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Carotid Web in a Patient with a Recurrent Stroke
No full textA 43 year old female smoker, suffered a left hemiparesis secondary to acute occlusion of the right middle cerebral artery and underwent mechanical thrombectomy with a good result. Four years later, she suffered a similar recurrent episode. Computed tomography angiography found an occlusive thrombus at the distal M1 segment and a spiculated septum in the lumen of the right carotid sinus, which was compatible with a carotid web (Figure 1A, white arrow). Mechanical thrombectomy was performed again, with a good clinical and angiographic result. Other causes of stroke were ruled out. The patient underwent resection of a membrane on the posterior wall of the carotid bulb (Figure 1B, black arrow). No thrombus was found along the surface of the web and the rest of the carotid artery looked normal. Histopathology showed a thickening of the elastic fibres of the arterial intima (fibromuscular dysplasia intimal variant). The post-operative course was uneventful. The patient was discharged on long term clopidogrel 75 mg daily
Mechanism of Immunoregulatory Properties of Vasoactive Intestinal Peptide in the K/BxN Mice Model of Autoimmune Arthritis
Get PDFThe K/BxN mouse model of rheumatoid arthritis (RA) closely resembles the human disease. In this model, arthritis results from activation of autoreactive KRN T cells recognizing the glycolytic enzyme glucose-6-phosphate isomerase (GPI) autoantigen, which provides help to GPI-specific B cells, resulting in the production of pathogenic anti-GPI antibodies that ultimately leads to arthritis symptoms from 4 weeks of age. Vasoactive intestinal peptide (VIP) is a neuropeptide broadly distributed in the central and peripheral nervous system that is also expressed in lymphocytes and other immune cell types. VIP is a modulator of innate and adaptive immunity, showing anti-inflammatory and immunoregulatory properties. Basically, this neuropeptide promotes a shift in the Th1/Th2 balance and enhances dedifferentiation of T regulatory cells (Treg). It has demonstrated its therapeutic effects on the collagen-induced arthritis (CIA) mouse model of RA. In the present hypothesis and theory article, we propose that the immunoregulatory properties of VIP may be due likely to the inhibition of T cell plasticity toward non-classic Th1 cells and an enhanced follicular regulatory T cells (Tfr) activity. The consequences of these regulatory properties are the reduction of systemic pathogenic antibody titers
Adherence to Treatment in Patients with Rheumatoid Arthritis from Spain
Get PDFObjective: To evaluate adherence to treatment in a cohort of patients with rheumatoid arthritis in Spain and to identify potential predictors of adherence.
Methods: An observational, cross-sectional, multicenter study in outpatient clinics of Rheumatology Departments from 41 centers was conducted. A validated Spanish version of the compliance questionnaire in Rheumatology was used to measure adherence in a cohort of patients with rheumatoid arthritis, representative of the Spanish population. Univariate and multivariate analyses were performed to detect predictors of adherence.
Results: A total of 859 patients were recruited. An adherence rate of 79% was established. No differences were detected in adherence in patients receiving biologic disease-modifying antirheumatic drugs compared to conventional disease-modifying antirheumatic drugs, in patients receiving intravenous therapies compared to other routes of administration and in patients treated in specific day hospitals compared to polyvalent day hospitals. The number of drugs and cohabitation were independent predictors of adherence.
Conclusion: An inexpensive and useful method was used to measure adherence in Spanish population. The adherence rate in rheumatoid arthritis is still suboptimal. Simpler, more convenient dosing regimens may improve compliance. Increased knowledge of compliance in patients with rheumatoid arthritis and the identification of possible predictors of adherence will allow to develop effective intervention strategies
Predictors of persistence in patients with schizophrenia treated with aripiprazole once-monthly long-acting injection in the Spanish clinical practice: a retrospective, observational study
Get PDFAbstract
Background: Poor adherence to antipsychotic drugs is a major problem in schizophrenia management and one of the most important risk factors for relapse and hospitalization. To date, there is little evidence on persistence predictors with long-acting injectable antipsychotics, especially with aripiprazole once-monthly (AOM). This study (NCT03130478) aimed to describe the impact of demographic and clinical characteristics on persistence with AOM treatment in real-world setting.
Methods: This was an observational, retrospective, non-interventional study that included adult patients with schizophrenia who were initiated on AOM during a schizophrenia-related hospitalization. Data were retrospectively collected from patients' medical records. The primary variable was persistence with AOM, measured as the number of days from AOM initiation up to all-cause AOM discontinuation during the first six months after treatment index.
Results: 140 patients were enrolled and 91 fulfilled the selection criteria. Six months after AOM initiation, 65 (71.4%) patients were still receiving AOM treatment, whereas 26 (28.6%) were not. The mean (standard deviation) time to AOM treatment discontinuation in the first six months was 138.1 (6.8) days, with most of the patients discontinuing at the first 28 days. The risk of AOM discontinuation in the first six months increases 1.05-fold annually since schizophrenia diagnosis (p=0.003); moreover, this risk increases 2.86-fold in patients with concomitant schizophrenia medication at AOM initiation compared to patients without concomitant schizophrenia treatments (p=0.02).
Conclusions: Main factors predicting persistence with AOM treatment at six months in clinical practice are fewer years since schizophrenia diagnosis and not receiving concomitant schizophrenia treatments at AOM initiation
Factors Related to Greater Functional Recovery after Suffering a Stroke
No full textBACKGROUND: In a stroke, the importance of initial functional status is fundamental for prognosis. The aim of the current study was to investigate functional status, assessed by the Functional Independence Measure (FIM) scale, and possible predictors of functional outcome at discharge from inpatient rehabilitation. METHODS: This is a retrospective study that was carried out at the Physical Medicine and Rehabilitation Service in A Coruna (Spain). A total of 365 consecutive patients with primary diagnosis of stroke were enrolled. The functional assessments of all patients were performed through the FIM. A descriptive and a bivariate analysis of the variables included in the study was made and a succession of linear regression models was used to determine which variables were associated with the total FIM at discharge. RESULTS: Prior to having the stroke, 76.7% were totally independent in activities of daily living. The FIM scale score was 52.5 +/- 25.5 points at admission and 83.4 +/- 26.3 at hospital discharge. The multivariate analysis showed that FIM scores on admission were the most important predictors of FIM outcomes. CONCLUSIONS: Our study indicates that the degree of independence prior to admission after suffering a stroke is the factor that will determine the functionality of patients at hospital discharge
Sex and Heart Failure Treatment Prescription and Adherence
Get PDFHeart disease is the leading cause of death in both men and women in developed countries. Heart failure (HF) contributes to significant morbidity and mortality and continues to remain on the rise. While advances in pharmacological therapies have improved its prognosis, there remain a number of unanswered questions regarding the impact of these therapies in women. Current HF guidelines recommend up-titration of neurohormonal blockade, to the same target doses in both men and women but several factors may impair achieving this goal in women: more adverse drug reactions, reduced adherence and even lack of evidence on the optimal drug dose. Systematic under-representation of women in cardiovascular drug trials hinders the identification of sex differences in the efficacy and safety of cardiovascular medications. Women are also under-represented in device therapy trials and are 30% less likely to receive a device in clinical practice. Despite presenting with fewer ventricular arrythmias and having an increased risk of implant complications, women show better response to resynchronization therapy, with lower mortality and HF hospitalizations. Fewer women receive advanced HF therapies. They have a better post-heart transplant survival compared to men, but an increased immunological risk needs to be acknowledged. Technological advances in mechanical circulatory support, with smaller and more hemocompatible devices, will likely increase their implantation in women. This review outlines current evidence regarding sex-related differences in prescription, adherence, adverse events, and prognostic impact of the main management strategies for HF
Attitudes and Intentions toward COVID-19 Vaccination among Spanish Adults: A Descriptive Cross-Sectional Study.
Get PDFVaccination against SARS-CoV-2 is postulated as the most effective measure to control the COVID-19 pandemic. However, the use of other protection measures is necessary to efficiently combat the spread of the virus. The aim of the present study was to determine the attitudes and intentions toward COVID-19 vaccination among non-regular social media users in Spain and to analyze how these factors could condition the acceptance of other personal protective measures once an individual has received the COVID-19 vaccine. A cross-sectional design was used in this work. In total, 719 subjects, ≥18 years old and of both sexes, were recruited from primary public healthcare centers to self-complete a questionnaire between March and April 2021. The majority of participants had a positive attitude toward vaccination and showed high levels of intention to be vaccinated. Likewise, except those participants who considered the vaccine to be the most effective measure to fight the COVID-19 pandemic, the rest of the participants highlighted the importance of continuing to limit social interactions and/or wearing masks even after being vaccinated. Since vaccination can create a perception of total immunity against SARS-CoV-2, it is necessary that healthcare staff organize effective awareness campaigns on the importance of maintaining personal protective measures until vaccination coverage is greater
Guía de coordinación e mobilización de recursos en urxencias extrahospitalarias. Actualización 2021
Get PDFDocumento en que se establecen os procedementos ou protocolos para a coordinación e mobilización de recursos sanitarios nas urxencias e emerxencias extrahospitalarias na Comunidade Autónoma de Galicia desde e a través da Central de Coordinación de Urxencias Sanitarias de Galicia-061.Documento en el que se establecen los procedimientos o protocolos para la coordinación y movilización de recursos sanitarios en las urgencias y emergencias extrahospitalarias en la Comunidad Autónoma de Galicia desde y a través de la Central de Coordinación de Urgencias Sanitarias de Galicia-061
Procedimiento de colocación y cuidados de la sonda nasográstrica FEMORA. Procedimientos de enfermería : cuidados de sondas
Get PDFEste procedemento pretende documentar os coidados que se van realizar no paciente portador ou que precisa dunha sonda nasogástrica, incorporando a mellor evidencia existente. A súa finalidade é a estandarización dos criterios de actuación e reducir a variabilidade clínica coa incorporación das mellores prácticas na actividade asistencial diaria dos profesionais e garantir en todo momento a seguridade, confort, así como a continuidade asistencial do paciente en todos os niveis asistenciais.Este procedimiento pretende documentar los cuidados que se van a realizar en el paciente portador o que precisa de una sonda nasogástrica, incorporando la mejor evidencia existente. Su finalidad es la estandarización de los criterios de actuación y reducir la variabilidad clínica con la incorporación de las mejores prácticas en la actividad asistencial diaria de los profesionales y garantizar en todo momento la seguridad, confort, así como la continuidad asistencial del paciente en todos los niveles asistenciales