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  • 1
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    Headache, comorbidities and lifestyle in an adolescent population (The TEENs Study)
    SAGE Publications ; 2019
    In:  Cephalalgia Vol. 39, No. 1 ( 2019-01), p. 91-99
    Details
    In: Cephalalgia, SAGE Publications, Vol. 39, No. 1 ( 2019-01), p. 91-99
    Abstract: To evaluate the prevalence and characteristics of headache and its relationship with comorbidities and lifestyle in a teenage population. Methods This is a cross-sectional study. Data was collected from students aged 12–18 years from six different schools in Catalonia, Spain. They completed an anonymous questionnaire with demographic, lifestyle, medical data, presence of recurrent headaches and its features, and completed the Strengths and Difficulties Questionnaire. We defined probable migraine if headache presented ≥ 3 ICHD-3 beta criteria for migraine. An analysis was performed to evaluate headache characteristics and compare lifestyles between those with or without headache. Results 1619 out of 1873 students completed the survey (response rate 86.4%). From these, 30.5% suffered from recurrent headache and 11.3% had migraine features; 32.9% of adolescents with headache had at least one episode per week and 44.1% showed some degree of headache-related disability measured by the PedMIDAS scale. In a univariate analysis, headache was significantly more frequent in girls (35.1% vs. 25.5%, p  〈  0.001), teenagers with poor sleeping habits (36.6% vs. 27.6%, p  〈  0.001), lower physical activity ( p = 0.002), those who did not have breakfast (37.3 vs. 28.4%, p = 0.001), smokers (10.5% vs. 4.9%, p  〈  0.001) and caffeine overusers (30.9% vs. 24.7%, p = 0.009). Comorbidities significantly associated with headache were: allergies (38.8% vs. 29.3%, p = 0.007), other chronic pain disorders (44.7% vs. 27.6% p  〈  0.001), mental health problems (53.2% vs. 29.0%, p  〈  0.001) and worse SDQ scores ( p  〈  0.001). Conclusions Headache is a common health problem among adolescents which impacts their quality of life. Headache is associated with presence of “unhealthy lifestyle” and other medical comorbidities. Educational initiatives should be started.
    Type of Medium: Online Resource
    ISSN: 0333-1024 , 1468-2982
    URL: Article
    DOI: 10.1177/0333102418777509
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 2
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    Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution
    SAGE Publications ; 2020
    In:  Cephalalgia Vol. 40, No. 13 ( 2020-11), p. 1410-1421
    Details
    In: Cephalalgia, SAGE Publications, Vol. 40, No. 13 ( 2020-11), p. 1410-1421
    Abstract: To define headache characteristics and evolution in relation to COVID-19 and its inflammatory response. Methods This is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution. Results Of 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p  〈  0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 ± 11.6 vs. 31.2 ± 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache ( p = 0.010). Conclusions Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia.
    Type of Medium: Online Resource
    ISSN: 0333-1024 , 1468-2982
    URL: Article
    DOI: 10.1177/0333102420965157
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 3
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    Plasmatic Level of Neuroinflammatory Markers Predict the Extent of Diffusion-Weighted Image Lesions in Hyperacute Stroke
    SAGE Publications ; 2003
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 23, No. 12 ( 2003-12), p. 1403-1407
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 23, No. 12 ( 2003-12), p. 1403-1407
    Abstract: Sixteen patients with acute middle cerebral artery stroke were studied to correlate neuroinflammatory markers with perfusion- and diffusion-weighted magnetic resonance imaging (MRI) lesion volumes (PWI and DWI). At arrival (less than 6 hours), plasmatic matrix metalloproteinase (MMP)-9, MMP-2, interleukin (IL)-6, IL-8, intercellular adhesion molecule (ICAM)-1, and tumor necrosis factor (TNF)-α were serially measured (by ELISA), and MRI was performed. In cerebral ischemia, tissue destruction seems related to matrix metalloproteinases expression because baseline MMP-9 was the only predictor of the infarct volume measured as a DWI lesion (lineal regression: b = 0.50, 0.25–0.74; P 〈 0.001). Moreover, the extent of hypoperfused brain area (PWI) was associated with a proinflammatory cytokine release in the next hours (TNF-α and IL-6).
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1097/01.WCB.0000100044.07481.97
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2003
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  • 4
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    The impact of post-stroke complications on in-hospital mortality depends on stroke severity
    SAGE Publications ; 2017
    In:  European Stroke Journal Vol. 2, No. 1 ( 2017-03), p. 54-63
    Details
    In: European Stroke Journal, SAGE Publications, Vol. 2, No. 1 ( 2017-03), p. 54-63
    Abstract: Controversies remain on whether post-stroke complications represent an independent predictor of poor outcome or just a reflection of stroke severity. We aimed to identify which post-stroke complications have the highest impact on in-hospital mortality by using machine learning techniques. Secondary aim was identification of patient’s subgroups in which complications have the highest impact. Patients and methods Registro Nacional de Ictus de la Sociedad Española de Neurología is a stroke registry from 42 centers from the Spanish Neurological Society. Data from ischemic stroke patients were used to build a random forest by combining 500 classification and regression trees, to weight up the impact of baseline characteristics and post-stroke complications on in-hospital mortality. With the selected variables, a logistic regression analysis was performed to test for interactions. Results 12,227 ischemic stroke patients were included. In-hospital mortality was 5.9% and median hospital stay was 7(4–10) days. Stroke severity [National Institutes of Health Stroke Scale  〉  10, OR = 5.54(4.55–6.99)], brain edema [OR = 18.93(14.65–24.46)] , respiratory infections [OR = 3.67(3.02–4.45)] and age [OR = 2.50(2.07–3.03) for 〉 77 years] had the highest impact on in-hospital mortality in random forest, being independently associated with in-hospital mortality. Complications have higher odds ratios in patients with baseline National Institutes of Health Stroke Scale 〈 10. Discussion Our study identified brain edema and respiratory infections as independent predictors of in-hospital mortality, rather than just markers of more severe strokes. Moreover, its impact was higher in less severe strokes, despite lower frequency. Conclusion Brain edema and respiratory infections were the complications with a greater impact on in-hospital mortality, with the highest impact in patients with mild strokes. Further efforts on the prediction of these complications could improve stroke outcome.
    Type of Medium: Online Resource
    ISSN: 2396-9873 , 2396-9881
    URL: Article
    DOI: 10.1177/2396987316681872
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2851287-X
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  • 5
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    Hyperglycemia during Ischemia Rapidly Accelerates Brain Damage in Stroke Patients Treated with tPA
    SAGE Publications ; 2007
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 27, No. 9 ( 2007-09), p. 1616-1622
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 27, No. 9 ( 2007-09), p. 1616-1622
    Abstract: To evaluate impact of glucose burden on diffusion-weighted imaging (DWI)-lesion evolution according to ischemia duration in stroke. We studied 47 patients with transcranial Doppler (TCD)-documented artery occlusion treated with intravenous tissue plasminogen activator. Hyperglycemia (HG) was defined as glucose 〉 140 mg/dL. A subcutaneous device continuously monitored glucose during 24 h. Magnetic resonance imaging was performed pretreatment (1) and at 24 to 36 h (2) in 30 patients. We measured initial PWI lesion (PW1) and DWI growth: DW2–DW1 (DWg). Serial TCD during 24 h determined occlusion time (OT). National Institutes of Health Stroke Scale (NIHSS) scores were obtained at baseline and 48 h. Poor short-term clinical course defined as 〈 50% recovery of initial NIHSS. Baseline NIHSS was 18. On admission 10 patients (21.3%) were hyperglycemic and presented similar NIHSS, DW1, and PW1 lesion extension as those without HG. During monitoring 24 patients (51%) had HG, 21 (45%) of them during OT (median OT 12 h). Median 48 h-NIHSS was 10; 15 patients presented poor outcome. 48 h-NIHSS was higher in patients with HG during OT (15 versus 3; P 〈 0.001). Patients with favorable outcome had shorter OT (8.4 versus 17.4 h; P 〈 0.001). However, the only independent predictor of poor outcome was HG during OT (OR: 20.3; 95% CI: 3.77 to 108.8; P 〈 0.001). At 24 h mean DWg was 52 cm 3 . A receiver operating characteristic curve identified DWg 〉 14 cm 3 best predictor of poor outcome (sensitivity, 85.7%; specificity, 75%). Total OT ( P = 0.007) and HG during OT ( P = 0.01) showed the strongest correlation with DWg. DWI lesion grew 2.7 times faster in patients with HG than without HG during OT (1.73 versus 4.63 cm 3 /h of occlusion; P = 0.07). In a regression model the only independent predictor of DWg was HG during OT (OR: 10.83; 95% CI: 1.96 to 59.83; P = 0.006). Hyperglycemia, especially during OT, has a powerful deleterious effect after stroke accelerating brain damage.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/sj.jcbfm.9600460
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
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  • 6
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    Spontaneous Hypoliquorrueic Headache, Study by Radioisotop Cisternography
    SAGE Publications ; 1985
    In:  Cephalalgia Vol. 5, No. 3_suppl ( 1985-07), p. 296-296
    Details
    In: Cephalalgia, SAGE Publications, Vol. 5, No. 3_suppl ( 1985-07), p. 296-296
    Type of Medium: Online Resource
    ISSN: 0333-1024 , 1468-2982
    URL: Article
    DOI: 10.1177/03331024850050S3112
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1985
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  • 7
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    A panel of biomarkers may successfully predict acute stroke diagnosis
    SAGE Publications ; 2005
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 25, No. 1_suppl ( 2005-08), p. S117-S117
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 25, No. 1_suppl ( 2005-08), p. S117-S117
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/sj.jcbfm.9591524.0117
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
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  • 8
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    Impact of a telemedicine system on acute stroke care in a community hospital
    SAGE Publications ; 2009
    In:  Journal of Telemedicine and Telecare Vol. 15, No. 5 ( 2009-07), p. 260-263
    Details
    In: Journal of Telemedicine and Telecare, SAGE Publications, Vol. 15, No. 5 ( 2009-07), p. 260-263
    Abstract: In January 2007, a telestroke system was established between a community hospital lacking a neurologist on call and a stroke centre 70 km away. The telestroke system allowed urgent remote evaluation of the patient by a specialized neurologist, supervised thrombolytic treatment or a decision for urgent transfer to the stroke centre. During the first year of operation of the telestroke system, we studied all acute ischaemic stroke patients admitted to the community hospital and compared the results with the previous year. Approximately the same number of acute stroke patients were admitted to the community hospital in each year (201 cases in 2006 and 198 in 2007). The telestroke system was activated 75 times in 2007, the number of stroke patients evaluated by a specialized neurologist increased (17% vs. 38%, P 〉 0.001) and interhospital transfers were reduced (17% vs. 6%, P = 0.001). The number of thrombolytic treatments was doubled: 4.5% ( n = 9) in 2006 vs. 9.6% ( n = 19, 12 of them in the community hospital) in 2007 ( P = 0.073). The telestroke system also reduced the time to tPA treatment from symptom onset (210 vs. 162 min, P = 0.05) and increased the number of patients treated in the 0–3 hours window (40% vs. 63%, P = 0.09). Telemedicine improved the quality of care administered to acute stroke patients admitted to a community hospital and reduced the number of inter-hospital transfers.
    Type of Medium: Online Resource
    ISSN: 1357-633X , 1758-1109
    URL: Article
    DOI: 10.1258/jtt.2009.090102
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2007700-2
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  • 9
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    Prognostic Value of Plasma Chitotriosidase Activity in Acute Stroke Patients
    SAGE Publications ; 2014
    In:  International Journal of Stroke Vol. 9, No. 7 ( 2014-10), p. 910-916
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 9, No. 7 ( 2014-10), p. 910-916
    Abstract: Chitotriosidase, a component of innate immunity, constitutes a sensitive parameter of macrophage activation and its elevated plasma activity reflects an inflammatory response. Given the deleterious effects of inflammation in brain ischemia, we aimed to assess the prognostic value of chitotriosidase activity in acute stroke patients. Methods The study comprised 159 acute stroke patients and 51 age-matched controls. Plasma chitotriosidase activity was serially determined by fluorometric assay. Short-term neurological outcome was determined at 48 h and functional outcome at three-months. Predictors of neurological and functional outcome were determined via multivariate analysis, and the additional predictive value of chitotriosidase was tested with the Integrated Discrimination Index and the Net Reclassification Improvement. Results Stroke patients showed increased levels of baseline chitotriosidase activity compared to controls [114·2 (74·65–182·95) nmol/ml/h vs. 54·4 (32·7–76·4); P 〈 0·0001]. Chitotriosidase activity ( 〈 118·75) was found to be an independent predictor of neurological improvement at 48 h (odds ratio: 3·25; 95% confidence interval: 1·54–6·85; P = 0·002), and the addition of plasma chitotriosidase activity showed a better prediction of improvement at 48 h (Integrated Discrimination Index = 5·7%, Net Reclassification Improvement = 11·6%, P 〈 0·05) over the predictive model constituted only with clinical information. Although patients disabled at three-months showed higher baseline chitotriosidase levels, it was not an independent predictor of long-term disability. Conclusions Baseline chitotriosidase activity in acute stroke patients treated with tissue plasminogen activator (tPA) may constitute a prognostic predictor of short-term outcome, adding a moderate additional predictive value. Our results underline the deleterious role of inflammation in acute stroke patients.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1111/ijs.12160
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2211666-7
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