanical thrombectomy at our hospital between July 2022 and March 2023 was investigated using access to a dissociated database and medical records.Results. Out of 155 included patients, spectral cranial CT was performed in 63, and conventional cranial CT in 75. In the spectral CT group, 21 hyperdense images were detected, compared to 28 in the conventional CT group. In 42.8% of cases where hyperdensity was detected in the conventional CT group, it was not possible to distinguish between contrast extravasation and hemorrhagic transformation, in contrast to the 4.8% in the spectral CT group (p < 0.001).Conclusions. Spectral CT provides high diagnostic confidence to the radiologist in identifying the type of detected hyperdensity, thereby offering significant therapeutic confidence to the neurologist in early resuming anticoagulation therapy. (AU)

Prognostic performance of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for mortality in patients with acute stroke / Rendimiento pronóstico de la razón neutrófilos/linfocitos y la razón plaquetas/linfocitos para la mortalidad en pacientes con ictus agudo

Objective: To evaluate the prognostic performance of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) for mortality in patients with acute stroke treated at a Peruvian hospital. Design: Retrospective cohort study. Setting: Tertiary care hospital. Patients: Patients aged ≥18 years with a diagnosis of acute stroke and admitted to the hospital from May 2019 to June 2021. Interventions: None. Main variables of interests: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mortality. Results: A total of 165 patients were included. The mean age was 66.1±14.2 years, and 59.4% were male. Only NLR had a performance superior to 0.7 (AUC: 0.75; 95%CI: 0.65–0.85), and its elevated levels were associated with an increased risk of mortality (aRR: 3.66; 95%CI: 1.77–8.85) after adjusting for confounders. Conclusion: The neutrophil-to-lymphocyte ratio has an acceptable prognostic performance for mortality in patients with acute stroke. Its use may be considered to stratify patients’ risk and to consider timely alternative care and management.(AU)

Objetivo: Evaluar el desempeño pronóstico de la relación neutrófilos-linfocitos (NLR) y la relación plaquetas-linfocitos (PLR) para la mortalidad en pacientes con stroke agudo tratados en un hospital peruano. Diseño: Estudio de cohorte retrospectivo. Ámbito: Hospital de atención terciaria. Participantes: Pacientes ≥18 años con diagnóstico de stroke agudo e ingresados en el hospital entre mayo de 2019 y junio de 2021. Intervenciones: Ninguna. Variables de interés principales: Razón neutrófilos/linfocitos, razón plaquetas/linfocitos y mortalidad. Resultados: Se incluyeron un total de 165 pacientes. La edad media fue de 66,1±14,2 años, y el 59,4% eran varones. Sólo el NLR tuvo un rendimiento superior a 0,7 (AUC: 0,75; IC95%: 0,65-0,85), y sus niveles elevados se asociaron con un mayor riesgo de mortalidad (RRa: 3,66; IC95%: 1,77-8,85) tras ajustar por factores de confusión. Conclusiones: La razón neutrófilos/linfocitos tiene un rendimiento pronóstico aceptable para la mortalidad en pacientes con stroke. Su uso puede ser considerado para estratificar el riesgo de los pacientes y considerar oportunamente cuidados y manejo alternativos.(AU)

Prognostic performance of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for mortality in patients with acute stroke.

OBJECTIVE: To evaluate the prognostic performance of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) for mortality in patients with acute stroke treated at a Peruvian hospital. DESIGN: Retrospective cohort study. SETTING: Tertiary care hospital. PATIENTS: Patients aged ≥18 years with a diagnosis of acute stroke and admitted to the hospital from May 2019 to June 2021. INTERVENTIONS: None. MAIN VARIABLES OF INTERESTS: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mortality. RESULTS: A total of 165 patients were included. The mean age was 66.1±14.2 years, and 59.4% were male. Only NLR had a performance superior to 0.7 (AUC: 0.75; 95%CI: 0.65-0.85), and its elevated levels were associated with an increased risk of mortality (aRR: 3.66; 95%CI: 1.77-8.85) after adjusting for confounders. CONCLUSION: The neutrophil-to-lymphocyte ratio has an acceptable prognostic performance for mortality in patients with acute stroke. Its use may be considered to stratify patients' risk and to consider timely alternative care and management.

Diferencias cliniconeurológicas en pacientes con enfermedad cerebrovascular isquémica de edades menores y mayores de 65 años

Introducción: La enfermedad cerebrovascular isquémica tiene una alta frecuencia debida, fundamentalmente, al envejecimiento poblacional. Objetivo: Comparar las características clínicas de pacientes con enfermedad cerebrovascular isquémica de dos grupos etarios. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo en 36 pacientes con enfermedad cerebrovascular isquémica correspondientes a dos grupos etarios (65 y menos años y mayores de 65), quienes fueron atendidos en el Instituto de Neurología y Neurocirugía, La Habana, de enero a diciembre del 2017. Al respecto, se analizaron variables demográficas y clínicas y se aplicaron diferentes pruebas estadísticas para comparar. Resultados: Se obtuvo un aumento significativo de pacientes hipertensos (88,9 %) en el grupo etario mayor de 65 años. La mediana de la escala de ictus del National Institute of Health fue superior en estos pacientes (mediana [10-90 percentil]: 9,5 (4-19]). Hubo incremento estadístico de los mayores de 65 años con parálisis parcial de la mirada y ataxia; en tanto, la monoparesia y la extinción visual predominaron en los de 65 y menos años. Dicha escala mostró un aumento estadístico en el ictus aterotrombótico y cardioembólico en comparación con otras causas en ambos grupos. Los pacientes mayores de 65 años con solo un factor de riesgo o ninguno y los que eran hipertensos tuvieron mayor puntuación de la escala. Conclusiones: El grado de afectación neurológica fue superior en los mayores de 65 años que tenían un factor de riesgo y en aquellos con hipertensión arterial. Puede sugerirse que los mecanismos moleculares y fisiopatológicos de estos pacientes varían según la edad.

Introduction: The ischemic cerebrovascular disease has a high frequency due to the population aging mainly. Objective: To compare clinical characteristics of patients with ischemic cerebrovascular of two age groups. Methods: A descriptive, cross-sectional, retrospective study was carried out in the Neurology and Neurosurgery Institute in Havana, from January to December, 2017 in patients with ischemic cerebrovascular disease; 36 individuals of both age groups. In this regard, demographic variables, risk factors, clinical manifestations, coma scale and neurological deficiency, etiology and localization of the ischemic ictus were analyzed. Results: The 65 years group had a significant increase of hypertensive patients (88.9%). The average of the National Institute of Health stroke scale was superior in these patients (median [10-90 percentile]: 9.5 [4-19]). There was statistical increment of over 65 years patients with partial paralysis of the look and ataxia, but monoparesis and visual extinction in the age under 65 years. Such a scale had a statistical increase in the atherothrombotic and cardioembolic ictus in comparison with other etiologies in both patient groups. The over 65 years patients with just one risk factor or and those with hypertension had a higher punctuation of the scale. Conclusions: The degree of neurological affectation was higher in over 65 years patients that had a risk factor and in those with hypertension. As a result it could be suggested that the molecular and pathophysiolologic mechanisms of these patients vary with the age.

Proteína-C reactiva de alta sensibilidad y homocisteína en pacientes con enfermedad cerebrovascular isquémica

Fundamento: la proteína C reactiva de alta sensibilidad (PCR-as) y la homocisteína (Hci) parecen relacionarse con la enfermedad cerebrovascular isquémica, pero sus hallazgos sobre el riesgo y pronóstico de esta enfermedad resultan controversiales y no concluyentes. Objetivo caracterizar la proteína C reactiva de alta sensibilidad y homocisteína en pacientes con enfermedad cerebrovascular isquémica. Métodos: se realizó un estudio descriptivo y retrospectivo de corte transversal en pacientes con enfermedad cerebrovascular isquémica, ingresados en el Servicio de Ictus del Instituto de Neurología y Neurocirugía entre 2016 y 2019. Se recogieron variables demográficas, manifestaciones clínicas, tiempo de evolución, etiología y localización del infarto y factores riesgo. Se cuantificaron la PCR-as (riesgo cardiovascular) y la Hci. Resultados las medias de PCR-as (7,0±8,3 mg/L) y Hci (17,1±7,3 µM) fueron elevadas. El riesgo cardiovascular moderado y alto se presentaron en igual proporción (46,8 %). Hubo diferencias estadísticas en la relación entre el riesgo cardiovascular y la edad (p=0,00); pero ni el tiempo de evolución ni los factores de riesgo de la enfermedad mostraron este comportamiento. Los pacientes con riesgo cardiovascular alto (PCR-as >3 mg/L) y elevada Hci (>15 (M) exhibieron mayores frecuencias de etiologías aterotrombótica o cardioembólica. Conclusiones el riesgo cardiovascular aumenta en la medida que se incrementa la edad de pacientes con enfermedad cerebrovascular isquémica. Las características demográficas, clínicas y neurológicas no mostraron relación con el alto riesgo cardiovascular y los valores elevados de Hci, aunque se encontró una tendencia asociativa de la etiología aterotrombótica con el incremento de PCR-as y Hci.

Foundation: High-sensitivity C-reactive protein and homocysteine seem to be related to ischemic cerebrovascular disease, but their findings on the risk and prognosis of this disease are controversial and inconclusive. Objective: to characterize high sensitivity C-reactive protein and homocysteine in patients with ischemic cerebrovascular disease. Methods: a descriptive and retrospective cross-sectional study was carried out in patients with ischemic cerebrovascular disease, admitted to the Stroke Service of the Neurology and Neurosurgery Institute between 2016 and 2019. Demographic variables, clinical manifestations, time of evolution, etiology and infarction location, risk factors. High-sensitivity C-reactive protein (cardiovascular risk) and homocysteine were quantified. Results: the means of C-reactive protein (7.0±8.3 mg/L) and homocysteine (17.1±7.3 µM) were high. Moderate and high cardiovascular risk occurred in equal proportions (46.8%). There were statistical differences in the relationship between cardiovascular risk and age (p=0.00); but neither the time of evolution nor the risk factors of the disease showed this behavior. Patients with high cardiovascular risk (hs-CRP >3 mg/L) and high homocysteine (>15 (M), exhibited higher frequencies of atherothrombotic or cardioembolic etiologies. Conclusions: cardiovascular risk increases as the age of patients with ischemic cerebrovascular disease increases. Demographic, clinical and neurological characteristics did not show a relationship with high cardiovascular risk and high homocysteine values, although an associative trend of atherothrombotic etiology was found with increased high-sensitivity C-reactive protein and homocysteine.

Assessing the individual risk of stroke in caregivers of patients with stroke / Evaluación del riesgo individual de enfermedad cerebrovascular en cuidadores de pacientes con enfermedad cerebrovascular

Abstract Background Genetic factors influence the risk of developing stroke. Still, it is unclear whether this risk is intrinsically high in certain people or if nongenetic factors explain it entirely. Objective To compare the risk of stroke in kin and nonkin caregivers. Methods In a cross-sectional study using the Stroke Riskometer app (AUT Ventures Limited, Auckland, AUK, New Zealand), we determined the 5- and 10-year stroke risk (SR) among caregivers of stroke inpatients. The degree of kinship was rated with a score ranging from 0 to 50 points. Results We studied 278 caregivers (69.4% of them female) with a mean age of 47.5 ± 14.2 years. Kin caregivers represented 70.1% of the sample, and 49.6% of them were offspring. The median SR at 5 years was of 2.1 (range: 0.35-17.3) versus 1.73 (range: 0.04-29.9), and of 4.0 (range: 0.45-38.6) versus 2.94 (range: 0.05-59.35) at 10 years for the nonkin and kin caregivers respectively. In linear logistic regression controlled for the age of the caregivers, adding the kinship score did not increase the overall variability of the model for the risk at 5 years (R2= 0.271; p= 0.858) nor the risk at 10 years (R2= 0.376; p= 0.78). Conclusion Caregivers of stroke patients carry a high SR regardless of their degree of kinship.

Resumen Antecedentes Los factores genéticos probablemente influyen en el riesgo de desarrollar enfermedad vascular cerebral (EVC), pero no está claro si el riesgo es intrínsecamente alto o si es totalmente explicado por factores modificables. Objetivo Comparar el riesgo de EVC (REVC) en cuidadores pertenecientes y no pertenecientes a la misma familia de pacientes con EVC. Métodos En un estudio transversal que utilizó la aplicación Stroke Riskometer (AUT Ventures Limited, Auckland, AUK, Nueva Zelanda), determinamos el REVC a 5 y 10 años en cuidadores de pacientes hospitalizados por EVC. El grado de parentesco se graduó con un puntaje de 0 a 50 dependiendo de su relación familiar con el paciente. Resultados Estudiamos a 278 cuidadores (69.4% de ellos mujeres) con edad media de 47.5 ± 14.2 años. Los cuidadores familiares representaron el 70.1% de la muestra, siendo el 49.6% hijos. Las medianas de REVC a 5 años fueron de 2.1 (rango: 0.35-17.3) versus 1.73 (rango: 0.04-29.9), y de 4.0 (rango: 0.45-38.6) versus 2.94 (rango: 0.05-59.35) a 10 años para el grupo de cuidadores familiares y no familiares, respectivamente. En una regresión logística lineal contralando para la edad de los cuidadores, la adición del puntaje de parentesco no incrementó la variabilidad general del modelo para el riesgo a 5 años (R2= 0.271; p= 0.858) ni para el riesgo a 10 años (R2= 0.376; p= 0.78). Conclusión Los cuidadores de pacientes con EVC tienen un REVC alto, independientemente de su grado de parentesco.

Infarto cerebral en pacientes jóvenes: características clínicas y evolución en una cohorte Argentina / Cerebral infarction in young patients: clinical character istics and evolution in an Argentine cohort

Resumen Introducción : El ataque cerebral (ACV) en adultos jó venes comprende aproximadamente el 10% de todos los eventos cerebrovasculares. La información disponible so bre la recurrencia de un nuevo evento en esta población y particularmente en Latinoamérica es limitada. Nuestro objetivo fue examinar la presencia de recurrencia de ACV luego de haber presentado un infarto cerebral. Métodos : Se realizó un estudio de cohorte retros pectivo, incluyendo pacientes con infartos cerebrales arteriales en edades comprendidas entre 18 y 55 años, entre enero de 2005 a mayo de 2020. El resultado principal fue la recurrencia de un ataque cerebro vascular. Resultados: Se incluyeron 138 pacientes durante una mediana de seguimiento de 24 meses. El 52.2% (n = 72) de sexo masculino y el 73,4% (n = 94) tuvo un NIHSS inicial menor a 4. El 38% (n = 52) tenía antecedentes de hipertensión arterial y 13,1% (n = 18) antecedentes de ACV / ataque isquémico transitorio (AIT) previo. El 13% (n = 18) presento recurrencia durante su seguimiento. Discusión : La recurrencia de los eventos neurovas culares ocurren predominantemente en pacientes con antecedentes de ACV/AIT previo, probablemente secun dario a enfermedades de difícil diagnóstico.

Abstract Introduction : Stroke (CVA) in young adults comprises approximately 10% of all cerebrovascular events. The information available on the recurrence of a new event in this population and particularly in Latin America is limited. Our objective was to examine the presence of stroke recurrence after having presented a stroke. Methods : A retrospective cohort study was carried out, including patients with arterial cerebral infarctions between the ages of 18 and 55, between January 2005 and May 2020. The main outcome was the recurrence of a cerebrovascular attack. Results : 138 patients were included during a median follow-up of 24 months. The 52.2% (n = 72) were male patients and 73.4% (n = 94) had an initial NIHSS score of less than 4. The 38% (n = 52) had a history of arterial hypertension and 13, 1% (n = 18) history of previous stroke / TIA. 13% (n = 18) presented recurrence during their follow-up. Discussion : The recurrence of neurovascular events occurs predominantly in patients with a history of previ ous stroke/TIA, probably secondary to diseases that are difficult to diagnose.

Home-based educational interventions for family caregivers of older adults after stroke: a scoping review / Intervenções educativas domiciliares para cuidadores familiares de idosos pós-AVC: revisão de escopo / Intervenciones educativas domiciliarias para cuidadores familiaresde adultos mayores después de un accidente cerebrovascular:revisión de alcance

ABSTRACT Objective: To map home-based educational interventions for family caregivers of older adults after stroke. Method: Scoping review based on the JBI methodology, carried out on May 23, 2023. The Rayyan application and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were used. Results: Of the 1,705 studies, nine published from 2006 to 2020 were included: 44% of interventions were theoretical-practical educational; 77.7% were randomized clinical trials; and the "in-person" intervention (56%) was the most common, carried out by nurses in 88.9% of cases. Three to 15 42-minute sessions were carried out. The educational contents were organized into ten categories, divided into education aimed at caring for older adults and self-care for caregivers. Conclusion: Identified educational interventions strengthen participants' knowledge and skills in areas such as education, care, communication, self-management, rehabilitation and nutrition as well as self-care to safely assist older adults in their activities of daily living.

RESUMO Objetivo: Mapear intervenções educativas domiciliares para cuidadores familiares de idosos pós-AVC. Método: Revisão de escopo baseada na metodologia JBI, realizada em 23 de maio de 2023. Foram utilizados o aplicativo Rayyan e Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Resultados: Dos 1.705 estudos, foram incluídos nove publicados de 2006 a 2020: 44% das intervenções foram educativas teórico-práticas; 77,7% eram ensaios clínicos randomizados; e a intervenção "presencial" (56%) foi a mais comum, realizada por enfermeiros em 88,9% dos casos. Foram realizadas de três a 15 sessões de 42 minutos. Os conteúdos educativos foram organizados em dez categorias, divididas em educação voltada ao cuidado do idoso e autocuidado ao cuidador. Conclusão: As intervenções educativas identificadas fortalecem os conhecimentos e habilidades dos participantes em áreas como educação, cuidado, comunicação, autogestão, reabilitação e nutrição, bem como autocuidado para auxiliar com segurança os idosos em suas atividades diárias.

RESUMEN Objetivo: Mapear las intervenciones educativas domiciliarias para cuidadores familiares de adultos mayores después de un accidente cerebrovascular. Método: Revisión de alcance basada en la metodología del JBI realizada el 23 de mayo de 2023. Se utilizó el aplicativo Rayyan y Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Resultados: De 1.705 estudios, se incluyeron nueve publicados del 2006 al 2020: el 44% de las intervenciones fueron educativas teórico-prácticas; el 77,7% fueron ensayos clínicos aleatorizados; y la intervención "cara a cara" (56%) fue el más común, entregadas por enfermeras en 88,9% de casos. Se realizaron de tres a 15 sesiones de 42 minutos. Los contenidos educativos se organizaron en diez categorías divididas en educación dirigida al cuidado del adulto mayor y al autocuidado del cuidador. Conclusión: Las intervenciones educativas identificadas fortalecen los conocimientos y habilidades de los participantes en áreas como la educación, cuidado, comunicación, autogestión, rehabilitación y nutrición, así como al autocuidado para asistir de forma segura al adulto mayor en sus actividades cotidianas.

Comparación entre tenecteplase y alteplase en la trombolisis intravenosa del ataque cerebrovascular isquémico

Introducción: la trombolisis intravenosa es parte fundamental del tratamiento agudo de los pacientes que sufren un ataque cerebrovascular (ACV) isquémico. Existe un interés creciente en la utilización de tenecteplase como alternativa trombolítica a alteplase. El objetivo del presente trabajo es comparar la efectividad clínica de tenecteplase respecto a alteplase en la trombolisis intravenosa del ACV isquémico. Método: estudio de cohorte, bispectivo y unicéntrico, de todos los pacientes ingresados con ACV isquémico y que recibieron trombolíticos intravenosos, desde 2019 a 2022. Se compararon prospectivamente los pacientes tratados con tenecteplase con aquellos tratados con alteplase como control histórico. Se realizó test de chi cuadrado o exacto de Fisher para la asociación de variables categóricas y prueba de Wilcoxon para la comparación de medianas. Se consideró significativo un valor p menor de 0,05. Resultados: se incluyeron 69 pacientes (33 recibieron alteplase y 36 tenecteplase). La mediana de la escala de NIHSS fue de 11 (RIC 8-18) y del tiempo inicio de síntomas-aguja de 160 minutos (RIC 120-208). No se hallaron diferencias estadísticamente significatvas entre los puntajes de las escalas de coma de Glasgow y NIHSS al egreso hospitalario, así como en la escala de Rankin modificada (mRS) 0-2 y mortalidad a los seis meses, entre los dos grupos de pacientes. Tampoco hubo diferencias en las complicaciones hemorrágicas intracraneanas entre ambos grupos (13,9% para tenecteplase y 12,1% para alteplase). Conclusiones: se presenta el primer estudio acerca del tema en nuestro medio. En concordancia con los recientes ensayos internacionales, el presente trabajo no mostró diferencias significativas en los resultados clínicos de los pacientes tratados con tenecteplase o alteplase. El tenecteplase podría ser una alternativa razonable a alteplase como terapia trombolítica en el ACV isquémico, con una buena relación costo-beneficio y forma de implementación más sencilla. Se necesitan estudios aleatorizados y con un mayor número de pacientes.

Introduction: intravenous thrombolysis is a key part of the acute treatment of patients with ischemic stroke. There is a growing interest in the use of tenecteplase as a thrombolytic alternative to alteplase. The aim of this study is to compare the clinical effectiveness of tenecteplase versus alteplase in intravenous thrombolysis for ischemic stroke. Method: a single-center, bispective cohort study of all patients admitted with ischemic stroke who received intravenous thrombolytics from 2019 to 2022. Patients treated with tenecteplase were prospectively compared with those treated with alteplase as a historical control. Chi-square or Fisher's exact test was used for the association of categorical variables, and the Wilcoxon test was used for median comparison A p-value of less than 0.05 was considered significant. Results: a total of 69 patients were included in the study (33 received alteplase and 36 received tenecteplase). The median NIHSS scale score was 11 (IQR 8-18), and the median time from symptom onset to needle was 160 minutes (IQR 120-208). No statistically significant differences were found between Glasgow Coma Scale and NIHSS scores at hospital discharge, as well as in modified Rankin Scale (mRS) 0-2 and mortality at 6 months, between the two groups of patients. There were also no differences in intracranial hemorrhagic complications between both groups (13.9% for tenecteplase and 12.1% for alteplase). Conclusions: This is the first study on the topic in our setting. In line with recent international trials, our study did not show significant differences in clinical outcomes of patients treated with tenecteplase or alteplase. Tenecteplase could be a reasonable alternative to alteplase as thrombolytic therapy in ischemic stroke, with a good cost-benefit ratio and simpler implementation. Randomized studies with a larger number of patients are needed.

Introdução: A trombólise intravenosa é uma parte essencial do tratamento agudo de pacientes que sofrem um acidente vascular cerebral isquêmico. Há um interesse crescente no uso da tenecteplase como uma alternativa trombolítica à alteplase. O objetivo deste estudo foi comparar a eficácia clínica da tenecteplase com a alteplase na trombólise intravenosa do AVC isquêmico. Métodos: estudo de coorte, bispectivo, em um único centro, de todos os pacientes admitidos com AVC isquêmico que receberam trombolíticos intravenosos de 2019 a 2022. Os pacientes tratados com tenecteplase foram comparados prospectivamente com aqueles tratados com alteplase como um controle histórico. O teste de qui-quadrado ou exato de Fisher foi realizado para a associação de variáveis categóricas e o teste de Wilcoxon para a comparação de medianas. Um valor de p inferior a 0,05 foi considerado significativo. Resultados: Foram incluídos 69 pacientes (33 receberam alteplase e 36 tenecteplase). A mediana do escore da escala NHISS foi de 11 (RIC 8-18) e a mediana do tempo de início dos sintomas foi de 160 minutos (RIC 120-208). Não foram encontradas diferenças estatisticamente significativas entre os escores de coma de Glasgow e NIHSS na alta hospitalar, bem como na Escala de Rankin modificada (MRS) 0-2 e na mortalidade em 6 meses, entre os dois grupos de pacientes. Também não houve diferenças nas complicações hemorrágicas intracranianas entre os dois grupos (13,9% para tenecteplase e 12,1% para alteplase). Conclusões: Este é o primeiro estudo sobre o assunto em nosso meio. De acordo com estudos internacionais recentes, nosso estudo não mostrou diferenças significativas nos resultados clínicos em pacientes tratados com tenecteplase ou alteplase. A tenecteplase poderia ser uma alternativa razoável à alteplase como terapia trombolítica no AVC isquêmico, com uma boa relação custo-benefício e implementação mais fácil. São necessários estudos randomizados com um número maior de pacientes.

Fatores associados a incapacidade funcional após acidente vascular cerebral isquêmico / Factores asociados a incapacidad funcional después de accidente cerebrovascular isquémico / Factors associated with functional disability after ischemic stroke

Resumo Objetivo Avaliar o nível de incapacidade funcional e identificar os fatores associados em pessoas após Acidente Vascular Cerebral Isquêmico. Métodos Coorte prospectiva, realizada em hospital de referência em neurologia, com 224 pessoas com acidente vascular cerebral isquêmico. A coleta de dados ocorreu entre março a outubro de 2019. Os participantes foram acompanhados durante a internação, quando as variáveis sociodemográficas e clínicas foram levantadas empregando-se instrumentos específicos e contatados após 90 dias, por ligação telefônica, para aplicação do Índice de Barthel modificado. Na análise, aplicou-se estatística descritiva e o teste Qui-quadrado de Pearson. Adotou-se significância estatística de 5%. Resultados A maioria apresentou algum grau de incapacidade funcional (58,5%), sendo que 29,5% apresentaram dependência moderada e 29,0% severa ou grave. As variáveis sexo feminino (p=0,011), tempo de chegada ao hospital de referência maior ou igual a 4,5h (p=0,017), Acidente vascular cerebral prévio (p=0,031), não ter realizado trombólise (p=0,023), ter hipertensão arterial (p=0,032) e maior gravidade estimada pela National Institute of Health Stroke Scale (p=0,000) foram associadas a maior nível de incapacidade. Conclusão Predominou a dependência de moderada a grave. A gravidade do evento, evento prévio, hipertensão, não submissão à trombólise, retardo à chegada ao hospital e sexo feminino foram associados a maior nível de incapacidade funcional.

Resumen Objetivo Evaluar el nivel de incapacidad funcional e identificar los factores asociados en las personas después de un accidente cerebrovascular isquémico. Métodos Cohorte prospectiva, realizada en un hospital de referencia en neurología, con 224 personas con accidente cerebrovascular isquémico. La recopilación de datos se llevó a cabo entre marzo y octubre de 2019. Se acompañó a los participantes durante la internación, momento en que se recopilaron las variables sociodemográficas y clínicas mediante la utilización de instrumentos específicos, y se los contactó 90 días después, por teléfono, para aplicar el Índice de Barthel modificado. En el análisis se aplicó estadística descriptiva y la prueba χ2 de Pearson. Se adoptó significación estadística de 5 %. Resultados La mayoría presentó algún nivel de incapacidad funcional (58,5 %), de los cuales el 29,5 % presentó dependencia moderada y el 29,0 % dependencia severa o grave. Las siguientes variables fueron asociadas a un mayor nivel de incapacidad: sexo femenino (p=0,011), tiempo de llegada al hospital de referencia mayor o igual a 4,5 h (p=0,017), accidente cerebrovascular previo (p=0,031), no haber realizado trombólisis (p=0,023), tener hipertensión arterial (p=0,032) y mayor gravedad estimada por la National Institute of Health Stroke Scale (p=0,000). Conclusión Predominó la dependencia de moderada a grave. La gravedad del evento, evento previo, hipertensión, no realización de trombólisis, retraso de la llegada al hospital y sexo femenino fueron las variables asociadas a un mayor nivel de incapacidad funcional.

Abstract Objective To assess the functional disability level and identify associated factors in people after Ischemic Cerebral Vascular Accident. Methods A prospective cohort, carried out in a reference hospital in neurology with 224 people with ischemic stroke. Data collection took place between March and October 2019. Participants were followed up during hospitalization, when sociodemographic and clinical variables were collected using specific instruments and contacted after 90 days, by telephone call, to apply the Modified Barthel Index. In the analysis, descriptive statistics and Pearson's chi-square test were applied. Statistical significance of 5% was adopted. Results Most had some degree of functional disability (58.5%), with 29.5% having moderate dependence and 29.0% having severe dependence. The variables being female (p=0.011), time of arrival at the reference hospital greater than or equal to 4.5 hours (p=0.017), previous stroke (p=0.031), not having undergone thrombolysis (p=0.023), having high blood pressure (p=0.032) and greater severity estimated by the National Institute of Health Stroke Scale (p=0.000) were associated with a higher disability level. Conclusion Moderate to severe dependence predominated. The severity of the event, previous event, hypertension, non-submission to thrombolysis, delay in arriving at the hospital and female gender were associated with a higher functional disability level.

Radiomic-based nonlinear supervised learning classifiers on non-contrast CT to predict functional prognosis in patients with spontaneous intracerebral hematoma.

PURPOSE: To evaluate if nonlinear supervised learning classifiers based on non-contrast CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma. METHODS: Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE > 18 years and with TCCSC performed within the first 24 h of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS 0-2) and poor prognosis (mRS 3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30% respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. RESULTS: 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC 0.798, 0.752 and 0.742 respectively). The predictions of these models, in the validation cohort, had a sensitivity of 0.897 (0.778-1;95%CI), with a false-negative rate of 0% for predicting poor functional prognosis at discharge. CONCLUSION: The use of radiomics-based nonlinear supervised learning classifiers are a promising diagnostic tool for predicting functional outcome at discharge in HIE patients, with a low false negative rate, although larger and balanced samples are still needed to develop and improve their performance.

Corrélation of EQ-5D and mRS in ischémie stroke: a multicenter cross-sectional study

Introduction: Assessing Health-Related Quality of Life (HRQOL), in addition to evaluating functional status in stroke patients could complement clinician practice. Objective: To assess HRQOL, applying EuroQol-5-dimensions (EQ-5D) in Colombian patients with stroke and correlating its results with the modified Rankin Scale (mRS). Methods: Analytical cross-sectional study in a cohort of ischemic stroke patients in Colombia at three months as a median follow-up (Q1: 1- Q3:3) after their event. We correlated EQ-5D domains, EQ-5D index, mRS with EQ-5D VAS score. We generated a simple linear regression robust model to evaluate the variability between using r2. Results: A total of 91 patients completed the EQ-5D questionnaire, with a mean age of 71.2 years; 59.3% were male. We identified an inverse correlation between EQ-5D VAS and EQ-5D domains with the highest for mobility (rs = -0.69) and the lowest for pain/discomfort (rs -0.52, p<0.001). The r2 ranged from 0.25 (pain/discomfort) to 0.47 (EQ-5D index). Patients with mRS ≥ 3 significantly reduced their EQ-5D VAS score by 25.64 points (95% CI -33.04, -18.24). Variability in EQ-5D VAS scores occurred by EQ-5D index (47%) and by mRS (34%). Conclusions: The correlation between EQ-5D and mRS was favorable. Although EQ-5D and mRS evaluated different spheres on stroke patients, applying the EQ-5D instrument in real-world clinical settings might contribute multidimensional information on how life is affected after a stroke. This kind of information serves to orientate rehabilitation strategies on specific domains such as depression, self-care, anxiety, and pain. This is especially relevant for patients with disabilities (mRS ≥ 3).

Introducción: La evaluación de la Calidad de Vida Relacionada con la Salud (CVRS) y el estado funcional de pacientes con Ataque Cerebrovascular (ACV), podría complementar la práctica clínica. Objetivo: Evaluar la CVRS, aplicando EuroQol-5-dimensiones (EQ-5D) en pacientes colombianos con ACV y correlacionar sus resultados con la escala de Rankin Modificada (mRS). Métodos: Estudio de corte transversal analítico anidado a una cohorte de pacientes con ACV isquémico en Colombia con mediana de 3 meses de seguimiento (Q1: 1- Q3:3) post-ictus. Correlacionamos los dominios del EQ-5D, índice EQ-5D y mRS con la puntuación de EQ-5D VAS. Generamos un modelo de regresión lineal simple para evaluar la variabilidad usando r2. Resultados: Un total de 91 pacientes con una edad media 71,2 años; 59,3 % hombres. Se encontró correlación inversa entre los dominios EQ-5D, mayor para movilidad (rs = -0,69) y menor para dolor/malestar (rs -0,52, p < 0,001). El r2 osciló entre 0,25 (dolor/malestar) y 0,47 (índice EQ-5D). Los pacientes con mRS ≥ 3 redujeron significativamente su puntuación EQ-5D VAS en 25,64 puntos (IC 95%: -33,04; -18,24). La variabilidad en las puntuaciones EQ-5D VAS se produjo por el índice EQ-5D (47 %) y por mRS (34 %). Conclusiones: La correlación entre EQ-5D y mRS fue favorable. Aunque EQ-5D y mRS evalúan diferentes esferas en los pacientes con ACV, la aplicación del EQ-5D en podría aportar información multidimensional sobre cómo se afecta la vida después de un ictus, así como orientar estrategias de rehabilitación en esferas como depresión, autocuidado, ansiedad y dolor; especialmente relevante para pacientes con discapacidades (mRS ≥ 3).

Aplicaciones móviles para el autoaprendizaje en el cuidador del adulto mayor con accidente cerebrovascular: Revisión integradora / Mobile applications for self-learning in the caregiver of the elderly with stroke: integrative review

Resumen Objetivo: Analizar la evidencia disponible en la literatura sobre intervenciones con aplicaciones móviles para favorecer el autoaprendizaje de atención y asistencia en el cuidador primario del adulto mayor, con secuelas físicas de accidente cerebrovascular. Material y Métodos: Revisión integradora de la literatura publicada entre Enero de 2018 y Junio 2022 en las bases de datos CINAHL, EMBASE, LILACS, PubMed, Scopus y EBSCOhost. Los datos obtenidos se analizaron en cuatro etapas: identificación del tema, muestreo, selección y categorización de estudios y análisis, evaluación e interpretación de resultados bajo el método CASPe. Resultados: 2 fueron cualitativos y 1 cuantitativo; las intervenciones digitales fueron: mHealth, Movies4Stroke y MoCaB utilizadas para el autoaprendizaje y asistencia en el cuidador primario en las dimensiones control de la presión arterial, glucosa, colesterol y adherencia farmacológica. Las intervenciones educativas digitales aumentan el autoaprendizaje y facilita la atención en el cuidador del adulto mayor con secuelas físicas por accidente cerebrovascular. Conclusiones: Las intervenciones educativas digitales para el autoaprendizaje y asistencia en el cuidador primario desde la evidencia científica son mínimas. Es necesario diseñar intervenciones digitales accesibles, dinámicas y de fácil interacción para el autoaprendizaje en la generación de habilidades de cuidados en el encargado primario del adulto mayor con secuelas físicas post accidente cerebrovascular.

Abstract Objective: To analyze the evidence available in the literature on interventions with mobile applications to promote self-learning of care and assistance in the primary caregiver of the elderly with physical sequelae of stroke. Material and Methods: Integrative review of the literature published between January 2018 and June 2022 in the CINAHL, EMBASE, LILACS, PubMed, Scopus and EBSCOhost databases. The data obtained was analyzed in four stages: theme identification, sampling, selection and categorization of studies and analysis, evaluation and interpretation of results under the CASPe method. Results: 2 were qualitative and 1 quantitative; the digital interventions were: mHealth, Movies4Stroke and MoCaB used for self-learning and assistance in the primary caregiver in the dimensions of blood pressure control, glucose, cholesterol and pharmacological adherence. Digital educational interventions increase self-learning and facilitate care in the caregiver of the elderly with physical sequelae due to stroke. Conclusions: Digital educational interventions for self-learning and assistance in the primary caregiver from the scientific evidence are minimal. It is necessary to design accessible, dynamic and easy-to-interact digital interventions for self-learning in the generation of care skills in the primary caregiver of the elderly with post-stroke physical sequelae.

Incidencia, circunstancias y consecuencias de caídas en sujetos con accidente cerebrovascular: un año de seguimiento / Incidence, circumstances and consequences of falls in subjects with stroke: One year of follow-up

Introducción: Luego del accidente cerebrovascular (ACV), una de las complicaciones más frecuentes son las caídas, impactando negativamente en la rehabilitación. Objetivos: Estudiar la incidencia, las circunstancias y las consecuencias de las caídas en sujetos con ACV hasta 12meses de iniciado el tratamiento kinésico ambulatorio. Materiales y métodos: Diseño prospectivo, serie de casos. Muestreo consecutivo. Pacientes ingresados en el Hospital de Día entre junio de 2019 y mayo de 2020. Se incluyeron: adultos con diagnóstico de primer ACV supratentorial y puntuación ≥3 en la Functional Ambulatory Category. Criterios excluyentes: otra afección que afecte la locomoción. Variables principales: número de caídas, circunstancias y consecuencias. Se midieron las características clínico-demográficas y funcionales. Resultados: Un total de 21 sujetos incluidos; 13 sufrieron al menos una caída. Reportaron 41 caídas: 15 fueron hacia el lado más afectado, 35 en el interior del hogar, 28 sin el equipamiento indicado, en 29 ocasiones estaban solos durante el evento y en 2 situaciones se requirió asistencia médica. Hubo diferencias estadísticamente significativas (p<0,05) en el desempeño funcional (equilibrio, velocidad de marcha) entre los que se cayeron con respecto a los que no. No se hallaron diferencias significativas entre la resistencia de la marcha y las caídas. Conclusión: Más de la mitad sufrieron caídas, estando solos, hacia el lado más débil y sin el equipamiento indicado. Con esta información se podría disminuir la incidencia desarrollando medidas preventivas.(AU)

Introduction: Falls are among the most frequent complications following stroke (CVA), and have a negative impact on rehabilitation. Objectives: To study the incidence, circumstances, and consequences of falls in stroke patients up to 12months after starting outpatient kinetic treatment. Materials and methods: Prospective design, case series. Consecutive sampling. Patients admitted to the day hospital between June 2019 and May 2020. Included: adults with a diagnosis of first supratentorial stroke and functional ambulatory category score ≥3. Exclusion criteria: other condition affecting locomotion. Main variables: number of falls, circumstances, and consequences. Clinical, demographic, and functional characteristics were measured. Results: Twenty-one subjects were included, 13 suffered at least one fall. The subjects reported 41 falls: 15 were to the most affected side, 35 inside the home, 28 without the indicated equipment, they were alone when the event occurred on 29 occasions, and in two situations medical assistance was required. There were statistically significant differences (P<.05) in functional performance (balance, gait velocity) between those who fell and those who did not. No significant differences were found between gait endurance and falls. Conclusion: More than half suffered a fall, alone, to the weaker side, and without the appropriate equipment. With this information the incidence could be reduced by preventive measures.(AU)

Quality of life in caregivers of aged stroke survivors in southern Brazil: Arandomized clinical trial / Qualidade de vida de cuidadores de idosos sobreviventes de AVC no sul do Brasil: Ensaio clínico randomizado / Calidad de vida en cuidadores de adultos mayores sobrevivientes de accidentes cerebrovasculares en el sur de Brasil: Ensayo clínico aleatorizado

Abstract Objective: to evaluate the effect of nursing home care interventions on the quality of life in family caregivers of aged stroke survivors. Method: a Randomized Clinical Trial, blinded for outcome evaluation. Forty-eighty family caregivers of aged stroke survivors participated in the study. The Intervention Group received three home visits by nurses one month after hospital discharge to provide stroke-related education (i.e., how to access health services and perform care activities) and emotional support. The Control Group received the usual guidance from the health services. Quality of life was assessed using the World Health Organization Quality of Life Assessment (WHOQOL-BREF) instrument and the Old Module(WHOQOL-OLD) 1 week, 2 months, and 1 year after discharge. Results: the caregivers were mainly women, children, or spouses. The caregivers in the Intervention Group and Control Group did not significantly differ in terms of their Overall Quality of Life at baseline. There was no interaction effect between group allocation and Overall Quality of Life(p=0.625) over time. However, there was an interaction effect for Social Relations(p=0.019) and Autonomy (p=0.004). Conclusion: the intervention exerted a statistically significant effect on the quality of life of family caregivers with respect to social relationships and autonomy. Trial registration: NCT02807012.

Resumo Objetivo: avaliar o efeito de intervenção educativa domiciliar de enfermagem na qualidade de vida de cuidadores familiares de idosos sobreviventes de acidente vascular cerebral (AVC). Método: Ensaio Clínico Randomizado, cego para avaliação de resultados. Quarenta e oito cuidadores familiares de idosos sobreviventes de AVC participaram do estudo. O Grupo de Intervenção recebeu três visitas domiciliares de enfermeiros, um mês após a alta hospitalar, para fornecer educação relacionada ao AVC (como acessar os serviços de saúde e realizar atividades de cuidado) e apoio emocional. O Grupo Controle recebeu as orientações habituais dos serviços de saúde. A qualidade de vida foi avaliada usando o instrumento Avaliação da Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-BREF) e o Módulo Old (WHOQOL-OLD) em 1 semana, 2 meses e 1 ano após a alta. Resultados: os cuidadores eram principalmente mulheres, filhos ou cônjuges. Os cuidadores do Grupo Intervenção e do Grupo Controle não diferiram significativamente em termos de Qualidade de Vida Geral no início do estudo. Não houve efeito de interação entre a alocação do grupo e a Qualidade de Vida Geral (p=0,625) ao longo do tempo. No entanto, houve efeito de interação para Relações Sociais (p=0,019) e Autonomia (p=0,004). Conclusão: a intervenção apresentou efeito estatisticamente significativo na qualidade de vida dos cuidadores familiares no que diz respeito às relações sociais e autonomia. Registro do ensaio clínico: NCT02807012.

Resumen Objetivo: evaluar el efecto de intervenciones de atención domiciliaria de enfermería sobre la calidad de vida en cuidadores familiares de adultos mayores sobrevivientes de accidentes cerebrovasculares. Método: Ensayo Clínico Aleatorizado, cegado para la evaluación de los desenlaces. Los participantes del estudio fueron 48cuidadores familiares de adultos mayores sobrevivientes de accidentes cerebrovasculares (ACV). El Grupo Intervención recibió tres visitas domiciliarias a cargo de enfermeros un mes después del alta hospitalaria, en las que se les ofreció instrucción relacionada con ACV (es decir, cómo acceder a los servicios de salud y realizar las actividades inherentes a los cuidados) y apoyo emocional. Al Grupo Control se le brindó la orientación habitual de los servicios de salud. La calidad de vida se evaluó mediante el instrumento World Health Organization Quality of Life Assessment (WHOQOL-BREF) y el módulo Old(WHOQOL-OLD) 1semana, 2meses y 1año después del alta. Resultados: en su mayoría, los cuidadores fueron mujeres, hijos o cónyuges. Los cuidadores de los grupos Intervención y Control no presentaron diferencias significativas en términos de su Calidad de Vida general de base. La intervención no ejerció ningún efecto entre la asignación a los grupos y la Calidad de Vida general(p=0,625) con el transcurso del tiempo. Sin embargo, la intervención sí tuvo efecto sobre las Relaciones Sociales (p=0,019) y la Autonomía(p=0,004). Conclusión: la intervención ejerció un efecto estadísticamente significativo sobre la calidad de vida de los cuidadores familiares con respecto a las relaciones sociales y a la autonomía. Registro del ensayo: NCT02807012.

Clasificadores de aprendizaje supervisado no lineales basados en radiómica de la TC cerebral sin contraste para predecir el pronóstico funcional en pacientes con hematoma intracerebral espontáneo / Radiomic-based nonlinear supervised learning classifiers on non-contrast CT to predict functional prognosis in patients with spontaneous intracerebral hematoma

Objetivo: Evaluar si clasificadores de aprendizaje supervisado no lineales basados en radiómica de la TC cerebral sin contraste (TCCSC) pueden predecir el pronóstico funcional al alta en pacientes con hematoma intracerebral espontáneo (HIE). Material y método: Análisis observacional retrospectivo y unicéntrico de pacientes con diagnóstico de HIE confirmado por TCCSC entre enero de 2016 y abril de 2018. Se incluyeron pacientes con HIE >18años y con TCCSC realizado dentro de las primeras 24horas del inicio de los síntomas. Se excluyeron los HIE secundarios y en los que no se disponía de las variables de radiómica. Se recogieron datos clínicos, demográficos y variables al ingreso. Los pacientes se clasificaron según la Escala Modificada de Rankin (mRS) al alta en buen (mRS0-2) y mal pronóstico (mRS3-6). Tras la segmentación manual de la TCCSC de cada HIE se obtuvieron las variables de radiómica. La muestra se dividió en una cohorte de entrenamiento y prueba y otra cohorte de validación (70-30%, respectivamente). Se usaron diferentes métodos de selección de variables y reducción de dimensionalidad, así como diferentes algoritmos para la construcción del modelo. Se realizaron 10 iteraciones de validación cruzada estratificada en la cohorte de entrenamiento y prueba y se calculó la media de los valores de área bajo la curva (AUC). Una vez entrenados los modelos, se calculó la sensibilidad de cada uno para predecir el pronóstico funcional al alta en la cohorte de validación. Resultados: Se analizaron 105 pacientes con HIE. Se evaluaron 105 variables de radiómica de cada paciente. Los algoritmos P-SVM, KNN-E y RF-10, en combinación con el método de selección de variables ANOVA, fueron los clasificadores con mejor rendimiento en la cohorte de entrenamiento y prueba (AUC: 0,798, 0,752 y 0,742, respectivamente)...(AU)

Purpose: To evaluate if nonlinear supervised learning classifiers based on non-contrast cerebral CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma (HIE). Methods: Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE >18years and with non-contrast CT performed within the first 24hours of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS0-2) and poor prognosis (mRS3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30%, respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. Results: 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC: 0.798, 0.752 and 0.742, respectively)...(AU)