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Gutiérrez-Zúñiga R, Alonso de Leciñana M, Delgado-Mederos R, Gállego-Cullere J, Rodríguez-Yáñez M, Martínez-Zabaleta M, Freijo M, Portilla JC, Gil-Núñez A, Díez Sebastián J, Lisbona A, Díez-Tejedor E, Fuentes B. Beyond hyperglycemia: glycaemic variability as a prognostic factor after acute ischemic stroke. Neurologia 2023; 38:150-158. [PMID: 37059570 DOI: 10.1016/j.nrleng.2020.06.017] [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: 03/14/2020] [Accepted: 06/14/2020] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION Glycaemic variability (GV) refers to variations in blood glucose levels, and may affect stroke outcomes. This study aims to assess the effect of GV on acute ischaemic stroke progression. METHODS We performed an exploratory analysis of the multicentre, prospective, observational GLIAS-II study. Capillary glucose levels were measured every 4 hours during the first 48 hours after stroke, and GV was defined as the standard deviation of the mean glucose values. The primary outcomes were mortality and death or dependency at 3 months. Secondary outcomes were in-hospital complications, stroke recurrence, and the impact of the route of insulin administration on GV. RESULTS A total of 213 patients were included. Higher GV values were observed in patients who died (n = 16; 7.8%; 30.9 mg/dL vs 23.3 mg/dL; p = 0.05). In a logistic regression analysis adjusted for age and comorbidity, both GV (OR = 1.03; 95% CI, 1.003-1.06; p = 0.03) and stroke severity (OR = 1.12; 95% CI, 1.04-1.2; p = 0.004) were independently associated with mortality at 3 months. No association was found between GV and the other outcomes. Patients receiving subcutaneous insulin showed higher GV than those treated with intravenous insulin (38.95 mg/dL vs 21.34 mg/dL; p < 0.001). CONCLUSIONS High GV values during the first 48 hours after ischaemic stroke were independently associated with mortality. Subcutaneous insulin may be associated with higher VG levels than intravenous administration.
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Affiliation(s)
- R Gutiérrez-Zúñiga
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - R Delgado-Mederos
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Gállego-Cullere
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, España
| | - M Freijo
- Servicio de Neurología, IIS Biocruces-Bizkaia, Bilbao, España
| | - J C Portilla
- Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - A Gil-Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J Díez Sebastián
- Servicio de Bioestadística, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - A Lisbona
- Servicio de Endocrinología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - E Díez-Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España.
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2
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Campo-Caballero D, de la Riva P, de Arce A, Martínez-Zabaleta M, Rodríguez-Antigüedad J, Ekiza J, Iruzubieta P, Purroy F, Fuentes B, de Lera Alfonso M, Krupinski J, Mengual Chirife JJ, Palomeras E, Guisado-Alonso D, Rodríguez-Yáñez M, Ustrell X, Tejada García J, de Felipe Mimbrera A, Paré-Curell M, Tembl J, Cajaraville S, Garcés M, Serena J. Reperfusion therapy in acute ischaemic stroke due to cervical and cerebral artery dissection: Results from a Spanish multicentre study. Neurologia (Engl Ed) 2022:S2173-5808(22)00074-8. [PMID: 35842129 DOI: 10.1016/j.nrleng.2020.10.012] [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: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD) is a rare entity, and few data are available on the use of such reperfusion therapies as intravenous fibrinolysis and mechanical thrombectomy in these patients. We analysed the use of these treatments in patients with IS due to CAD and compared them against patients receiving reperfusion treatment for IS of other aetiologies. METHODS We conducted an observational, retrospective, multicentre study of patients with IS due to CAD recorded in the National Stroke Registry of the Spanish Society of Neurology during the period 2011-2019. Comparative analyses were performed between: a) patients with CAD treated and not treated with reperfusion therapies and b) patients treated with reperfusion for IS due to CAD and patients treated with reperfusion for IS due to other causes. Epidemiological data, stroke variables, and outcomes at discharge and at 3 months were included in the analysis. RESULTS The study included 21,037 patients with IS: 223 (1%) had IS due to CAD, of whom 68 (30%) received reperfusion treatment. Reperfusion treatments were used less frequently in cases of vertebral artery dissection and more frequently in patients with carotid artery occlusion. Compared to patients with IS due to other causes, patients with CAD were younger, more frequently underwent mechanical thrombectomy, and less frequently received intravenous fibrinolysis. Rates of haemorrhagic complications, mortality, and independence at 3 months were similar in both groups. CONCLUSIONS Reperfusion therapy is frequently used in patients with IS due to CAD. The outcomes of these patients demonstrate the efficacy and safety of reperfusion treatments, and are comparable to the outcomes of patients with IS due to other aetiologies.
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Affiliation(s)
- D Campo-Caballero
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain.
| | - P de la Riva
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | - A de Arce
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | | | - J Ekiza
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | - P Iruzubieta
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova de Lleida, Lleida, Spain
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
| | - M de Lera Alfonso
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J Krupinski
- Servicio de Neurología, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | | | - E Palomeras
- Servicio de Neurología, Hospital de Mataró, Mataró, Spain
| | - D Guisado-Alonso
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - X Ustrell
- Servicio de Neurología, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | | | - M Paré-Curell
- Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - J Tembl
- Servicio de Neurología, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - S Cajaraville
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M Garcés
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - J Serena
- Servicio de Neurología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
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3
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Alonso de Leciñana M, Morales A, Martínez-Zabaleta M, Ayo-Martín Ó, Lizán L, Castellanos M. Characteristics of stroke units and stroke teams in Spain in 2018. Pre2Ictus project. Neurologia (Engl Ed) 2022; 38:173-180. [PMID: 35780047 DOI: 10.1016/j.nrleng.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/18/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain. METHODS We performed a cross-sectional study based on an ad-hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year. RESULTS The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. A mean (standard deviation) of 4 (3) neurologists were assigned to each stroke unit/team; 98% of stroke units (and 38% of stroke teams) have an on-call neurologist available 24 hours a day, 98% of units (79% of stroke teams) included specialised nurses, 86% of units (71% of stroke teams) included a social worker, and 81% of units (71% of stroke teams) included a rehabilitation physician. Most stroke units (80%) had 4--6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds was 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring was 3 (1) days. All stroke units and 86% of stroke teams had intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams were able to perform mechanical thrombectomy, whereas the remaining centres had referral pathways in place. Telestroke systems were in place at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases. CONCLUSIONS Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.
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Affiliation(s)
- M Alonso de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Ó Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - L Lizán
- Outcomes'10 SLU, Castellón, Spain; Departamento de Medicina, Universitat Jaume I, Castellón, Spain
| | - M Castellanos
- Servicio de Neurología, Hospital Universitario e Instituto de Investigación Biomédica, La Coruña, Spain
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4
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Campo-Caballero D, de la Riva P, de Arce A, Martínez-Zabaleta M, Rodríguez-Antigüedad J, Ekiza J, Iruzubieta P, Purroy F, Fuentes B, de Lera Alfonso M, Krupinski J, Mengual Chirife JJ, Palomeras E, Guisado-Alonso D, Rodríguez-Yáñez M, Ustrell X, Tejada García J, de Felipe Mimbrera A, Paré-Curell M, Tembl J, Cajaraville S, Garcés M, Serena J. Reperfusion treatment in acute ischaemic stroke due to cervical and cerebral artery dissection: results of a Spanish national multicentre study. Neurologia 2020; 38:S0213-4853(20)30430-8. [PMID: 33358059 DOI: 10.1016/j.nrl.2020.10.016] [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: 07/21/2020] [Revised: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD) is a rare entity, and few data are available on the use of such reperfusion therapies as intravenous fibrinolysis and mechanical thrombectomy in these patients. We analysed the use of these treatments in patients with IS due to CAD and compared them against patients receiving reperfusion treatment for IS of other aetiologies. METHOD We conducted an observational, retrospective, multicentre study of patients with IS due to CAD recorded in the National Stroke Registry of the Spanish Society of Neurology during the period 2011-2019. Comparative analyses were performed between: a) patients with CAD treated and not treated with reperfusion therapies and b) patients treated with reperfusion for IS due to CAD and patients treated with reperfusion for IS due to other causes. Epidemiological data, stroke variables, and outcomes at discharge and at 3 months were included in the analysis. RESULTS The study included 21,037 patients with IS: 223 (1%) had IS due to CAD, of whom 68 (30%) received reperfusion treatment. Reperfusion treatments were used less frequently in cases of vertebral artery dissection and more frequently in patients with carotid artery occlusion. Compared to patients with IS due to other causes, patients with CAD were younger, more frequently underwent mechanical thrombectomy, and less frequently received intravenous fibrinolysis. Rates of haemorrhagic complications, mortality, and independence at 3 months were similar in both groups. CONCLUSIONS Reperfusion therapy is frequently used in patients with IS due to CAD. The outcomes of these patients demonstrate the efficacy and safety of reperfusion treatments, and are comparable to the outcomes of patients with IS due to other aetiologies.
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Affiliation(s)
- D Campo-Caballero
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España.
| | - P de la Riva
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | - A de Arce
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | | | - J Ekiza
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | - P Iruzubieta
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova de Lleida, Lleida, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, España
| | - M de Lera Alfonso
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J Krupinski
- Servicio de Neurología, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | | | - E Palomeras
- Servicio de Neurología, Hospital de Mataró, Mataró, España
| | - D Guisado-Alonso
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - X Ustrell
- Servicio de Neurología, Hospital Universitari Joan XXIII, Tarragona, España
| | | | | | - M Paré-Curell
- Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - J Tembl
- Servicio de Neurología, Hospital Universitari i Politécnic La Fe, Valencia, España
| | - S Cajaraville
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - M Garcés
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | - J Serena
- Servicio de Neurología, Hospital Universitari Dr. Josep Trueta, Girona, España
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Gutiérrez-Zúñiga R, Alonso de Leciñana M, Delgado-Mederos R, Gállego-Cullere J, Rodríguez-Yáñez M, Martínez-Zabaleta M, Freijo M, Portilla JC, Gil-Núñez A, Díez Sebastián J, Lisbona A, Díez-Tejedor E, Fuentes B. Beyond hyperglycemia: glycaemic variability as a prognostic factor after acute ischemic stroke. Neurologia 2020; 38:S0213-4853(20)30272-3. [PMID: 33069448 DOI: 10.1016/j.nrl.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/14/2020] [Revised: 05/10/2020] [Accepted: 06/14/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Glycaemic variability (GV) refers to variations in blood glucose levels, and may affect stroke outcomes. This study aims to assess the effect of GV on acute ischaemic stroke progression. METHODS We performed an exploratory analysis of the multicentre, prospective, observational GLIAS-II study. Capillary glucose levels were measured every 4 hours during the first 48 hours after stroke, and GV was defined as the standard deviation of the mean glucose values. The primary outcomes were mortality and death or dependency at 3 months. Secondary outcomes were in-hospital complications, stroke recurrence, and the impact of the route of insulin administration on GV. RESULTS A total of 213 patients were included. Higher GV values were observed in patients who died (n = 16; 7.8%; 30.9 mg/dL vs 23.3 mg/dL; p = 0.05). In a logistic regression analysis adjusted for age and comorbidity, both GV (OR = 1.03; 95% CI, 1.003-1.06; p = 0.03) and stroke severity (OR = 1.12; 95% CI, 1.04-1.2; p = 0.004) were independently associated with mortality at 3 months. No association was found between GV and the other outcomes. Patients receiving subcutaneous insulin showed higher GV than those treated with intravenous insulin (38.95 mg/dL vs 21.34 mg/dL; p < 0.001). CONCLUSIONS High GV values during the first 48 hours after ischaemic stroke were independently associated with mortality. Subcutaneous insulin may be associated with higher VG levels than intravenous administration.
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Affiliation(s)
- R Gutiérrez-Zúñiga
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - R Delgado-Mederos
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Gállego-Cullere
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, España
| | - M Freijo
- Servicio de Neurología, IIS Biocruces-Bizkaia, Bilbao, España
| | - J C Portilla
- Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - A Gil-Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J Díez Sebastián
- Servicio de Bioestadística, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - A Lisbona
- Servicio de Endocrinología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - E Díez-Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España.
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Alonso de Leciñana M, Morales A, Martínez-Zabaleta M, Ayo-Martín Ó, Lizán L, Castellanos M. Characteristics of stroke units and stroke teams in Spain in 2018. Pre2Ictus project. Neurologia 2020; 38:S0213-4853(20)30222-X. [PMID: 32917435 DOI: 10.1016/j.nrl.2020.06.012] [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: 02/18/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain. METHOD We performed a cross-sectional study based on an ad hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year. RESULTS The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. The mean (SD) number of neurologists assigned to each unit/team is 4±3. 98% of stroke units (and 38% of stroke teams) have a neurologist on-call available 24hours, 365 days. 98% of stroke units (79% of stroke teams) have specialised nurse, 95% of units (71% of stroke teams) auxiliary personnel, 86% of units (71% of stroke teams) social worker, 81% of stroke units (71% of stroke teams) have a rehabilitation physician and 81% of stroke units (86% of stroke teams) a physiotherapist. Most stroke units (80%) have 4-6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds is 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring is 3 (1) days. All stroke units and 86% of stroke teams have intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams are able to perform mechanical thrombectomy, whereas the remaining centres have referral pathways in place. Telestroke systems are available at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases. CONCLUSIONS Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.
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Affiliation(s)
- M Alonso de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, España.
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario de Donostia, San Sebastián, España
| | - Ó Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - L Lizán
- Outcomes'10 SLU, Castellón, España; Departamento de Medicina, Universitat Jaume I, Castellón, España
| | - M Castellanos
- Servicio de Neurología, Hospital Universitario e Instituto de Investigación Biomédica, La Coruña, España
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Tejada Meza H, Lambea Gil Á, Sancho Saldaña A, Martínez-Zabaleta M, Garmendia Lopetegui E, López-Cancio Martínez E, Castañón Apilánez M, Herrera Isasi M, Marta Enguita J, Gómez-Vicente B, Arenillas JF, Arenaza Basterrechea N, Timiraos Fernández JJ, Sánchez Herrero J, Maciñeiras Montero JL, Castellanos Rodrigo M, Fernández-Coud D, Casado Menéndez I, Temprano Fernández MT, Freijo M, Luna A, Palacio Portilla EJ, Jiménez López Y, Rodríguez-Castro E, Rodríguez-Yáñez M, Tejada García J, Beltrán Rodríguez I, Julián-Villaverde F, Moreno García MP, Trejo Gabriel-Galán JM, Echavarría Iñiguez A, Pérez Lázaro C, Navarro Pérez MP, Marta Moreno J. Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain. Eur J Neurol 2020; 27:2491-2498. [PMID: 32761981 PMCID: PMC7436392 DOI: 10.1111/ene.14467] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 06/24/2020] [Accepted: 08/01/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.
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Affiliation(s)
- H Tejada Meza
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
| | - Á Lambea Gil
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
| | - A Sancho Saldaña
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
| | | | | | | | - M Castañón Apilánez
- Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Herrera Isasi
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - J Marta Enguita
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - B Gómez-Vicente
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J F Arenillas
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neurovascular Research Laboratory, Instituto de Biología y Genética Molecular, Universidad de Valladolid - Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | | | | | - J Sánchez Herrero
- Department of Neurology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - M Castellanos Rodrigo
- Department of Neurology, Complexo Hospitalario Universitario A Coruña / A Coruña Biomedical Research Insitute, A Coruña, Spain
| | - D Fernández-Coud
- Department of Neurology, Complexo Hospitalario Universitario A Coruña / A Coruña Biomedical Research Insitute, A Coruña, Spain
| | - I Casado Menéndez
- Stroke Unit, Department of Neurology, Hospital Universitario de Cabueñes, Gijón, Spain
| | | | - M Freijo
- Neurovascular Department Biocruces Bizkaia Health Research Institute, Osakidetza, Hospital Universitario Cruces, Barakaldo, Spain
| | - A Luna
- Neurovascular Department Biocruces Bizkaia Health Research Institute, Osakidetza, Hospital Universitario Cruces, Barakaldo, Spain
| | - E J Palacio Portilla
- Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Y Jiménez López
- Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - E Rodríguez-Castro
- Department of Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M Rodríguez-Yáñez
- Department of Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - J Tejada García
- Department of Neurology, Complejo Asistencial Universitario de León, León, Spain
| | | | | | | | | | - A Echavarría Iñiguez
- Department of Neurology, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - C Pérez Lázaro
- Department of Neurology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - M P Navarro Pérez
- Department of Neurology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - J Marta Moreno
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
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8
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Fuentes B, Sanz-Cuesta BE, Gutiérrez-Fernández M, Martínez-Sánchez P, Lisbona A, Madero-Jarabo R, Delgado-Mederos R, Gállego-Cullere J, Rodríguez-Yáñez M, Martínez-Zabaleta M, Freijo M, Alonso de Leciñana M, Portilla JC, Gil-Núñez A, Díez-Tejedor E. Glycemia in Acute Stroke II study: a call to improve post-stroke hyperglycemia management in clinical practice. Eur J Neurol 2017; 24:1091-1098. [PMID: 28707377 DOI: 10.1111/ene.13354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/21/2016] [Accepted: 06/01/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the study was to analyze the effect of conventional glucose management, which aimed to maintain glucose levels <155 mg/dL (8.5 mmol/L), on glucose control and the outcomes of patients with acute ischaemic stroke (IS) in a clinical practice setting. METHODS This was a multicenter, prospective cohort study of patients with acute IS. Patients were classified into four groups based on their initial 48-h capillary glucose levels and the administration of and response to corrective treatment: (i) untreated and maximum glucose levels <155 mg/dL (8.5 mmol/L) within the first 48 h; (ii) treated and good responders [glucose levels persistently <155 mg/dL (8.5 mmol/L)]; (iii) treated and non-responders [any glucose values ≥155 mg/dL (8.5 mmol/L) during the 24 h after the start of corrective treatment]; and (iv) untreated with any glucose value ≥155 mg/dL (8.5 mmol/L). The primary outcome was death or dependence at 3 months (blinded rater). RESULTS A total of 213 patients were included. Ninety-seven (45.5%) patients developed glucose levels ≥155 mg/dL (8.5 mmol/L), 69 (71.1%) underwent corrective treatment and 31 patients underwent no corrective treatment at the physician's discretion [28 of whom had isolated values ≥155 mg/dL (8.5 mmol/L)]. Only 11 (16%) patients responded to conventional treatment, whereas 58 (84%) patients were non-responsive. Non-responders showed a twofold higher risk of death or dependence at 3 months (odds ratio, 2.472; 95% confidence interval, 1.096-5.576; P = 0.029). CONCLUSIONS Lack of response to conventional treatment for glucose management in acute IS is frequent and associated with poor outcomes.
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Affiliation(s)
- B Fuentes
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - B E Sanz-Cuesta
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - M Gutiérrez-Fernández
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - P Martínez-Sánchez
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - A Lisbona
- Department of Endocrinology, La Paz University Hospital, Madrid, Spain
| | - R Madero-Jarabo
- Department of Biostatistics, La Paz University Hospital, Madrid, Spain
| | - R Delgado-Mederos
- Department of Neurology, Santa Creu I Sant Pau Hospital, Barcelona, Spain
| | | | - M Rodríguez-Yáñez
- Department of Neurology, University Hospital Clinic, Santiago de Compostela, Spain
| | | | - M Freijo
- Department of Neurology, Basurto Hospital, Bilbao, Spain
| | - M Alonso de Leciñana
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain.,Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain
| | - J C Portilla
- Department of Neurology, San Pedro de Alcántara Hospital, Cáceres, Spain
| | - A Gil-Núñez
- Department of Neurology, Gregorio Marañón University Hospital, Madrid, Spain
| | - E Díez-Tejedor
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
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9
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Otaegui D, Sáenz A, Martínez-Zabaleta M, Villoslada P, Fernández-Manchola I, Alvarez de Arcaya A, Emparanza JI, López de Munain A. Mitochondrial haplogroups in Basque multiple sclerosis patients. Mult Scler 2005; 10:532-5. [PMID: 15471369 DOI: 10.1191/1352458504ms1069oa] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previous studies have suggested that mitochondrial metabolism and/or mitochondrial DNA (mtDNA) could be, in conjunction with other genetic or environmental factors, a risk factor for the development of multiple sclerosis (MS). One of these studies establishes that mitochondrial haplogroup JT is a risk factor for developing the disease, in particular the visual manifestations [optic neuritis (ON)]. Nevertheless, as distribution of these haplogroups varies between populations, the observed association may be due to a slanted sample with no physiopathological value. This hypothesis was checked with MS patients, originals from Basque country (this population has peculiar genetic characteristics) and from other Spanish regions. We concluded that such an association does not exist. By contrast, a decrease could be seen in the frequency of the JT haplogroup in the ON group and in the MS-Basque group. That trend could be a protective effect, which needs to be verified in further investigations.
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Affiliation(s)
- D Otaegui
- Experimental Unit, Hospital Donostia, San Sebastián, Spain.
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