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Background: There is a growing body of evidence suggesting a link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). The primary objective of this study is to evaluate the association between OSA and AF in acute ischemic stroke. The secondary objective is to describe the clinical features of patients with acute ischemic stroke and concomitant OSA. Methods: We enrolled consecutive patients with acute ischemic stroke. All patients underwent full-night cardiorespiratory polygraphy. To determine if there is an association between AF and OSA, we compared the observed frequency of this association with the expected frequency from a random co-occurrence of the two conditions. Subsequently, patients with and without OSA were compared. Results: A total of 174 patients were enrolled (mean age 67.3 ± 11.6 years; 95 males). OSA and AF were present in 89 and 55 patients, respectively. The association OSA + AF was observed in 33/174 cases, which was not statistically different compared to the expected co-occurrence of the two conditions. Patients with OSA showed a higher neck circumference and body mass index, a higher prevalence of hypertension and dysphagia, and a higher number of central apneas/hypoapneas. In the multivariate analysis, dysphagia and hypertension were independent predictors of OSA. A positive correlation was observed between OSA severity, BMI, and neck circumference. The number of central apneas/hypoapneas was positively correlated with stroke severity. Conclusions: Our data suggest that OSA and AF are highly prevalent but not associated in acute stroke. Our findings support the hypothesis that OSA acts as an independent risk factor for stroke.

Introduction: Noncommunicable diseases have emerged as the main causes of death in the world, representing in 2019, 73.6% of all deaths from all causes and in Cuba 81.5%. Premature mortality from cardiovascular diseases turned out to be 34.7% of the total number of premature deaths globally. Objective: To describe mortality from ischemic heart, cerebrovascular and hypertensive diseases in Cuba, in the 2011- 2020 decade. Material and Methods: A descriptive longitudinal ecological study of annual mortality from ischemic heart, cerebrovascular and hypertensive diseases in Cuba was carried out in the 2011-2020 decade. Crude mortality rates for these diseases were taken into account. The statistical yearbooks published by the Directorate of Medical Records and Health Statistics of the Ministry of Public Health for those years were the source of information. Results: The annual mortality rates from ischemic heart, cerebrovascular and hypertensive diseases in Cuba showed overall increasing trends in the 2011- 2020 decade, more pronounced in the case of hypertensive diseases. An increase in premature mortality rates from these diseases was observed. Conclusions: Arterial hypertension constitutes a severe health problem in Cuba, both as a cause of death and as a risk factor attributable to mortality from ischemic heart and cerebrovascular diseases., Introducción: Las enfermedades no transmisibles se han erigido como las principales causas de muerte en el mundo, representando en 2019, 73,6 % del total de defunciones por todas las causas y en Cuba 81,5 %. La mortalidad prematura por enfermedades cardiovasculares, resultó ser 34,7 % del total de fallecidos prematuramente a nivel global. Objetivo: Describir la mortalidad por enfermedades isquémicas del corazón, cerebrovasculares e hipertensivas en Cuba, en el decenio 2011-2020. Material y Métodos: Se realizó un estudio ecológico longitudinal descriptivo de la mortalidad anual por enfermedades isquémicas del corazón, cerebrovasculares e hipertensivas en Cuba, en el decenio 2011-2020. Se tuvieron en cuenta, las tasas de mortalidad brutas por esas dolencias. Los anuarios estadísticos publicados por la Dirección de Registros Médicos y Estadísticas de Salud, del Ministerio de Salud Pública de esos años, fueron la fuente de información. Resultados: Las tasas de mortalidad anual por las enfermedades isquémicas del corazón, cerebrovasculares e hipertensivas en Cuba mostraron globalmente tendencias al incremento en el decenio 2011-2020, más pronunciada en el caso de las enfermedades hipertensivas. Se observó un incremento en las tasas de mortalidad prematura por dichas enfermedades. Conclusiones: La hipertensión arterial constituye un severo problema de salud en Cuba, tanto como causa de muerte, como factor de riesgo atribuible para la mortalidad por enfermedades isquémicas del corazón y cerebrovasculares.

Producción Científica, Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage (ICH) in elderly patients. Growing evidence suggests a potential role of aquaporin 4 (AQP4) in amyloid-beta-associated diseases, including CAA pathology. Our aim was to investigate the circulating levels of AQP4 in a cohort of patients who had suffered a lobar ICH with a clinical diagnosis of CAA. AQP4 levels were analyzed in the serum of 60 CAA-related ICH patients and 19 non-stroke subjects by enzyme-linked immunosorbent assay (ELISA). The CAA–ICH cohort was divided according to the time point of the functional outcome evaluation: mid-term (12 ± 18.6 months) and long-term (38.5 ± 32.9 months) after the last ICH. Although no differences were found in AQP4 serum levels between cases and controls, lower levels were found in CAA patients presenting specific hemorrhagic features such as ≥2 lobar ICHs and ≥5 lobar microbleeds detected by magnetic resonance imaging (MRI). In addition, CAA-related ICH patients who presented a long-term good functional outcome had higher circulating AQP4 levels than subjects with a poor outcome or controls. Our data suggest that AQP4 could potentially predict a long-term functional outcome and may play a protective role after a lobar ICH., Instituto de Salud Carlos III y Fondo Europeo de Desarrollo Regional (FEDER) - (projects PI17/00275 and PI20/00465), Instituto de Salud Carlos III - (project RD16/0019/0021), Instituto de Salud Carlos III - (project CPII17/00010)

According to the World Health Organization (WHO), particulate matter (PM) contamination causes around 800,000 premature deaths per year, ranking 13th in the world in terms of mortality. However, several findings revealed that the correlation is much stronger and more complicated than previously believed. PM is an element of emissions comprised of very small, acidic, organic compounds, metals, and particulate soil or dust particles or fluid droplets. The most consistent air quality component linked to human illness is PM, which is categorized by size. PM is likely to develop cardiovascular and cerebrovascular disorders due to the mechanisms of inflammation, overt and indirect coagulation activation, and direct translocation to the systemic circulation. The evidence on the cardiovascular system that shows a PM effect is strong. Coronary incidence and mortality rates in populations prone to long-term PM toxicity were significantly higher. Short-term acute emissions increase coronary incidence rates subtly within days of the pollution peak. While some evidence and associated mechanisms show a smaller outcome, the findings for PM’s cortical disease symptoms are not as promising. Respiratory infections are aggravated by exposure to PM. More analysis is needed to clarify the effects of structure, chemistry, and PM for vulnerable groups. The existing research indicates that PM toxicity causes a minor but significant increase in human morbidity and mortality. Air conditioners and particulate matter filters reduced internal heating, and cooking combustion and smoking cessation will reduce indoor PM exposure. These fundamental improvements can be beneficial to patients with acute and chronic cardiovascular and respiratory symptoms. This article provides an overview of the effects of atmospheric airborne suspended particulate matter on population morbidity and mortality. This critical review concludes with public health recommendations based on a summary of the published litera

According to the World Health Organization (WHO), particulate matter (PM) contamination causes around 800,000 premature deaths per year, ranking 13th in the world in terms of mortality. However, several findings revealed that the correlation is much stronger and more complicated than previously believed. PM is an element of emissions comprised of very small, acidic, organic compounds, metals, and particulate soil or dust particles or fluid droplets. The most consistent air quality component linked to human illness is PM, which is categorized by size. PM is likely to develop cardiovascular and cerebrovascular disorders due to the mechanisms of inflammation, overt and indirect coagulation activation, and direct translocation to the systemic circulation. The evidence on the cardiovascular system that shows a PM effect is strong. Coronary incidence and mortality rates in populations prone to long-term PM toxicity were significantly higher. Short-term acute emissions increase coronary incidence rates subtly within days of the pollution peak. While some evidence and associated mechanisms show a smaller outcome, the findings for PM’s cortical disease symptoms are not as promising. Respiratory infections are aggravated by exposure to PM. More analysis is needed to clarify the effects of structure, chemistry, and PM for vulnerable groups. The existing research indicates that PM toxicity causes a minor but significant increase in human morbidity and mortality. Air conditioners and particulate matter filters reduced internal heating, and cooking combustion and smoking cessation will reduce indoor PM exposure. These fundamental improvements can be beneficial to patients with acute and chronic cardiovascular and respiratory symptoms. This article provides an overview of the effects of atmospheric airborne suspended particulate matter on population morbidity and mortality. This critical review concludes with public health recommendations based on a summary of the published litera

According to the World Health Organization (WHO), particulate matter (PM) contamination causes around 800,000 premature deaths per year, ranking 13th in the world in terms of mortality. However, several findings revealed that the correlation is much stronger and more complicated than previously believed. PM is an element of emissions comprised of very small, acidic, organic compounds, metals, and particulate soil or dust particles or fluid droplets. The most consistent air quality component linked to human illness is PM, which is categorized by size. PM is likely to develop cardiovascular and cerebrovascular disorders due to the mechanisms of inflammation, overt and indirect coagulation activation, and direct translocation to the systemic circulation. The evidence on the cardiovascular system that shows a PM effect is strong. Coronary incidence and mortality rates in populations prone to long-term PM toxicity were significantly higher. Short-term acute emissions increase coronary incidence rates subtly within days of the pollution peak. While some evidence and associated mechanisms show a smaller outcome, the findings for PM’s cortical disease symptoms are not as promising. Respiratory infections are aggravated by exposure to PM. More analysis is needed to clarify the effects of structure, chemistry, and PM for vulnerable groups. The existing research indicates that PM toxicity causes a minor but significant increase in human morbidity and mortality. Air conditioners and particulate matter filters reduced internal heating, and cooking combustion and smoking cessation will reduce indoor PM exposure. These fundamental improvements can be beneficial to patients with acute and chronic cardiovascular and respiratory symptoms. This article provides an overview of the effects of atmospheric airborne suspended particulate matter on population morbidity and mortality. This critical review concludes with public health recommendations based on a summary of the published litera

OBJECTIVES: Many patients who have had stroke survive with functional disability for years. Stroke prevalence is a fundamental measure of the impact of stroke in society. Stroke prevalence has never been evaluated in Sweden. MATERIALS & METHODS: 2019 with respect to stroke survivors (ICD-10 I60-I69) living in Kumla (population 21,738), a municipality well representative of Sweden. RESULTS: 330 individuals with stroke were found, of which 42% were women. The mean age was 74.1 years in men and 75.1 years in women. 11.5% of the patients had more than one stroke. The mean duration since the first stroke was 8.3 years. The crude prevalence per 100,000 was 1754 in men, 1281 in women and 1518 in both sexes. Adjusted to the European population, the ratio was 1570 per 100,000, and to the World population 936 per 100,000. CONCLUSIONS: In spite of a declining stroke incidence in Sweden, the stroke prevalence in Kumla, Sweden, is relatively high. Comparisons with other studies indicate that a decline in prevalence may have occurred since the early 2000s. Modern registers can support data collection, but the index stroke may have occurred almost forty years back in time.

Background and purpose: The aim of this study was to determine the differences in life expectancy and causes of death after primary intracerebral hemorrhage (ICH) relative to general population controls. Methods: In a population-based setting, 963 patients from Northern Ostrobothnia who had their first-ever ICH between 1993 and 2008 were compared with a cohort of 2884 sex- and age-matched controls in terms of dates and causes of death as extracted from the Causes of Death Register kept by Statistics Finland and valid up to the end of 2017. Results: Of our 963 patients, 781 died during the follow-up time (mortality 81.1%). Cerebrovascular disease was the most common cause of death for these patients, 37.3% compared with 8.2% amongst the controls. The most common reasons for cerebrovascular mortality in the ICH patients were late sequelae of ICH in 12.8% (controls 0%) and new bleeding in 10.6% (controls 1.0%). The long-term survivors had a smaller ICH volume (median 12 ml) than those patients who died within 3 months (median 39 ml). The mortality rate of ICH patients during a follow-up between 12 and 24 years was still higher than that of their controls (hazard ratio 2.08, 95% confidence interval 1.58–2.74, p < 0.001). Conclusions: Very long-term ICH survivors have a constant excess mortality relative to controls even 10 years after the index event. A significantly larger proportion of patients died of cerebrovascular causes and fewer because of cancer relative to the controls.

In recent years, the problem of diagnosis and preventive treatment of cerebrovascular diseases has become increasingly relevant. Stroke is the most common cause of permanent disability (E. I. Gusev, 2007). The leading role in the diagnosis and prognosis of stroke, as well as the choice of further treatment and rehabilitation tactics is assigned to non-invasive ultrasound research methods, which make it possible to assess the parameters of cerebral hemodynamics. (I. D. Stulin, 2006). &nbsp

Background: Cardiovascular disease is the first cause of death in Spain. There are a few studies about the incidence of ischemic heart disease and cerebrovascular disease in workers. The objectives of this study were to determine the incidence of coronary and cerebrovascular disease in a cohort of workers of a public administration in the south of Spain, to estimate the prevalence of CVRF and its contribution to it, as well as to evaluate the predictive behavior of the REGICOR function. Methods: Longitudinal historical cohort study, not concurrent, consisting of 698 workers, recruited from occupational health examinations. The dependent variables were the appearance of CI or CVD while leading independent were glucose, cholesterol, triglycerides, BMI, blood pressure, waist circumference, physical activity, smoking and REGICOR score and Score. Is performed Cox regression and its calculated area AUC of the ROC curve area for the explanatory variables. Results: According to the REGICOR function, 0.6% of the population was classified as high risk. The Incidence Density per 100,000 persons-year for ischemic heart disease in women was found to be 53.9 by 357.4 in men, without significant differences with respect to those expected from the REGICOR function. The combined DI for ischemic heart disease and stroke was 477.1 per 100,000 person- years (men). Conclusions: The REGICOR function adequately assesses cardiovascular risk globally, losing predictive capacity according to risk groups. Smoking and blood pressure are shown as modifiable risk factors with greater independent association in the onset of cardiovascular disease., Fundamentos: Las enfermedades cardiovasculares son la primera causa de muerte en España. Existen escasos estudios sobre incidencia de acontecimientos cardiovasculares en trabajadores. Los objetivos de este trabajo fueron conocer la incidencia de cardiopatía isquémica (CI) y enfermedad cerebrovascular (ECV) en trabajadores de una administración pública del sur de España, estimar la prevalencia de los factores de riesgo cardiovascular (FRCV) y su contribución a la misma, así como evaluar el comportamiento predictivo de la función REGICOR. Métodos: Se realizó un estudio longitudinal de cohortes históricas, no concurrentes, constituidas por 698 trabajadores, reclutados en los exámenes de salud laboral. Las variables dependientes fueron la aparición de CI o ECV, mientras que las principales independientes fueron glucosa, colesterol, triglicéridos, Índice de Masa Corporal (IMC), presión arterial, perímetro abdominal, actividad física, tabaquismo y puntuación REGICOR. Se llevó a cabo una regresión de Cox y se calculó el área ABC de la curva ROC para las variables explicativas. Resultados: Según la función REGICOR, se clasificó de alto riesgo al 0,6% de la población. La Densidad de Incidencia (DI) por cada 100.000 personas- año para cardiopatía isquémica en mujeres resultó ser de 53,9 por 357,4 en hombres, sin diferencias significativas respecto a las esperadas a partir de la función REGICOR. La DI combinada para cardiopatía isquémica y accidentes cerebrovasculares fue de 477,1 por cada 100.000 personas-año (en hombres). Conclusiones: La función REGICOR valora adecuadamente el riesgo cardiovascular de manera global, perdiendo capacidad predictiva según grupos de riesgo. El tabaquismo y la presión arterial se muestran como los factores de riesgo modificables con mayor asociación independiente en la aparición de una enfermedad cardiovascular.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China and rapidly spread worldwide, with a vast majority of confirmed cases presenting with respiratory symptoms. Potential neurological manifestations and their pathophysiological mechanisms have not been thoroughly established. In this narrative review, we sought to present the neurological manifestations associated with coronavirus disease 2019 (COVID-19). Case reports, case series, editorials, reviews, case-control and cohort studies were evaluated, and relevant information was abstracted. Various reports of neurological manifestations of previous coronavirus epidemics provide a roadmap regarding potential neurological complications of COVID-19, due to many shared characteristics between these viruses and SARS-CoV-2. Studies from the current pandemic are accumulating and report COVID-19 patients presenting with dizziness, headache, myalgias, hypogeusia and hyposmia, but also with more serious manifestations including polyneuropathy, myositis, cerebrovascular diseases, encephalitis and encephalopathy. However, discrimination between causal relationship and incidental comorbidity is often difficult. Severe COVID-19 shares common risk factors with cerebrovascular diseases, and it is currently unclear whether the infection per se represents an independent stroke risk factor. Regardless of any direct or indirect neurological manifestations, the COVID-19 pandemic has a huge impact on the management of neurological patients, whether infected or not. In particular, the majority of stroke services worldwide have been negatively influenced in terms of care delivery and fear to access healthcare services. The effect on healthcare quality in the field of other neurological diseases is additionally evaluated.

In recent years, the problem of diagnosis and preventive treatment of cerebrovascular diseases has become increasingly relevant. Stroke is the most common cause of permanent disability (E. I. Gusev, 2007). The leading role in the diagnosis and prognosis of stroke, as well as the choice of further treatment and rehabilitation tactics is assigned to non-invasive ultrasound research methods, which make it possible to assess the parameters of cerebral hemodynamics. (I. D. Stulin, 2006). &nbsp

In recent years, the problem of diagnosis and preventive treatment of cerebrovascular diseases has become increasingly relevant. Stroke is the most common cause of permanent disability (E. I. Gusev, 2007). The leading role in the diagnosis and prognosis of stroke, as well as the choice of further treatment and rehabilitation tactics is assigned to non-invasive ultrasound research methods, which make it possible to assess the parameters of cerebral hemodynamics. (I. D. Stulin, 2006). &nbsp

Introduction: pneumonias associated with ventilation cause great concern to physicians who pose serious diagnostic difficulties which in turn often motivate the making of disproportionate therapeutic decisions that favor the genesis of antimicrobial resistance. Objective: assess the behavior of pneumonia associated with mechanical ventilation as an indicator of quality of care in the Unit of Intensive Adult Therapy of the General Teaching Hospital "Octavio de la Concepción y de la Pedraja" of Baracoa between January-December 2015. Method: a cross-sectional descriptive study was carried out. From a universe of 67 patients, a sample of 27 patients was taken by the simple random method, which developed this disease associated with ventilation according to age groups, sex, conditions that led to its use, time of onset of symptoms and microbiological results. Results: the underlying diseases that most affected were cerebrovascular diseases followed by respiratory distress and severe sepsis. In the first nine days, the symptoms appeared. Greater isolation of Gram negative germs was obtained. Conclusions: the behavior of the pneumonias associated to ventilation was given in the male sex, older than 60 years, they were associated with a greater frequency to the cerebrovascular diseases, in the majority the symptoms appeared between 4 and 6 days; Staphylococcus epidermidis and Klebsiellap pneumoniae were the germs that were most frequently isolated in these patients., Introdução: as pneumonias associadas à ventilação são motivo de grande preocupação para os médicos que apresentam sérias dificuldades diagnósticas, que por sua vez, muitas vezes motivam a tomada de decisões terapêuticas desproporcionais que favorecem a gênese da resistência antimicrobiana. Objetivo: avaliar o comportamento da pneumonia associada à ventilação mecânica como um indicador de qualidade de atendimento na Unidade de Terapia Intensiva de Adultos do Hospital Geral de Ensino "Octavio de la Concepción y de la Pedraja" de Baracoa entre janeiro-dezembro de 2015. Método: foi realizado um estudo descritivo transversal. De um universo de 67 pacientes, uma amostra de 27 pacientes foi tomada pelo método aleatório simples, que desenvolveu essa doença associada à ventilação de acordo com as faixas etárias, sexo, condições que levaram ao seu uso, tempo de início dos sintomas e resultados microbiológicos. Resultados: as doenças de base que mais afetaram foram as doenças cerebrovasculares, seguidas de desconforto respiratório e sepse grave. Nos primeiros nove dias, os sintomas apareceram. Maior isolamento de germes Gram negativos foi obtido. Conclusões: o comportamento das pneumonias associadas à ventilação foi dado no sexo masculino, com idade superior a 60 anos, foram associadas com maior frequência às doenças cerebrovasculares, na maioria os sintomas apareceram entre 4 e 6 dias; Staphylococcus epidermidis e Klebsiellap pneumoniae foram os germes mais freqüentemente isolados nesses pacientes., Introducción: las neumonías asociadas a la ventilación causan grandes inquietudes a los médicos que plantean serias dificultades diagnósticas las que a su vez motivan a menudo la toma de decisiones terapéuticas desproporcionadas que favorecen la génesis de la resistencia antimicrobiana. Objetivo: valorar el comportamiento de la neumonía asociada a la ventilación mecánica como indicador de calidad asistencial en la Unidad de Terapia Intensiva de Adultos del Hospital General Docente “Octavio de la Concepción y de la Pedraja” de Baracoa entre enero-diciembre de 2015. Método: se realizó un estudio descriptivo transversal. De un universo de 67 pacientes se tomó una muestra de 27 pacientes por el método aleatorio simple, que desarrollaron esta enfermedad asociada a la ventilación según grupos de edades, sexo, afecciones que propiciaron usarla, tiempo de aparición de los síntomas y resultados microbiológicos. Resultados: las enfermedades de base que más incidieron fueron las enfermedades cerebrovasculares seguidas por distrés respiratorio y sepsis severa. En los primeros nueve días fue que aparecieron los síntomas. Se obtuvo mayor aislamiento de gérmenes Gram negativo. Conclusiones: el comportamiento de las neumonías asociadas a la ventilación estuvo dado en el sexo masculino, mayores de 60 años, se asociaron con mayor frecuencia a las enfermedades cerebrovasculares, en su mayoría los síntomas aparecieron entre 4 y 6 días; el Staphylococcus epidermidis y la Klebsiellap neumoniae fueron los gérmenes que con mayor frecuencia se aislaron en estos pacientes.

The health of the working population is an important characteristic of the economic and social state of the country. Occupational diseases according to WHO is the cause of 1.7 million deaths in the world. The third place in the structure of occupational morbidity is occupied by vibration-noise pathology (5-18%). In this group, cases of vibration disease (VD) make up 60-70%. In the structure of diseases of the circulatory system (DCS) among the adult population, cerebrovascular diseases (CVD) rank third after hypertension and coronary heart disease and make up 16.8%. Death rate from CVD takes the 4th place in the world. To develop a forecast for the emergence of CVD in patients with VD caused by whole-body vibration, we analyzed a number of anthropometric and physiological indicators. There was performed a profound in patient examination of 179 patients with VD (149 workers of mining enterprise with surface mining operations with VD caused by whole-body vibration without CVD and 30 patients with diagnosed CVD in addition to CVD). The diagnostic value of individual anthropometric indicators and indicators of systemic hemodynamics (arterial pressure) in VD caused by whole-body vibration and CVD in these patients was proved. Increased body weight with fat distribution by the abdominal type increases the risk of early VD and CVD occurrence. The regularity of dependence of arterial hypertension onset (increase of blood pressure above the level of 140/86 mm Hg) with the duration of the harmful effect of vibration was determined. At the same time, the share of workers with optimal blood pressure figures decreases with increasing duration of the action of the whole-body vibration. Thus, the metabolic and blood pressure indicators can be used to further construct predictive models for the development of CVD in patients with VD caused by whole-body vibration.

Cerebral autoregulation (CA) is the brain's ability to always maintain an adequate and relatively constant blood supply, which is often impaired in cerebrovascular diseases. Near-infrared spectroscopy (NIRS) examines oxygenated hemoglobin (OxyHb) in the cerebral cortex. Low- and very low-frequency oscillations (LFOs 0.1 Hz and VLFOs 0.05 to 0.01 Hz) in OxyHb have been proposed to reflect CA. Aim: To systematically review published results on OxyHb LFOs and VLFOs in cerebrovascular diseases and related conditions measured with NIRS. Approach: A systematic search was performed in the MEDLINE database, which generated 36 studies relevant for inclusion. Results: Healthy people have relatively stable LFOs. LFO amplitude seems to reflect myogenic CA being decreased by vasomotor paralysis in stroke, by smooth muscle damage or as compensatory action in other conditions but can also be influenced by the sympathetic tone. VLFO amplitude is believed to reflect neurogenic and metabolic CA and is lower in stroke, atherosclerosis, and with aging. Both LFO and VLFO synchronizations appear disturbed in stroke, while the former is also altered in internal carotid stenosis and hypertension. Conclusion: We conclude that amplitudes of LFOs and VLFOs are relatively robust measures for evaluating mechanisms of CA and synchronization analyses can show temporal disruption of CA. Further research and more coherent methodologies are needed.

Objectives: Our purpose was to explore major vascular and bleeding outcomes in relation to risk and severity scores (ABCD2 or NIHSS) in patients with transient ischemic attack (TIA) or acute ischemic stroke (AIS). Methods: This nationwide observational study was based on data from 4 national registries. Outcomes were assessed by Kaplan-Meier and Cox regression analyses. Results: The total cohort comprised 21268 patients (median age 73years, 47.6% females). Based on ABCD2-score, the TIA-population (n=10174) was divided into low-risk (0-3 p, n=3463) and high-risk (4-7 p, n=6711). Based on NIHSS-score, the AIS-population (n=11454) was divided into minor (0-5 p, n=8596), moderate (6-10 p, n=1630) and severe (11 p, n=1228). During follow-up (mean 1.7years), the composite endpoint of stroke, myocardial infarction or death occurred in 3572 (16.5%) of all the patients, and major bleeding in 668 (3.1%) patients. Using low-risk TIA as reference, the adjusted hazard ratios (HR, 95% CI) of the composite endpoint were 1.41 (1.23-1.62) for high-risk TIA, 1.94 (1.70-2.22) for minor, 2.86 (2.45-3.34) for moderate and 4.18 (3.57-4.90) for severe stroke. When analyzed separately, the association with increased risk remained significant for stroke and death, but not for myocardial infarction. The HR of major bleeding were 1.31 (0.99-1.73) for high-risk TIA, 1.49 (1.13-1.95) for minor, 1.54 (1.08-2.21) for moderate and 2.10 (1.44-3.05) for severe stroke. Conclusions: This study confirms the association between severity of the index ischemic stroke and risk of future major vascular and bleeding events, and highlights the increased risk also for patients with high-risk TIA.

BACKGROUND: Patients with aneurysmal subarachnoid hemorrhage (aSAH) have poor outcome. Studies on outcome beyond 1 year post-aSAH are few, and late recovery is poorly investigated, initiating this prospective outcome study on patients 12-15 years after an aSAH. We hypothesized to find; functional improvement > 1 year post-ictus; increased long-term mortality in aSAH patients vs matched controls, and finally to present; predictors of long-term favorable outcome (GOS 4-5). METHODS: We prospectively investigated patients, admitted 2000-2003 to the Sahlgrenska University Hospital, 1 year post-ictus using Glasgow Outcome Scale (GOS). The patients were revalidated 12-15 years post-aSAH by structured-telephone interviews (GOS), followed by statistical analysis. RESULTS: A total of 158 patients were included, (women n = 114, men n = 44), with a mean age of 55 years at aSAH. Patients treated with surgical clipping had lower mortality. At the follow-up 12-15 years post-aSAH, all 103 survivors (65.2%) were categorized as having; good recovery (39.9%), moderate disability (15.2%), or severe disability (10.1%). Within the patient cohort, 23.6% improved GOS over time. Fifty-five patients died, median at 4 years post-ictus. aSAH patients had 3.5 times increased mortality 12-15 years post-ictus vs matched controls (P < .0001). Patients with favorable outcome at 1 year (67.3%, n = 101) had similar survival probability as control patients. Prognostic indicators of long-term favorable outcome were low age and high GOS at 1-year follow-up, (AUCROC, 0.79). CONCLUSIONS: Individual functional improvement was found >1 year post-ictus. Patients with favorable outcome at 1 year had similar long-term life expectancy as the general population. Indicators of long-term favorable prognosis were low age at ictus and high GOS at 1-year follow-up.

Одной из ведущих проблем общественного здоровья и здравоохранения в мире и в Российской Федерации является ущерб, наносимый цереброваскулярными заболеваниями. Заболевания системы кровообращения устойчиво занимают лидирующую позицию в структуре общей смертности: в 2017 году России — 47,8 %, в Свердловской области — 48,2 %. В данном классе болезней доля смертности от цереброваскулярных болезней (ЦВБ) составляет 30,9 %, занимая 2-е место после кардиоваскулярной патологии. В России за 2012–2016 годы общая смертность от ЦВБ в целом по стране снизилась на 15,4 %, а в Свердловской области на 49,1 %. Смертность населения от ЦВБ трудоспособном возрасте является одним из индикаторов оценки трудового потенциала. Первичная заболеваемость ЦВБ в Свердловской области на 11,3 % ниже по сравнению с Россией, и наблюдается тенденция к снижению заболеваемости. Инвалидность населения в связи с болезнями кровообращения обладает тенденцией к снижению как в России (-18,6 %), так и в Свердловской области (-24,6 %), и занимает второе место после новообразований. Необходимо совершенствование и оценка эффективности оказания медицинской помощи и реабилитации, мониторинга реабилитации на основе современных информационных технологий., One of the leading public health and health problems in the world and in the Russian Federation is the damage caused by cerebrovascular diseases. Diseases of the circulatory system steadily occupy a leading position in the structure of total mortality: in 2017 in Russia — 47.8 %, in the Sverdlovsk region — 48.2 %. In this class of diseases, the share of mortality from cerebrovascular diseases (CVB) is 30.9 %, taking 2nd place after cardiovascular disease. In Russia, in 2012–2016, the total mortality from CVB in the whole country decreased by 15.4 %, and in the Sverdlovsk region by 49.1 %. Mortality from CVB at working age is one of the indicators of labour potential assessment. The primary incidence of CVB in the Sverdlovsk region is 11.3 % lower than in Russia, and there is a tendency to reduce the incidence. Disability of the population due to diseases of blood circulation has a tendency to decrease in Russia (-18.6 %) and in the Sverdlovsk region (-24.6 %), and ranks second after tumors. Therefore, it is necessary to improve and evaluate the effectiveness of medical care and rehabilitation, monitoring of rehabilitation on the basis of modern information technologies.

Cerebral autoregulation (CA) is the brain's ability to always maintain an adequate and relatively constant blood supply, which is often impaired in cerebrovascular diseases. Near-infrared spectroscopy (NIRS) examines oxygenated hemoglobin (OxyHb) in the cerebral cortex. Low- and very low-frequency oscillations (LFOs 0.1 Hz and VLFOs 0.05 to 0.01 Hz) in OxyHb have been proposed to reflect CA. Aim: To systematically review published results on OxyHb LFOs and VLFOs in cerebrovascular diseases and related conditions measured with NIRS. Approach: A systematic search was performed in the MEDLINE database, which generated 36 studies relevant for inclusion. Results: Healthy people have relatively stable LFOs. LFO amplitude seems to reflect myogenic CA being decreased by vasomotor paralysis in stroke, by smooth muscle damage or as compensatory action in other conditions but can also be influenced by the sympathetic tone. VLFO amplitude is believed to reflect neurogenic and metabolic CA and is lower in stroke, atherosclerosis, and with aging. Both LFO and VLFO synchronizations appear disturbed in stroke, while the former is also altered in internal carotid stenosis and hypertension. Conclusion: We conclude that amplitudes of LFOs and VLFOs are relatively robust measures for evaluating mechanisms of CA and synchronization analyses can show temporal disruption of CA. Further research and more coherent methodologies are needed.

Objective: to determine the inequalities in mortality due to specific causes related to socioeconomic characteristics in the municipalities of the Huila department, Colombia between 2009 and 2013. Methodology: an ecological study comparing mortality rates due to acute respiratory infection, stomach cancer, hypertensive and cerebrovascular disease, traffic accidents, homicide, diabetes and childhood mortality based on socioeconomic status according to the following socioeconomic variables: secondary education coverage, unsatisfied basic needs, rurality, economic sufficiency, municipality’s added value and water quality index. The study included the 37 municipalities of the Huila department. Age-adjusted rates were calculated using the direct method and the inequalities were measured by comparing against the described variables using rank, regression and disproportionality based measures. The Epidat 4.0 software was used for this purpose. Results: child mortality and mortality due to gastric cancer and hypertensive disease showed constant inequality regarding the assessed socioeconomic variables in the less favored municipalities. As for mortality due to acute respiratory infections and homicides, higher rates were observed in municipalities with better socioeconomic conditions. Conclusions: there is great variability in the socioeconomic conditions of the municipalities and the mortality rates due to the assessed events. The authors observed an acceptable correlation between the different measures of inequality used in the study., Objetivo: determinar as desigualdades na mortalidade por causas específicas relacionadas a características socioeconômicas nos municípios de Huila entre os anos de 2009 e 2013. Metodologia: estudo ecológico que comparou as mortalidades por infecção respiratória aguda, câncer de estômago, doenças hipertensivas e acidentes vasculares cerebrais, acidentes de trânsito, homicídio, diabetes e mortalidade na infância com base na situação socioeconômica segundo as variáveis socioeconômicas cobertura do ensino médio, NBI, Ruralidade, Suficiência Econômica; Valor Agregado Municipal e o Índice de Qualidade da Água nos 37 municípios de Huila. Foram calculadas as taxas ajustadas por idade com o método direto e a medição de desigualdades, confrontando-as com as variáveis descritas, a partir da utilização de medidas baseadas no intervalo, em regressão e em desproporcionalidade, utilizando-se o software Epidat 4.0. Resultados: na mortalidade por câncer gástrico, por doenças hipertensivas e na mortalidade na infância foram identificadas constantes desigualdades em relação às variáveis socioeconômicas avaliadas contrárias aos municípios menos favorecidos. Para a mortalidade por infecções respiratórias agudas e homicídios, foram observadas maiores taxas nos municípios com melhores condições socioeconômicas. Conclusões: existe uma grande variedade entre as condições socioeconômicas dos municípios e entre as mortalidades para os eventos avaliados, observando-se uma correlação aceitável entre as diferentes medidas de desigualdade utilizadas., Introducción: Las condiciones en que la gente nace, vive, trabaja y envejece se relacionan con la situación de salud. La cuantificación de diferencias en estas condiciones confrontadas con variables sanitarias es medición de desigualdades.Objetivo: Determinar las desigualdades en la mortalidad por causas específicas relacionadas con características socioeconómicas en municipios del Huila 2009-2013.Materiales y métodos: Estudio ecológico que comparó las mortalidades por infección respiratoria aguda, cáncer de estómago, enfermedades hipertensivas y cerebrovasculares, accidentes de tránsito, homicidio, diabetes y mortalidad en niñez con base en su situación socioeconómica según las variables socioeconómicas cobertura de educación media, NBI, Ruralidad, Suficiencia Económica; Valor Agregado Municipal y el Índice de Calidad del Agua en los 37 municipios del Huila. Se calcularon tasas ajustadas por edad con el método directo y medición de desigualdades confrontando las variables descritas, usando medidas basadas en rango, en regresión y en desproporcionalidad, usando el software Epidat 4.0. Resultados: En la mortalidad por cáncer gástrico, por enfermedades hipertensivas y la mortalidad en niñez se identificó constante desigualdad frente a las variables socioeconómicas evaluadas en contra de los municipios menos favorecidos. En la mortalidad por infecciones respiratorias agudas y homicidios se observaron mayores tasas en los municipios con mejores condiciones socioeconómicas. Conclusiones: Existe gran variabilidad entre los condiciones socioeconómicas de los municipios y entre las mortalidades por los eventos evaluados, observando aceptable correlación entre las diferentes medidas de desigualdades utilizadas.

A descriptive cross-sectional study was carried out to evaluate the behavior of ventilator-associated pneumonia (VAP) in the Adult Intensive Care Unit of the General Teaching Hospital "Octavio de la Concepción and de la Pedraja" in Baracoa between January –December 2015. From a universe of 67 patients, a sample of 27 patients was taken by the simple random method, which developed this disease associated with ventilation according to age, groups, sex, conditions that led to its use, time of onset of symptoms and microbiological results. The behavior of mechanic ventilator-associated pneumonias in males, older than 60 years, were more frequently associated with cerebrovascular diseases, most of the symptoms appeared between 4 and 6 days; Staphylococcus epidermidis and Klebsiellap pneumoniae were the most frequently isolated germs in these patients., Se realizó un estudio descriptivo transversal con el objetivo de valorar el comportamiento de la neumonía asociada a la ventilación mecánica (NAV) en la Unidad de Terapia Intensiva de Adultos del Hospital General Docente “Octavio de la Concepción y de la Pedraja” de Baracoa entre enero-diciembre de 2015. De un universo de 67 pacientes se tomó una muestra de 27 pacientes por el método aleatorio simple, que desarrollaron esta enfermedad asociada a la ventilación según grupos de edades, sexo, afecciones que propiciaron usarla, tiempo de aparición de los síntomas y resultados microbiológicos. El comportamiento de las neumonías asociadas a la ventilación estuvo dado en el sexo masculino, mayores de 60 años, se asociaron con mayor frecuencia a las enfermedades cerebrovasculares, en su mayoría los síntomas aparecieron entre 4 y 6 días; el Staphylococcus epidermidis y la Klebsiellap neumoniae fueron los gérmenes que con mayor frecuencia se aislaron en estos pacientes.

Актуальність. Медико-соціальне значення проблеми гострих порушеннь мозкового кровообігу визначається високою питомою вагою їх у структурі захворюваності та смертності населення, високими показниками первинної інвалідності. Мета дослідження. Вивчення та узагальнення статистичних даних щодо епідеміології транзиторних ішемічних атак у структурі гострих порушень мозкового кровообігу в Україні та інших країнах. Матеріали та методи. Аналітичний огляд наукових публікацій та офіційних статистичних звітів за останні 15 років із використанням сучасних наукометричних баз даних і фондів наукових бібліотек України, Європейського Союзу, Великобританії, Сполучених Штатів Америки. Висновки. Проведений епідеміологічний аналіз свідчить про підвищений інтерес клініцистів до проблеми гострих порушень мозкового кровообігу з епідеміологічних і організаційних питань, що сприятиме удосконаленню терапевтичних методів, зниженню захворюваності, поширеності, інвалідності та смертності населення, а також продовженню тривалості якісного життя таких пацієнтів., Актуальность. Медико-социальное значение проблемы острых нарушений мозгового кровообращения определяется высоким удельным весом их в структуре заболеваемости и смертности населения, высокими показателями первичной инвалидности. Цель. Изучение и обобщение статистических данных по эпидемиологии транзиторных ишемических атак в структуре острых нарушений мозгового кровообращения в Украине и других странах. Материалы и методы. Аналитический обзор научных публикаций и официальных статистических отчетов за последние 15 лет с использованием современных наукометрических баз данных и фондов научных библиотек Украины, Европейского союза, Великобритании, Соединенных Штатов Америки. Выводы. Проведенный эпидемиологический анализ свидетельствует о повышенном интересе клиницистов к проблеме острых нарушений мозгового кровообращения в эпидемиологических и организационных аспектах, что способствует совершенствованию терапевтических методов, снижению заболеваемости, распространенности, инвалидности и смертности населения, а также увеличению продолжительности качественной жизни пациентов с острыми нарушениями мозгового кровообращения., Background. Few epidemiological data are available regarding the prevalence and incidence of transient ischemic attack (TIA). The purpose of our work was to analyze the epidemiology of transient ischemic attacks in the structure of acute cerebrovascular disorders in Ukraine and other countries based on official statistical reports. Materials and methods. Analytical review of official statistical reports and scientific publications for the last 15 years based on the analysis of modern scientometric databases and libraries of Ukraine, the EU, US, UK has been performed. Conclusions. We found a high annual TIA incidence rate and a fair TIA prognosis confirming higher acute cerebrovascular disorders incidence and mortality rates in Ukraine compared to other countries.

Objective. Evaluate the provision of the neurosurgical care to the patients with the cerebrovascular diseases (CVD) in Ukraine and determine the ways of its improvement.Materials and methods. The analysis has been performed based on the statistical data regarding the clinical care in the departments of neurosurgery in Ukraine within 2006-2015 years. The statistical methods of sampling and grouping and statistical series studies have been used. Calculations have been performed using Microsoft Office Excel.Results. The number of the patients with CVD who were hospitalized into national departments of neurosurgery increased by 76% (from 143 patients with CVD per 1 million of population — in 2006 up to 252 — in 2015) over the past decade. In 2015, 119 patients with CVD per 1 million had surgeries; it is 2.3-fold higher than in 2006 (51). The proportion of hospitalized patients with CVD increased from 7 to 10% within 10 years, surgically operated patients — from 6 to 11%.The surgical activity increased from 36% — in 2006 to 47.4% — in 2015 (rate of increase: 32%). The rate of mortality was decreased: total — from 10.5 to 8.9% (rate of decrease: 15%), post-surgical — from 16.9 to 8.9% (rate of decrease: 47%).Kiev is the leader of the neurosurgical care provision to the patients with CVD based on the absolute values. In 2015, 4173 patients with CVD (46% of all patients in Ukraine — 9146) were hospitalized into the departments of neurosurgery in the capital city; 2177 surgical interventions (50% of all patients who underwent surgeries in the country — 4336) were performed.In 2015, Ivano-Frankovsk (17.9%), Dnepropetrovsk (16.2%), Lvov (12.1%) regions provided the most neurosurgical care in CVD; in 8 regions the provision index was 5-10%; in 10 regions it was less than 5%. No neurosurgical care was provided to the patients with CVD in Sumy region. Overall, the provision index of the neurosurgical care in CVD in Ukraine was 13.3%.Conclusions. The number of patients with CVD, Цель. Оценить качество оказания нейрохирургической помощи пациентам при цереброваскулярных болезнях (ЦВБ) в Украине, определить пути ее совершенствования.Материалы и методы. Анализ проведен на основе статистических сведений о лечебной работе нейрохирургических отделений Украины за период 2006-2015 гг. Использованы статистические методы выборки и группировки, исследования динамических рядов. Подсчеты осуществлены с помощью программы Microsoft Office Excel.Результаты. За 10 лет число пациентов с ЦВБ, госпитализированных в нейрохирургические отделения страны, увеличилась на 76% (с 143 на 1 млн. населения — в2006 г. до 252 — в2015 г.). В2015 г. на 1 млн. оперированы 119 пациентов по поводу ЦВБ, что в 2,3 раза больше, чем в2006 г. (51). Доля пациентов с ЦВБ в структуре госпитализированных за 10 лет увеличилась с 7 до 10%, в структуре оперированных — с 6 до 11%.Хирургическая активность с 36% — в2006 г. увеличилась до 47,4% — в2015 г. (темп прироста — 32%). Отмечено снижение летальности: общей — с 10,5 до 8,9% (темп снижения — 15%), послеоперационной — с 16,9 до 8,9% (темп снижения — 47%).Лидером по абсолютным показателям предоставления нейрохирургической помощи пациентам с ЦВБ является Киев. В2015 г. в нейрохирургические отделения столицы госпитализированы 4173 пациентов с ЦВБ (46% всех больных в Украине — 9146); оперированы 2177 (50% всех оперированных в стране — 4336).В2015 г. наиболее обеспеченными нейрохирургической помощью при ЦВБ были Ивано-Франковская (17,9%), Днепропетровская (16,2%), Львовская (12,1%) области, в 8 областях показатель обеспеченности был в пределах 5—10%; в 10 — меньше 5%. В Сумской области нейрохирургическую помощь пациентам по поводу ЦВБ не оказывали. В целом по Украине обеспеченность нейрохирургической помощью при ЦВБ составила 13,3%.Выводы. За 10 лет число пациентов с ЦВБ, которым оказана специализированная нейрохирургическая помощь, увеличилось более чем вдвое. Отмечено значительное повышение хирургической активности и снижение общей и посл, Мета. Оцінити якість надання нейрохірургічної допомоги пацієнтам з цереброваскулярними хворобами (ЦВХ) в Україні, визначити шляхи її вдосконалення.Матеріали і методи. Аналіз проведений на основі статистичних відомостей про лікувальну роботу нейрохірургічних відділень України за період 2006—2015 рр. Використані статистичні методи вибірки і групування, дослідження динамічних рядів. Обчислення здійснені за допомогою програми Microsoft Office Excel.Результати. За останні 10 років кількість пацієнтів з ЦВХ, госпіталізованих в нейрохірургічні відділення країни, збільшилася на 76% (з 143 на 1 млн. населення — у 2006 р. до 252 — у 2015 р.). У 2015 р. на 1 млн. оперовані 119 пацієнтів з ЦВХ, що у 2,3 разу більше, ніж у 2006 р. (51). Частка пацієнтів з ЦВХ в структурі госпіталізованих за 10 років збільшилася з 7 до 10%, в структурі оперованих — з 6 до 11%.Хірургічна активність з 36% — у 2006 р. збільшилася до 47,4% у 2015 р. (темп приросту — 32%). Відзначене зниження летальності: загальної — з 10,5 до 8,9% (темп зниження — 15%), післяопераційної — з 16,9 до 8,9% (темп зниження — 47%).Лідером за абсолютними показниками надання нейрохірургічної допомоги пацієнтам з приводу ЦВХ є Київ. У 2015 р. у нейрохірургічні відділення столиці госпіталізовані 4173 пацієнтів з ЦВХ (46% усіх хворих в Україні — 9146); оперовані — 2177 (50% усіх оперованих в країні — 4336).У 2015 р. найбільш забезпеченими нейрохірургічною допомогою при ЦВХ були Івано-Франківська (17,9%), Дніпропетровська (16,2%), Львівська (12,1%) області; у 8 областях показник забезпечення становив 5—10%; в 10 — менше 5%. У Сумській області нейрохірургічну допомогу пацієнтам з приводу ЦВХ не надавали. В цілому по Україні забезпечення нейрохірургічною допомогою при ЦВХ становило 13,3%.Висновки. За 10 років кількість пацієнтів з ЦВХ, яким надано спеціалізовану нейрохірургічну допомогу, збільшилася більш ніж удвічі. Спостерігали значне збільшення хірургічної активності, зниження загальної та післяопераційної летальності. Рівен

BACKGROUND: There is a need for a prehospital stroke test that in addition to high sensitivity for stroke, also is able to communicate stroke severity similar to the National Institute of Health Stroke Scale (NIHSS). METHODS: The PreHospital Ambulance Stroke Test (PreHAST), an eight item test based on NIHSS, which scores stroke severity from 0-19 points, was designed and adapted for the ambulance services. In the pilot study the ambulance nurses used PreHAST to assess patients with suspected stroke in the prehospital setting. Regardless of the results after PreHAST testing the patients were triaged with a provisional stroke diagnosis. The PreHAST scores were compared with the final diagnosis and the ability to differentiate stroke and transient ischemic attacks (TIA) with ongoing symptoms at evaluation from non-stroke patients was analysed. RESULTS: 69 patients were included in the study, 26 had stroke/TIA and 43 other diagnoses. All stroke/TIA patients were identified by PreHAST (sensitivity 100% (95% CI; 87-100%)). The specificity increased with higher PreHAST scores and the discriminative capacity for PreHAST for different cut off values showed an area under the curve of 0.77 (95%CI; 0.66-0.88) in the receiver operating characteristic (ROC) analysis. DISCUSSION: PreHAST is designed for high sensitivity, screening for a broad range of stroke symptoms including most key components of NIHSS. The promising sensitivity between 87 and 100% in our study has to be confirmed in a larger study also including multiple centres. Higher PreHAST scores implied more typical patterns of stroke and accordingly the proportion of stroke mimics decrease with higher scores. However, also stroke mimics with epilepsy/seizure and patients with deficit after prior stroke could show higher PreHAST scores. Other prehospital stroke tests that evaluate stroke severity have been designed with the main purpose to screen for large vessel occlusion. The advantage of PreHAST is the dual purpose no

Background and purposeAortic arch plaque (AAP) is a risk factor for ischemic stroke, but its association with subclinical cerebrovascular disease is not established. We investigated the association between AAP and subclinical cerebrovascular disease in an elderly stroke-free community-based cohort.MethodsThe CABL study (Cardiovascular Abnormalities and Brain Lesions) was designed to investigate cardiovascular predictors of silent cerebrovascular disease in the elderly. AAPs were assessed by suprasternal transthoracic echocardiography in 954 participants. Silent brain infarcts and white matter hyperintensity volume (WMHV) were assessed by brain magnetic resonance imaging. The association of AAP thickness with silent brain infarcts and WMHV was evaluated by logistic regression analysis.ResultsMean age was 71.6±9.3 years; 63% were women. AAP was present in 658 (69%) subjects. Silent brain infarcts were detected in 138 participants (14.5%). In multivariate analysis adjusted for potential confounders, AAP thickness and large AAP (≥4 mm in thickness) were significantly associated with the upper quartile of WMHV (WMHV-Q4; odds ratio =1.17; 95% confidence interval, 1.04-1.32; P=0.009 and odds ratio =1.79; 95% confidence interval, 1.40-3.09; P=0.036, respectively), but not with silent brain infarcts (odds ratio =1.08; 95% confidence interval, 0.94-1.23; P=0.265 and odds ratio =1.46; 95% confidence interval, 0.77-2.77; P=0.251, respectively).ConclusionsAortic arch atherosclerosis was associated with WMHV in a stroke-free community-based elderly cohort. This association was stronger in subjects with large plaques and independent of cardiovascular risk factors. Aortic arch assessment by transthoracic echocardiography may help identify subjects at higher risk of subclinical cerebrovascular disease, who may benefit from aggressive stroke risk factors treatment.

A study of partial economic evaluation and description of cost-consequence is done in order to determine the cost of rehabilitation treatment from 1 January 2012 to 31 December 2012 of cerebrovascular disease in the Service Rehabilitation at the Policlinic "Hermanos Martinez Tamayo" ofBaracoa,Guantanamo. The universe was represented by 93 patients, of whom 78 met the inclusion criteria (slight dependence according Barthel scale): 51 had ischemic brain vascular disease and 27 of hemorrhagic type. Taking into account the status, progress and results into the scale of Barthel and medical judgment. It was found that the rehabilitation treatment had better outcome in ischemic cerebrovascular disease, showing greater capacity for independence from hemorrhagic etiology, which proved more costly than ischemic, most cost pressure in the rehabilitation of this disease is in the direct cost, Se realizó un estudio de evaluación económica parcial de descripción de costo-consecuencia con la finalidad de determinar el costo del tratamiento rehabilitador desde el 1ro de enero de 2012 hasta el 31 de Diciembre de 2012 de la enfermedad cerebrovascular en la sala del servicio de rehabilitación del Policlínico Universitario “Hermanos Martínez Tamayo” de Baracoa, Guantánamo. El universo estuvo representado por 93 pacientes de ellos 78 cumplieron con los criterios de inclusión: 51 tenían una enfermedad cerebrovascular isquémica y 27 de tipo hemorrágica. Para tener en cuenta el estado, evolución y resultado se tuvo en cuenta la escala de Barthel, así como el criterio médico. La recolección de los datos se realizó a través los registros de costos del departamento de contabilidad y estadística de las tarjetas de cada paciente, encontrándose que el tratamiento rehabilitador tuvo mejor resultado en la enfermedad cerebrovascular isquémica, mostrando mayor capacidad de independencia respecto a la etiología hemorrágica, que resultó ser más costosa que la isquémica, la mayor presión de costos en la rehabilitación de esta enfermedad se encuentra en el costo directo.

Introduction: Recently, several epidemiological studies have demonstrated that epilepsy develops after approximately 10% of all cerebrovascular lesions. With an aging population, poststroke epilepsy is likely to be of increasing relevance to neurologists and more knowledge on the condition is needed. Patients with poststroke epilepsy are likely to differ from other epilepsy patient populations regarding age, side-effect tolerability, comorbidities, and life expectancy, all of which are important aspects when counselling newly diagnosed patients to make informed treatment decisions. Method: We have here performed a nested case-control study on 36 patients with poststroke epilepsy and 55 controls that suffered stroke but did not develop epilepsy. The average follow-up time was between 3 and 4 years. Results: In our material, two-thirds of patients achieved seizure freedom and 25% experienced a prolonged seizure (status epilepticus) during the follow-up period. Cases consumed more health care following their stroke, but did not suffer more traumatic injuries. Interestingly, the mortality among cases and controls did not differ significantly. This observation needs to be confirmed in larger prospective studies, but indicate that poststroke epilepsy might not infer additional mortality in this patient group with considerable comorbidities. Conclusions: The observations presented can be of value in the counselling of patients, reducing the psychosocial impact of the diagnosis, and planning of future research on poststroke epilepsy.

Introduction: Recently, several epidemiological studies have demonstrated that epilepsy develops after approximately 10% of all cerebrovascular lesions. With an aging population, poststroke epilepsy is likely to be of increasing relevance to neurologists and more knowledge on the condition is needed. Patients with poststroke epilepsy are likely to differ from other epilepsy patient populations regarding age, side-effect tolerability, comorbidities, and life expectancy, all of which are important aspects when counselling newly diagnosed patients to make informed treatment decisions. Method: We have here performed a nested case-control study on 36 patients with poststroke epilepsy and 55 controls that suffered stroke but did not develop epilepsy. The average follow-up time was between 3 and 4 years. Results: In our material, two-thirds of patients achieved seizure freedom and 25% experienced a prolonged seizure (status epilepticus) during the follow-up period. Cases consumed more health care following their stroke, but did not suffer more traumatic injuries. Interestingly, the mortality among cases and controls did not differ significantly. This observation needs to be confirmed in larger prospective studies, but indicate that poststroke epilepsy might not infer additional mortality in this patient group with considerable comorbidities. Conclusions: The observations presented can be of value in the counselling of patients, reducing the psychosocial impact of the diagnosis, and planning of future research on poststroke epilepsy.

Introduction: Recently, several epidemiological studies have demonstrated that epilepsy develops after approximately 10% of all cerebrovascular lesions. With an aging population, poststroke epilepsy is likely to be of increasing relevance to neurologists and more knowledge on the condition is needed. Patients with poststroke epilepsy are likely to differ from other epilepsy patient populations regarding age, side-effect tolerability, comorbidities, and life expectancy, all of which are important aspects when counselling newly diagnosed patients to make informed treatment decisions. Method: We have here performed a nested case-control study on 36 patients with poststroke epilepsy and 55 controls that suffered stroke but did not develop epilepsy. The average follow-up time was between 3 and 4 years. Results: In our material, two-thirds of patients achieved seizure freedom and 25% experienced a prolonged seizure (status epilepticus) during the follow-up period. Cases consumed more health care following their stroke, but did not suffer more traumatic injuries. Interestingly, the mortality among cases and controls did not differ significantly. This observation needs to be confirmed in larger prospective studies, but indicate that poststroke epilepsy might not infer additional mortality in this patient group with considerable comorbidities. Conclusions: The observations presented can be of value in the counselling of patients, reducing the psychosocial impact of the diagnosis, and planning of future research on poststroke epilepsy.

Introduction: Recently, several epidemiological studies have demonstrated that epilepsy develops after approximately 10% of all cerebrovascular lesions. With an aging population, poststroke epilepsy is likely to be of increasing relevance to neurologists and more knowledge on the condition is needed. Patients with poststroke epilepsy are likely to differ from other epilepsy patient populations regarding age, side-effect tolerability, comorbidities, and life expectancy, all of which are important aspects when counselling newly diagnosed patients to make informed treatment decisions. Method: We have here performed a nested case-control study on 36 patients with poststroke epilepsy and 55 controls that suffered stroke but did not develop epilepsy. The average follow-up time was between 3 and 4 years. Results: In our material, two-thirds of patients achieved seizure freedom and 25% experienced a prolonged seizure (status epilepticus) during the follow-up period. Cases consumed more health care following their stroke, but did not suffer more traumatic injuries. Interestingly, the mortality among cases and controls did not differ significantly. This observation needs to be confirmed in larger prospective studies, but indicate that poststroke epilepsy might not infer additional mortality in this patient group with considerable comorbidities. Conclusions: The observations presented can be of value in the counselling of patients, reducing the psychosocial impact of the diagnosis, and planning of future research on poststroke epilepsy.

Introduction: Recently, several epidemiological studies have demonstrated that epilepsy develops after approximately 10% of all cerebrovascular lesions. With an aging population, poststroke epilepsy is likely to be of increasing relevance to neurologists and more knowledge on the condition is needed. Patients with poststroke epilepsy are likely to differ from other epilepsy patient populations regarding age, side-effect tolerability, comorbidities, and life expectancy, all of which are important aspects when counselling newly diagnosed patients to make informed treatment decisions. Method: We have here performed a nested case-control study on 36 patients with poststroke epilepsy and 55 controls that suffered stroke but did not develop epilepsy. The average follow-up time was between 3 and 4 years. Results: In our material, two-thirds of patients achieved seizure freedom and 25% experienced a prolonged seizure (status epilepticus) during the follow-up period. Cases consumed more health care following their stroke, but did not suffer more traumatic injuries. Interestingly, the mortality among cases and controls did not differ significantly. This observation needs to be confirmed in larger prospective studies, but indicate that poststroke epilepsy might not infer additional mortality in this patient group with considerable comorbidities. Conclusions: The observations presented can be of value in the counselling of patients, reducing the psychosocial impact of the diagnosis, and planning of future research on poststroke epilepsy.

Обстежені 89 пацієнтів. Із них 67 хворих на дисциркуляторну енцефалопатію ІІ стадії, із яких були виділені 2 групи, що відрізнялися методами лікування — із застосуванням L-аргініну в основній групі та без його застосування в контрольній. У пацієнтів досліджувалася церебральна гемодинаміка, еластичні властивості судин шляхом проведення дуплексного сканування екстра- та інтракраніальних артерій. Отримані дані свідчать, що у хворих на дисциркуляторну енцефалопатію ІІ стадії після лікування L-аргініном відзначається вірогідне покращення показників гемодинаміки та пружно-еластичних властивостей судин., Обследовано 89 пациентов. Из них 67 больных дисциркуляторной энцефалопатией II стадии, из которых были выделены 2 группы, отличавшиеся методами лечения — с применением L-аргинина в основной группе и без его применения в контрольной. У пациентов исследовалась церебральная гемодинамика и эластические свойства артерий путем проведения дуплексного сканирования экстра- и интракраниальных артерий. Полученные данные свидетельствуют, что у больных дисциркуляторной энцефалопатией ІІ стадии после лечения L-аргинином отмечается достоверное улучшение показателей гемодинамики и упруго-эластичных свойств артерий., 89 patients were examined. Among them 67 patients with dyscirculatory encephalopathy II stage were divided in two groups differed by treatment regimens — with use of L-arginine in the main group and without it — in the control group. In patients we studied cerebral hemodynamics and elastic properties of arteries by duplex scanning of extra- and intracranial arteries. The findings suggest that patients with dyscirculatory encephalopathy stage II after treatment with L-arginine there was a significant improvement in hemodynamics and elastic properties of the arteries.

Background: Studies based on a cohort design requires access to both subject-specific and period-specific information. In order to conduct an occupational cohort study, access to exposure information and the possibility and permission to link information on outcomes from other registers are generally necessary. The analysis phase is also aggravated by its added complexity because of the longitudinal dimension of the cohort’s data.This thesis aims at increasing the knowledge on hazards from work on fatalities and cancer within the domain of cohort studies on miners and metal refiners and to study the complexity of the analysis by discussing and suggesting analytical strategies. Methods: The study population for this thesis consisted of a cohort of 2264 blue-collar aluminium smelter workers (paper I) and a cohort of 13000 blue-collar iron-ore miners (papers II-IV), both followed for over 50 years. The outcomes were collected from the Swedish Cause of Death Register and the Swedish Cancer Register. The primary methods of analysis were either Standardized Morbidity Ratios (SMR) or internal comparisons based on Cox or Poisson regression modeling. In paper IV, a g-estimation based on an accelerated failure-time model was performed to estimate the survival ratio. Results: The results from paper I suggested that working as a blue-collar worker metal refiner was associated with increased rates of incidental lung cancer. Elevated rates among short term workers were observed for several outcomes. Paper I also showed that the choice of reference population when calculating SMR could influence the conclusions of the results. In paper II, several outcomes were elevated among the miners compared to the reference population from northern Sweden. However, no outcome except lung cancer was associated with cumulative employment time. The most recurrent pattern of the results was the negative association between cumulative employment time underground and several outcomes. The results f

Eighty patients were examined. Sixty one of them had dyscirculatory encephalopathy II stage. They were divided into two groups differed by treatment mode. Namely, the patients of the first group got L-arginine and the patients from the control did not use it. The cerebral hemodynamics in the patients was examined through the duplex scanning of extra- and intracranial arteries. According to the results there were found significantly improved hemodynamic parameters in the patients with dyscirculatory encephalopathy II stage treated with L-arginine., Обследованы 84 пациента, из них 62 больных дисциркуляторной энцефалопатией II стадии, которые были распределены на 2 группы, отличавшиеся методами лечения. А именно с применением L-аргинина в основной группе и без его применения в контрольной. У пациентов исследовалась церебральная гемодинамика путем проведения дуплексного сканированя экстра- и интракраниальных артерий. Полученные данные свидетельствуют, что у больных дисциркуляторной энцефалопатией ІІ стадии после лечения L-аргинином отмечается достоверное улучшение показателей гемодинамики., Обстежено 84 пацієнти, з них 62 хворі на дисциркуляторну енцефалопатію ІІ стадії, які були розподілені на 2 групи, що відрізнялися методами лікування. А саме із застосуванням L-аргініну в основній групі та без його застосування у контрольній. У пацієнтів досліджувалася церебральна гемодинаміка шляхом проведення дуплексного сканування екстра- та інтракраніальних артерій. Отримані дані свідчать, що у хворих на дисциркуляторну енцефалопатію ІІ стадії після лікування L-аргініном відзначається вірогідне покращення показників гемодинаміки.

В огляді висвітлюються сучасні уявлення про обмін селену і його роль у розвитку кардіоваскулярних і цереброваскулярних захворювань. Наведено результати сучасних досліджень із вивчення ролі селену в розвитку цих захворювань і перспектив використання цього мікроелемента в неврології., В обзоре освещаются современные представления об обмене селена и его роли в развитии кардиоваскулярных и цереброваскулярных заболеваний. Приведены результаты современных исследований по изучению роли селена в развитии этих заболеваний и перспектив использования этого микроэлементa в неврологии., The review highlights the current views on selenium exchange and its role in the development of cardіovascular and cerebrovascular diseases. The authors provided the findings of current research on the role of selenium in the development of these diseases and the prospects for the use of this trace element in neurology.

В статье обосновываются современные механизмы нейротрофичности, нейропротекции, нейропластичности и их взаимосвязь с нейрогенезом. Впервые в литературе обосновывается применение ноотропных препаратов при различных функционально-органических заболеваниях мозга у взрослых и детей. Представлена современная классификация ноотропных препаратов и нейропротекторов с механизмами нейропластичности. Рассматриваются нейрофармакологические механизмы первичной и вторичной нейропротекции. Обосновывается отличие апоптоза от аноикиса и их роль в нейрогенезе., У статті обґрунтовуються сучасні механізми ней-ротрофічності, нейропротекції, нейропластичності та їх взаємозв’язок з нейрогенезом. Уперше в літературі обґрунтовується застосування ноотропних препаратів при різних функціонально-органічних захворюваннях мозку у дорослих та дітей. Наведена сучасна класифікація ноотропних препаратів та нейропротекторів із механізмами нейропластичності. Розглядаються нейрофармакологічні механізми первинної та вторинної нейропротекції. Обґрунтовується відмінність апоптозу від аноїкісу та їх роль у нейрогенезі., In the article the modern mechanisms of neurotrophi-city, neuroprotection, neuroplasticity and their correlation with neurogenesis are substantiated. For the first time in the literature the use of nootropic drugs in different functional organic brain disease in adults and children is proved. The current classification of nootropic drugs and neuroprotective agents with mechanisms of neuroplasticity is presented. Neuropharmacological mechanisms of primary and secondary neuroprotection are considered. Diffe-rence between apoptosis and anoikis and their role in neurogenesis are substantiated.

Background: Studies based on a cohort design requires access to both subject-specific and period-specific information. In order to conduct an occupational cohort study, access to exposure information and the possibility and permission to link information on outcomes from other registers are generally necessary. The analysis phase is also aggravated by its added complexity because of the longitudinal dimension of the cohort’s data.This thesis aims at increasing the knowledge on hazards from work on fatalities and cancer within the domain of cohort studies on miners and metal refiners and to study the complexity of the analysis by discussing and suggesting analytical strategies. Methods: The study population for this thesis consisted of a cohort of 2264 blue-collar aluminium smelter workers (paper I) and a cohort of 13000 blue-collar iron-ore miners (papers II-IV), both followed for over 50 years. The outcomes were collected from the Swedish Cause of Death Register and the Swedish Cancer Register. The primary methods of analysis were either Standardized Morbidity Ratios (SMR) or internal comparisons based on Cox or Poisson regression modeling. In paper IV, a g-estimation based on an accelerated failure-time model was performed to estimate the survival ratio. Results: The results from paper I suggested that working as a blue-collar worker metal refiner was associated with increased rates of incidental lung cancer. Elevated rates among short term workers were observed for several outcomes. Paper I also showed that the choice of reference population when calculating SMR could influence the conclusions of the results. In paper II, several outcomes were elevated among the miners compared to the reference population from northern Sweden. However, no outcome except lung cancer was associated with cumulative employment time. The most recurrent pattern of the results was the negative association between cumulative employment time underground and several outcomes. The results f

Background: Studies based on a cohort design requires access to both subject-specific and period-specific information. In order to conduct an occupational cohort study, access to exposure information and the possibility and permission to link information on outcomes from other registers are generally necessary. The analysis phase is also aggravated by its added complexity because of the longitudinal dimension of the cohort’s data.This thesis aims at increasing the knowledge on hazards from work on fatalities and cancer within the domain of cohort studies on miners and metal refiners and to study the complexity of the analysis by discussing and suggesting analytical strategies. Methods: The study population for this thesis consisted of a cohort of 2264 blue-collar aluminium smelter workers (paper I) and a cohort of 13000 blue-collar iron-ore miners (papers II-IV), both followed for over 50 years. The outcomes were collected from the Swedish Cause of Death Register and the Swedish Cancer Register. The primary methods of analysis were either Standardized Morbidity Ratios (SMR) or internal comparisons based on Cox or Poisson regression modeling. In paper IV, a g-estimation based on an accelerated failure-time model was performed to estimate the survival ratio. Results: The results from paper I suggested that working as a blue-collar worker metal refiner was associated with increased rates of incidental lung cancer. Elevated rates among short term workers were observed for several outcomes. Paper I also showed that the choice of reference population when calculating SMR could influence the conclusions of the results. In paper II, several outcomes were elevated among the miners compared to the reference population from northern Sweden. However, no outcome except lung cancer was associated with cumulative employment time. The most recurrent pattern of the results was the negative association between cumulative employment time underground and several outcomes. The results f

Background: Studies based on a cohort design requires access to both subject-specific and period-specific information. In order to conduct an occupational cohort study, access to exposure information and the possibility and permission to link information on outcomes from other registers are generally necessary. The analysis phase is also aggravated by its added complexity because of the longitudinal dimension of the cohort’s data.This thesis aims at increasing the knowledge on hazards from work on fatalities and cancer within the domain of cohort studies on miners and metal refiners and to study the complexity of the analysis by discussing and suggesting analytical strategies. Methods: The study population for this thesis consisted of a cohort of 2264 blue-collar aluminium smelter workers (paper I) and a cohort of 13000 blue-collar iron-ore miners (papers II-IV), both followed for over 50 years. The outcomes were collected from the Swedish Cause of Death Register and the Swedish Cancer Register. The primary methods of analysis were either Standardized Morbidity Ratios (SMR) or internal comparisons based on Cox or Poisson regression modeling. In paper IV, a g-estimation based on an accelerated failure-time model was performed to estimate the survival ratio. Results: The results from paper I suggested that working as a blue-collar worker metal refiner was associated with increased rates of incidental lung cancer. Elevated rates among short term workers were observed for several outcomes. Paper I also showed that the choice of reference population when calculating SMR could influence the conclusions of the results. In paper II, several outcomes were elevated among the miners compared to the reference population from northern Sweden. However, no outcome except lung cancer was associated with cumulative employment time. The most recurrent pattern of the results was the negative association between cumulative employment time underground and several outcomes. The results f

Peningkatan usia harapan hidup seseorang sangat berdampak dengan adanya pola penyakit yang diderita dan berkaitan erat dengan usia lanjut. Defisitnya fungsi kognitif merupakan salah satu contoh dan biasanya terjadi setelah adanya serangan stroke. Terjadinya kerusakan jaringan otak yang diakibatkan oleh berkurangnya aliran darah ke otak yang kemudian menganggu kebutuhan darah dan oksigen di jaringan otak akan menimbulkan stroke. Demensia vascular (DVa) merupakan kerusakan otak yang diakibatkan penyakit serebrovascular yang menyebabkan penurunan kognitif dan fungsional.Tujuan penelitian ini adalah untuk mengetahui karakteristik penderita demensia vascular pasca stroke di Poliklinik saraf RSUD dr. Zainoel Abidin Banda Aceh. Desain penelitian ini adalah penelitian deskriptif dengan pendekatan cross sectional study dengan sampel yang diambil dengan cara consecutive sampling. Penelitian ini menggunakan kuisioner MMSE dan Hachinski Ischaemia Stroke (HIS) dengan metode wawancara terpimpin. Penelitian ini menunjukkan bahwa distribusi frekuensi terbesar pasien DVa adalah laki-laki (58,5%), berumur 60-74 tahun (46,2%), yang berpendidikan tinggi dan bekerja, dengan hasil CT Scan letak infark pada bagian multiple lebih dominan (50,8%). DVa bisa dicegah dengan cara mengendalikan faktor resiko dan dapat meningkatkan usia harapan hidup.Kata kunci: Demensia vascular, karakteristik klinis, serebrovascular., Banda Aceh

The worst headache of his life, a sudden onset of severe headache accompanied by nausea, blurred vision, stiff neck and loss of consciousness, happened when he was simply at home doing daily activities. He had no symptoms before it happened and after he was taken to the hospital, he was diagnosed with aneurysmal subarachnoid hemorrhage. Cerebrovascular diseases, mainly stroke, are the second leading causes of death worldwide according to the WHO. Approximately 5% to 15% of stroke cases have aneurismal origin with a 30-day mortality rate of 45%. Among the survivors 30% has moderate-to-severe disabilities . No less than an estimated 2% of the population has an intracranial aneurysm but fortunately only a few of them rupture, with an annual estimated risk of 0.7% . Research shows that most aneurysms are small and 50% to 80% of them do not rupture during the course of a person’s life. Between 10% to 30% of the patients have multiple aneurysms.