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Fernández-Eulate G, Arocena P, Muñoz-Lopetegi A, Rodriguez-Antigüedad J, Campo-Caballero D, Equiza J, Andrés N, de Arce A, Gonzalez F, Diez N, Basterrechea J, Suquia E, de la Riva P, Martinez-Zabaleta M. Attention to acute cerebrovascular disease in Guipúzcoa: description of the results of a reference hospital in a centralized care model. Neurologia (Engl Ed) 2022; 37:355-61. [PMID: 35672122 DOI: 10.1016/j.nrleng.2019.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/03/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model. MATERIAL AND METHODS We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients' baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year. RESULTS AND DISCUSSION We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in < 6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2. CONCLUSIONS After the strategic changes implemented in acute stroke care in Guipuzkoa, including the centralisation of the acute stroke care model, mortality rates at discharge and at one year are lower in 2015 than the previously reported rates, with similar rates of independence. These results are consistent with those published by other Spanish and European centres.
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Fernández-Eulate G, Arocena P, Muñoz-Lopetegi A, Rodriguez-Antigüedad J, Campo-Caballero D, Equiza J, Andrés N, de Arce A, Gonzalez F, Diez N, Basterrechea J, Suquia E, de la Riva P, Martinez-Zabaleta M. Attention to acute cerebrovascular disease in Guipúzcoa: Description of the results of a reference hospital in a centralized care model. Neurologia 2022; 37:355-361. [PMID: 31053483 DOI: 10.1016/j.nrl.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/22/2019] [Accepted: 03/03/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model. MATERIAL AND METHODS We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients' baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year. RESULTS AND DISCUSSION We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in <6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2. CONCLUSIONS After the strategic changes implemented in acute stroke care in Guipuzkoa, including the centralisation of the acute stroke care model, mortality rates at discharge and at one year are lower in 2015 than the previously reported rates, with similar rates of independence. These results are consistent with those published by other Spanish and European centres.
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Affiliation(s)
- G Fernández-Eulate
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España.
| | - P Arocena
- Facultad de Medicina, UPV, San Sebastián, Guipúzcoa, España
| | - A Muñoz-Lopetegi
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - J Rodriguez-Antigüedad
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - D Campo-Caballero
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - J Equiza
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - N Andrés
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - A de Arce
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - F Gonzalez
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - N Diez
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - J Basterrechea
- Servicio de Calidad, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - E Suquia
- Servicio de Calidad, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - P de la Riva
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - M Martinez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España; Facultad de Medicina, UPV, San Sebastián, Guipúzcoa, España
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Favas TT, Dev P, Chaurasia RN, Chakravarty K, Mishra R, Joshi D, Mishra VN, Kumar A, Singh VK, Pandey M, Pathak A. Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci 2020; 41:3437-70. [PMID: 33089477 DOI: 10.1007/s10072-020-04801-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronaviruses mainly affect the respiratory system; however, there are reports of SARS-CoV and MERS-CoV causing neurological manifestations. We aimed at discussing the various neurological manifestations of SARS-CoV-2 infection and to estimate the prevalence of each of them. METHODS We searched the following electronic databases; PubMed, MEDLINE, Scopus, EMBASE, Google Scholar, EBSCO, Web of Science, Cochrane Library, WHO database, and ClinicalTrials.gov . Relevant MeSH terms for COVID-19 and neurological manifestations were used. Randomized controlled trials, non-randomized controlled trials, case-control studies, cohort studies, cross-sectional studies, case series, and case reports were included in the study. To estimate the overall proportion of each neurological manifestations, the study employed meta-analysis of proportions using a random-effects model. RESULTS Pooled prevalence of each neurological manifestations are, smell disturbances (35.8%; 95% CI 21.4-50.2), taste disturbances (38.5%; 95%CI 24.0-53.0), myalgia (19.3%; 95% CI 15.1-23.6), headache (14.7%; 95% CI 10.4-18.9), dizziness (6.1%; 95% CI 3.1-9.2), and syncope (1.8%; 95% CI 0.9-4.6). Pooled prevalence of acute cerebrovascular disease was (2.3%; 95%CI 1.0-3.6), of which majority were ischaemic stroke (2.1%; 95% CI 0.9-3.3), followed by haemorrhagic stroke (0.4%; 95% CI 0.2-0.6), and cerebral venous thrombosis (0.3%; 95% CI 0.1-0.6). CONCLUSIONS Neurological symptoms are common in SARS-CoV-2 infection, and from the large number of cases reported from all over the world daily, the prevalence of neurological features might increase again. Identifying some neurological manifestations like smell and taste disturbances can be used to screen patients with COVID-19 so that early identification and isolation is possible.
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Zhu J, Chen M, Li N, Yang S, Xu L, Wang Y, Li H. Correlation analysis of serum thyroid stimulating hormone with acute cerebrovascular disease. Eur J Med Res 2019; 24:35. [PMID: 31651357 PMCID: PMC6813055 DOI: 10.1186/s40001-019-0395-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 10/16/2019] [Indexed: 02/06/2023] Open
Abstract
Background Acute cerebrovascular disease (ACVD) could cause abnormal metabolism of thyroid hormones (TH), mostly represented as a euthyroid sick syndrome or low T3 syndrome. However, the changes in serum thyroid-stimulating hormone (TSH) are controversial. The aim of this study is to investigate the clinical significance of TSH alteration in patients with ACVD. Method Patients with ACVD admitted in our hospitals between January 2013 and September 2017 were enrolled in this study (n = 245, including 176 cerebral infarctions and 69 cerebral hemorrhages). Their thyroid hormones were measured and compared with healthy individuals (n = 75). The correlation of TSH with severity and prognosis of ACVD were analyzed by receiver operating characteristic curve. Results Serum TSH in ACVD group was higher than the control group (1.64 ± 1.08 vs. 1.26 ± 0.36 μIU/mL, P < 0.05). The TSH levels in intermediate and severe patients with ACVD were higher than in mild patients (1.72 ± 1.18 vs. 2.71 ± 0.93 vs. 1.02 ± 0.47 μIU/mL, P < 0.05). Receiver Operating Characteristic curve (ROC) of TSH in determining the severity of patients were 0.863 (Area under the curve, AUC), 1.496 μIU/L (optimal threshold), 76.5% (sensitivity) and 87.3% (specificity). TSH levels in improved and unchanged groups were significantly higher than the primarily healing group (2.27 ± 1.11 vs. 2.88 ± 1.07 vs. 0.86 ± 0.46 μIU/mL, P < 0.05). ROC of TSH in determining the prognosis of patients was 0.910 (AUC), 1.681 mIU/L (optimal threshold), 79.8% (sensitivity) and 90.5% (specificity) correspondingly. Conclusion Since elevated TSH in ACVD patients affects the outcome of thyroid function evaluation, it is preferable to re-check after the acute period. A correlation between a high TSH level and the severity and prognosis of ACVD was detected, but the mechanism of this correlation needs to be further studied.
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Affiliation(s)
- Jian Zhu
- Department of Neurology, Dachang Hospital of Baoshan District, Shanghai, 200444, China
| | - Ming Chen
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Nan Li
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Shaoling Yang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Lu Xu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Yanru Wang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Hong Li
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China.
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Dong XL, Xu SJ, Zhang L, Zhang XQ, Liu T, Gao QY, Qian QQ, Sun BL, Yang MF. Serum Resistin Levels May Contribute to an Increased Risk of Acute Cerebral Infarction. Mol Neurobiol 2016; 54:1919-1926. [PMID: 26899574 DOI: 10.1007/s12035-016-9751-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 01/26/2016] [Indexed: 12/14/2022]
Abstract
The objective of this study was to investigate the association between serum resistin levels and acute cerebral infarction (ACI). PubMed, SpringerLink, Wiley, EBSCO, Ovid, Web of Science, Wanfang, China National Knowledge Infrastructure, and VIP databases (last updated search in October 2014) were exhaustively searched, and data from the eligible studies were extracted and analyzed to assess the association between serum resistin levels and ACI. STATA software (version 12.0, Stata Corporation, College Station, TX, USA) was utilized for data analysis. Ten studies including 1829 ACI patients and 1557 healthy controls were eligible for inclusion in the meta-analysis. Our major result revealed that ACI patients exhibited higher serum resistin levels compared with healthy controls. Asubgroup analysis based on ethnicity showed a significant association between serum resistin levels and ACI in Asians, but surprisingly not in Caucasians. The results of our meta-analysis suggest that serum resistin levels are associated with an increased risk of ACI.
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Affiliation(s)
- Xiao-Liu Dong
- Department of Neurology, Tangshan People's Hospital, No. 65 Shengli Road, Lunan District, Tangshan, 063000, People's Republic of China.
| | - Shi-Jun Xu
- Department of Neurology, Tangshan People's Hospital, No. 65 Shengli Road, Lunan District, Tangshan, 063000, People's Republic of China
| | - Li Zhang
- Department of Neurosurgery, Tangshan People's Hospital, Tangshan, 063000, People's Republic of China
| | - Xiu-Qing Zhang
- Department of Neurology, Tangshan People's Hospital, No. 65 Shengli Road, Lunan District, Tangshan, 063000, People's Republic of China
| | - Ting Liu
- Department of Neurology, Tangshan People's Hospital, No. 65 Shengli Road, Lunan District, Tangshan, 063000, People's Republic of China
| | - Qiu-Yan Gao
- Department of Ultrasonic Medicine, Tangshan People's Hospital, Tangshan, 063000, People's Republic of China
| | - Qing-Qiang Qian
- Department of Neurology, Affiliated Tangshan Gongren Hospital of North China University of Science and Technology, Tangshan, 063000, People's Republic of China
| | - Bao-Liang Sun
- Key Lab of Cerebral Microcirculation in Universities of Shandong, Taishan Medical University, Taian, 271000, People's Republic of China
| | - Ming-Feng Yang
- Key Lab of Cerebral Microcirculation in Universities of Shandong, Taishan Medical University, Taian, 271000, People's Republic of China
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