Browsing by Author "Navia, Víctor"
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Item COVID-19 Lockdown Effects on Acute Stroke Care in Latin America(2021) Pujol-Lereis, Virginia A.; Flores, Alan; Barboza, Miguel A.; Abanto-Argomedo, Carlos; Amaya, Pablo; Bayona, Hernán; Bonardo, Pablo; Díaz-Escobar, Luis; Gómez-Schneider, Maia; Góngora-Rivera, Fernando; Lavados, Pablo; León, Carolina; Luraschi, Adriana; Márquez-Romero, Juan Manuel; Ouriques-Martins, Sheila C.; Navia, Víctor; Ruiz-Franco, Angélica; Vences, Miguel Angel; Zurru, María Cristina; Arauz, Antonio; Ameriso, Sebastián; Latin American Stroke rEgistry (LASE) COVID-19 Collaborators.Objectives: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially during peak periods. We assessed the impact of the pandemic and lockdowns in stroke admissions and care in Latin America. Materials and Methods: A multinational study (7 countries, 18 centers) of patients admitted during the pandemic outbreak (March-June 2020). Comparisons were made with the same period in 2019. Numbers of cases, stroke etiology and severity, acute care and hospitalization outcomes were assessed. Results: Most countries reported mild decreases in stroke admissions compared to the same period of 2019 (1187 vs. 1166, p = 0.03). Among stroke subtypes, there was a reduction in ischemic strokes (IS) admissions (78.3% vs. 73.9%, p = 0.01) compared with 2019, especially in IS with NIHSS 0 5 (50.1% vs. 44.9%, p = 0.03). A substantial increase in the proportion of stroke admissions beyond 48 h from symptoms onset was observed (13.8% vs. 20.5%, p < 0.001). Nevertheless, no differences in total reperfusion treatment rates were observed, with similar door-to-needle, door-toCT, and door-to-groin times in both periods. Other stroke outcomes, as all-type mortality during hospitalization (4.9% vs. 9.7%, p < 0.001), length of stay (IQR 1 5 days vs. 0 9 days, p < 0.001), and likelihood to be discharged home (91.6% vs. 83.0%, p < 0.001), were compromised during COVID-19 lockdown period. Conclusions: In this Latin America survey, there was a mild decrease in admissions of IS during the COVID-19 lockdown period, with a significant delay in time to consultations and worse hospitalization outcomes.Item Determinantes del tiempo puerta-aguja en trombolisis endovenosa en el infarto cerebral, experiencia de un centro(2020) Brunser, Alejandro; Mazzon, Enrico; Muñoz, Paula; Hoppe, Arnold; Lavados, Pablo; Rojo, Alexis; Navia, Víctor; Cavada, Gabriel; Olavarría, Verónica; Mansilla, EloyBackground: Intravenous thrombolysis (IT) in acute ischemic stroke (AIS) is time dependent. The time elapsed from hospital admission to the thrombolytic bolus is named door to needle time (DNT) and is recommend to be of less than 60 min. Aim: To describe the DNT in our center and determine those factors associated with a DNT longer than 60 min. Material and Methods: Prospective analysis of patients treated with IT at a private hospital between June 2016 and June 2019. The percentage of patients with DNT exceeding 60 min, and the causes for this delay were evaluated. Results: IT was used in 205 patients. DNT was 43.6 ± 23.8 min. Forty patients (19.5% (95% CI, 14.4-25.7), had a DNT longer than 60 min. Uni-varied analysis demonstrated that AIS with infratentorial symptomatology (ITS), was significantly associated with DNTs exceeding 60 min. A history of hypertension, a higher NIH Stroke Scale score, the presence of an hyperdense sign in brain tomography (p = 0.001) and the need for endovascular therapy (p = 0.019), were associated with DNT shorter than 60 min. Multivariate analysis ratified the relationship between ITS and DNT longer than 60 min (Odds ratio: 3.19, 95% confidence intervals 1.26-8). Conclusions: The individual elements that correlated with a DNT longer than 60 min were the failure to detect the AIS during triage and doubts about its diagnosisPublication Developing clinical decision making in stroke through virtual online simulation: automated asynchronous or instructor-led synchronous feedback? A randomized controlled trial(2023) Fuentes, Valentina; Palominos, Javier; Pettersen, María; Caro, Patricio; Navia, Víctor; Hoppe, Arnold; Armijo, Soledad; Machuca, FelipeAim: to determine whether asynchronous virtual simulation with automatic feedback enhances learning about clinical decision-making in stroke compared with synchronous simulation with instructor-guided feedback in 4th-year medical students. We hypothesize that instructor-guided feedback drives better learning than automatic feedback. Methodology: a quantitative randomized controlled parallel study was designed using the CONSORT extension to simulation studies. Twenty 4th year undergraduate medical students were divided into two groups. One group performed virtual simulations with instructor-guided feedback, and the other worked autonomously with automatic feedback. We administered a knowledge score test survey before and after applying the intervention bundle and a usefulness perception survey. Two-way repeated measures analysis of variance (ANOVA) was used to compare changes in performance. Results: the results of the two-way ANOVA on the performance level showed no significant changes between groups and between the first and third scenarios (p=0,428). Analysis of the simple main effect showed no significant difference between groups in the post-test (p =0,086) and no significant difference after the third scenario in the Synchronous (p = 0,001) and Asynchronous (p = 0,009) groups. The most remarkable improvement was the International Normalized Ratio that contraindicates thrombolysis (70 % improvement), followed by the first-line drug for hypertension and the platelet value that contraindicates thrombolysis (25 % improvement for both). Conclusion: we did not identify differences in student stroke knowledge gained via virtual simulation with automated v/s instructor-guided feedback. The students learned specific elements linked to the safety of administering thrombolytics in patients with stroke. Objetivo: determinar si la simulación virtual asíncrona con retroalimentación automática mejora el aprendizaje sobre la toma de decisiones clínicas en el ictus en comparación con la simulación síncrona con retroalimentación guiada por el instructor en estudiantes de medicina de 4º curso. Nuestra hipótesis es que la retroalimentación guiada por el instructor conduce a un mejor aprendizaje que la retroalimentación automática. Métodos: se diseñó un estudio cuantitativo aleatorizado controlado paralelo utilizando la extensión CONSORT para estudios de simulación. Veinte estudiantes de medicina de 4º curso se dividieron en dos grupos. Un grupo realizó simulaciones virtuales con feedback guiado por el instructor y el otro trabajó de forma autónoma con feedback automático. Se administró una encuesta de puntuación de conocimientos antes y después de aplicar el paquete de intervención y una encuesta de percepción de utilidad. Se utilizó un análisis de varianza (ANOVA) de medidas repetidas de dos vías para comparar los cambios en el rendimiento. Resultados: los resultados del ANOVA de dos vías sobre el nivel de rendimiento no mostraron cambios significativos entre los grupos ni entre el primer y el tercer escenario (p = 0,428). El análisis del efecto principal simple no mostró diferencias significativas entre los grupos en la prueba posterior (p = 0,086) ni diferencias significativas después del tercer escenario en los grupos Síncrono (p = 0,001) y Asíncrono (p = 0,009). La mejora más destacable fue la de la razón normalizada internacional que contraindica la trombólisis (mejora del 70 %), seguida del fármaco de primera línea para la hipertensión y el valor de plaquetas que contraindica la trombólisis (mejora del 25 % para ambos). Conclusiones: no identificamos diferencias en los conocimientos sobre ictus adquiridos por los estudiantes mediante simulación virtual con feedback automatizado v/s guiado por el instructor. Los alumnos aprendieron elementos específicos relacionados con la seguridad de la administración de trombolíticos en pacientes con ictus.Item Effects of an Avocado-based Mediterranean Diet on Serum Lipids for Secondary Prevention after Ischemic Stroke Trial (ADD-SPISE)(2021) Olavarría, Verónica; Campodónico, Paola; Vollrath, Valeska; Von Geldern, Paula; Velásquez, Carolina; Pávez, Patricia; Valente, Bárbara; Donoso, Pamela; Ginesta, Alexandra; Cavada, Gabriel; Mazzon, Enrico; Navia, Víctor; Guzmán, Matías; Brinck, Pablo; Lavados, PabloBackground: A poor or unhealthy diet is responsible for an important fraction of ischemic stroke risk. Adherence to dietary patterns, such as the Mediterranean diet, rich in monounsaturated fatty acids mainly from olive oil, is associated with a lower stroke risk. Furthermore, lowering low-density cholesterol (LDL-C) levels decreases stroke recurrence. Interestingly, Avocado-substituted diets, which are also rich in monounsaturated fatty acids, significantly decrease LDL cholesterol levels. This study aims to evaluate whether a Mediterranean diet based on Avocados reduces LDL-C compared to a low-fat high-complex carbohydrate diet after 3 months of the intervention in patients who had a recent acute ischemic stroke. The trial will also assess safety and feasibility. Patients and methods: Prospective, randomized open-label, blinded outcome assessment clinical trial. Participants are patients within a month of being admitted with an ischemic stroke, who consent and fulfil the eligibility criteria. Patients are randomly assigned to either diet intervention in a 1:1 ratio on top of the usual secondary prevention treatment. The intervention diet is: A)Avocado-based Mediterranean diet with intake of 1/2 portion of Avocado per day and B)The control diet is a low-fat high-complex carbohydrate diet. The main efficacy outcome is a reduction in plasma LDL-C levels at 3 months of the dietary intervention. Secondary outcomes include changes in the levels of serum lipid profile and serum inflammation markers, safety, and feasibility. A sample size of 200 patients was estimated to provide 80% power and 5% level of significance (10% loss and 5% crossover) to detect a minimum difference of 4.6 mg/dL in LDL-C after 3 months of intervention. Conclusion: We hypothesize that an Avocado-based Mediterranean diet will further reduce the levels of LDL-cholesterol at 3 months compared to the control diet, and that the intervention is safe and feasible.Item Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments(2021) Ouriques Martins, Sheila Cristina; Lavados, Pablo; Secchi, Thaís Leite; Brainin, Michael; Ameriso, Sebastián; Gongora-Rivera, Fernando; Sacks, Claudio; Cantú-Brito, Carlos; Álvarez Guzmán, Tony Fabián; Pérez-Romero, Germán Enrique; Muñoz Collazos, Mario; Barboza, Miguel A.; Arauz, Antonio; Abanto Argomedo, Carlos; Novarro-Escudero, Nelson; Amorin Costabile, Héctor Ignacio; Crosa, Roberto; Camejo, Claudia; Mernes, Ricardo; Maldonado, Nelson; Mora Cuervo, Daissy Liliana; Pontes Neto, Octávio Marques; Sampaio Silva, Gisele; Carbonera, Leonardo Augusto,; Souza, Ana Claudia; Gomes de Sousa, Eduardo David; Flores, Alan; Melgarejo, Donoban; Santos Carquín, Irving R.; Hoppe, Arnold; Freitas de Carvalho, João José; Mont'Alverne, Francisco; Amaya, Pablo; Bayona, Hernán; Navia, Víctor; Duran, Juan Carlos; Urrutia, Víctor C.; Vianna Araujo, Denizar; Feigin, Valery L.; Nogueira, Raúl G.Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.Item Global Impact of COVID-19 on Stroke Care and IV Thrombolysis(2021) Nogueira, Raúl G.; Qureshi, Muhammad M.; Abdalkader, Mohamad; Martins, Sheila Ouriques; Yamagami, Hiroshi; Mansour, Ossama Yassin; Qiu, Zhongming; Sathya, Anvitha; Czlonkowska, Anna; Tsivgoulis, Georgios; Aguiar de Sousa, Diana; Demeestere, Jelle; Mikulik, Robert; Vanacker, Peter; Siegler, James E.; Kõrv, Janika; Biller, Jose; Liang, Conrad W.; Sangha, Navdeep S.; Zha, Alicia M.; Czap, Alexandra L.; Holmstedt, Christine Anne; Turan, Tanya N.; Ntaios, George; Malhotra, Konark; Tayal, Ashis; Loochtan, Aaron; Ranta, Annamarei; Mistry, Eva A.; Alexandrov, Anne W.; Huang, David Y.; Yaghi, Shadi; Raz, Eytan; Sheth, Sunil A.; Mohammaden, Mahmoud H.; Frankel, Michael; Bila Lamou, Eric Guemekane; Aref, Hany M.; Elbassiouny, Ahmed; Hassan, Farouk; Menecie, Tarek; Mustafa, Wessam; Shokr, Hossam M.; Roushdy, Tamer; Sarfo, Fred S.; Alabi, Tolulope Oyetunde; Arabambi, Babawale; Nwazor, Ernest O.; Sunmonu, Taofiki Ajao; Wahab, Kolawole; Yaria, Joseph; Hussein Mohammed, Haytham; Adebayo, Philip B.; Riahi, Anis D.; Sassi, Samia Ben; Navia, Víctor; Olavarría, VerónicaObjective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] −11.7 to −11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI −13.8 to −12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI −13.7 to −10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2–9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.Item Impact of COVID-19 Pandemic on Stroke Severity and Mortality in the South-East of Santiago, Chile(2021) Silva Pozo, Andrés; Vallejos, José; Almeida, Juan; Martoni, Mariano; Uribe-San Martin, Reinaldo; Miranda, María; Díaz, Pablo; García, Dominga; Navia, VíctorBackground and purpose; Chile has been one of the most affected countries by the COVID-19 pandemic, with one of the highest case rates per population. This has affected the epidemiological behaviour of various pathologies. We analyze the impact of the pandemic on the number of admissions due to stroke, its severity and mortality in Santiago, Chile. Methods: a multicenter observational study based on the records of the 3 hospitals of the South East health service in Santiago, Chile. We recorded the number of patients admitted for ischemic stroke between 01 January 2020 and 30 June 2020. We grouped the cases into two periods, pre-pandemic and pandemic, according to the setting of the state of emergency in Chile. Results: 431 patients were admitted with ischemic stroke during the study period. There was a non-significant decrease in weekly admissions (17 vs 15 patients per week). No differences were observed in the proportion of patients with medical treatment (p = 0.810), IVT (p = 0.638), EVT (p = 0.503) or IVT + EVT (p = 0.501). There was a statistically significant increase in the NIHSS on admission (7.23 vs 8.78, p = 0.009) and mortality (5.2% vs 12.4%, p = 0.012). In a multivariate analysis the NIHSS on admission was associated with the increased mortality (RR 1.11, CI 1.04-1.19, p = 0.003). Conclusion: We found an increase in the severity of ischemic stroke on admission and in-hospital mortality during the pandemic period. The main factor to increase in-hospital mortality was the NIHSS on admissionItem In-Hospital Acute Ischemic Stroke is Associated with Worse Outcome: Experience of a Single Center in Santiago Chile(2021) Brunser, Alejandro; Navia, Víctor; Araneda, Patricia; Mazzon, Enrico; Muñoz Venturelli, Paula; Cavada, Gabriel; Olavarría, Verónica; Lavados, PabloObjectives: In-hospital acute ischemic stroke (HIS) accounts for 217% of all acute ischemic strokes (AIS) seen in hospital and they have worse prognosis. In this study we aimed to identify the frequency of HIS and their characteristics in our center. Materials and Methods: Retrospective analysis of a prospective register of patients with AIS seen at Clínica Alemana de Santiago, between January 2017 and January 2019. HIS and community onset ischemic strokes patients (CIS) were compared, univariate analysis was performed, covariates with p < 0.25 were selected for multivariate analysis. Differences between, proportion of strokes treated with thrombolytic therapy, door to needle time were compared between HIS and CIS patients, as also mortality rates at 90 days. Results: During the study period 369 patients with AIS were seen; of these 20 (5.4%, 95 CI%, 3.58.2) corresponded to HIS. In univariate analysis, HIS compared to patients arriving form the community to the emergency room, suffered more frequently from, heart failure (p = 0.04), and active malignancies (p < 0.001). HIS patients had longer times from symptom onset to non-contrast brain tomography (540 §150 minutes); they were also less frequently treated with intravenous thrombolysis compared to community AIS: 15% versus 30% respectively (p = 0.08). Mortality rates at 90 days were higher in HIS: 30 versus 5% (p = 0.001). Conclusions: In this cohort, HIS patients suffered delays in their neuroimaging studies and received less intravenous thrombolysis; this underscores the need for a standardized approach to the recognition and management of inhospital acute ischemic strokeItem Niveles de orientación empática en estudiantes de medicina Universidad del Desarrollo, sede Santiago, Chile(2019) Abarca, Cristóbal; Eltit, Ignacio; Casas-Cordero, Juan Pablo; Tolosa, Álvaro; Bianchi, Sebastián; Koch, Ricardo; Navia, VíctorIntroducción: La empatía es una actitud que favorece la relación médico-paciente, mejora la adherencia al tratamiento, aumenta la comprensión de la patología y produce mayor satisfacción del paciente respecto a la atención recibida. Objetivo: Determinar el nivel de orientación empática de los estudiantes de 1° a 7° año de la Carrera de Medicina de la Universidad del Desarrollo y su relación con variables socio-demográficas. Metodología: Estudio cuantitativo descriptivo transversal. Previa firma de consentimiento informado y autorización de Comité de Ética de la Universidad, se realizó muestreo por conveniencia (n=428), considerando criterios de inclusión. Se aplicó cuestionario de variables sociodemográficas e Instrumento EEMJ (α de Cronbach 0,80 - 0,90), de 20 ítems y escala de Lickert. El puntaje máximo (140), se asocia a mayor orientación empática. El análisis de datos se realizó mediante SPSS, y para obtención de pruebas no paramétricas, Kruskal-Wallis y Mann-Whitney (p < 0,05). Resultados: El nivel de empatía obtenido en los cursos de 1° a 7° año fue 115, 118, 120, 117, 122, 113 y 114 respectivamente. Mujeres obtuvieron en promedio 119 puntos v/s hombres 115, diferencia estadísticamente significativa. Los estudiantes cuyos padres no son médicos, presentan en promedio 118 puntos (v/s 116 de estudiantes con padres médicos). Discusión: El nivel de empatía al iniciar la carrera es mayor que al término, con fluctuaciones hasta un peak en 5° año. Conclusiones: La empatía aumenta progresivamente, alcanzando un peak en 5° año, para luego disminuir. Mujeres y estudiantes sin padres médicos son más empáticos. El desafío es introducir cambios en la malla curricular que aseguren el desarrollo de esta habilidad a lo largo de toda la carrera.Item Risk Factors and Diet Components Determining Adherence to the Mediterranean Diet in Acute Ischemic Stroke Patients: A Cross-Sectional Analysis of a Prospective Hospital Register Study(2021) Olavarría, Verónica; Navia, Víctor; Mazzon, Enrico; Rojo, Alexis; Brunser, Alejandro M.; Lavados, PabloObjectives: Low adherence to a Mediterranean diet (MeDi) is associated with increased incidence, mortality, and severity of acute ischemic strokes (AIS). Nevertheless, the explanatory factors associated with such results are unclear. Our aim was to investigate stroke risk factors associated with adherence to a MeDi in a prospective cohort of AIS patients. Materials and Methods: Patients admitted from February 2017 to February 2020 were included in this study. Adherence was measured using the 14-point Mediterranean Diet Adherence Screener (MEDAS). Demographic and clinical characteristics were compared with adherence with a univariate analysis. A binomial regression was used to investigate the independent association of premorbid factors and MeDi compo- nents with adherence. Results: There were 413 patients. Mean age was 68.6 (17.4), 176 (42.6%) women. Median MEDAS score was 6 (IQR 47) points. 253 patients (61.2%) had a low adherence (MEDAS 6). In the univariate analysis, a low MEDAS was associated with lower education, diabetes, sedentary life- style, greater body mass index (BMI), lower alcohol consumption, and higher LDLc. In the regression analysis, younger age, lower education, functional dis- ability, hypertension, sedentary lifestyle, and higher BMI were associated with lower MEDAS scores. Six MeDi components had particularly low patient adherence: seafood, legumes, olive oil, nuts, wine, and fruit. Discussion: These data indicate low adherence to MeDi in younger patients who are less educated and have existing cardiovascular risk factors, in particular hypertension, sed- entary lifestyle, and higher BMI. Some components of the diet had a particu- larly low adherence. Conclusions: Tailoring diet prevention interventions to these specific populations, focusing on components with known less adher- ence, could improve adherence to a MeDi and the opportunity for secondary stroke prevention.Item Stroke care and collaborative academic research in Latin America(2022) Muñoz, Paula; González, Francisca; Urrutia, Francisca; Mazzon, Enrico; Navia, Víctor; Brunser, Alejandro; Lavados, Pablo; Olavarría, Verónica; Almeida, Juan; Guerrero, Rodrigo; Rojo, Alexis; Gigoux, Juan; Vallejos, José; Conejan, Nathalie; Esparza, Tomas; Escobar, Arturo; Soto, Álvaro; Pontes, Octavio; Arauz, Antonio; Abanto, Carlos; Carce, Cheryl; Zafra, Jessica; Liu, Hueiming; Song, Lili; Miranda, Jaime; Anderson, CraigObjective: A narrative overview of regional academic research collaborations to address the increasing burden and gaps in care for patients at risk of, and who suffer from, stroke in Latin America (LA). Materials and methods: A summary of experiences and knowledge of the local situation is presented. No systematic literature review was performed. Results: The rapidly increasing burden of stroke poses immense challenges in LA, where prevention and manage-ment strategies are highly uneven and inadequate. Clinical research is increasing through various academic consortia and networks formed to overcome structural, funding and skill barriers. However, strengthening the ability to generate, analyze and interpret randomized evidence is central to further develop effective therapies and healthcare systems in LA. Conclusions: Regional networks foster the conduct of multicenter studies -particularly randomized controlled trials-, even in resource-poor regions. They also contribute to the external validity of international studies and strengthen systems of care, clinical skills, critical thinking, and international knowledge exchange.Publication Stroke symptoms, risk factors awareness and personal decision making in Chile. A national survey(2022) Navia, Víctor; Mazzon, Enrico; Olavarría, Verónica; Almeida, Juan; Brunser, Alejandro; Lavados, Pablo; Hoffmeister, Lorena; Muñoz Venturelli, PaulaBackground: Knowledge about stroke symptoms, correct decision in front of a stroke case and recognition of stroke risk factors are crucial to fight against stroke burden. We aimed to assess the stroke awareness among a sample of the Chilean population. Methods: A closed-ended questions structured survey was applied in November 2019 using a computer-assisted telephone interviewing system. Probabilistic sample, random selection and stratification for region was used. Multivariate logistic regression model was used to estimate the association between participants' characteristics and responses. Results: Of 706 participants, only 74.4% (95% CI 70.9-77.5) recognized at least one typical stroke symptom. Most (586, 82.4% 95% CI 75.2-89.7) chose to contact the emergency ambulance or directly go to the emergency department in case of a stroke symptom and recognized at least one risk factor (692, 97.9% CI 96.7-98.8). In multivariable analysis, sociodemographic characteristics associated to a worse recognition of at least one stroke symptom were being men (OR 0.67, 95% CI 0.47-0.96), being 55 years old or older (OR 0.59 95% CI 0.37-0.93) and from the lowest socioeconomic level (SES) (OR 0.33 95% CI 0.16-0.67). Female sex was associated with lower stroke risk factor knowledge (OR 0.64 95% IC 0.47-0.87). Participants who recognized at least one typical stroke symptom and would promptly seek care at an emergency department differed significantly between SES (p=0.001) and age groups (p=0.035). Conclusions: We found insufficient knowledge about stroke symptoms and best decisions making in the Chilean population. We describe gaps that can be targeted in future stroke awareness campaigns. There is a need to strengthen tailored stroke education particularly for underserved populations.Item Transcranial Doppler as a Predictor of Ischemic Events in Vertebral Artery Dissection(2020) Brunser, Alejandro; Lavados, Pablo; Cavada, Gabriel; Muñoz Venturelli, Paula; Olavarría, Verónica; Navia, Víctor; Mansilla, Eloy; Díaz, VioletaBackground and purpose: Transcranial Doppler (TCD) helps identify patients with carotid dissections at risk of ischemic events (IEs). There is paucity of data identifying independent predictors of IE in vertebral arterial dissection (VAD). We sought to investigate the clinical and ultrasound predictors of IE. Methods: Patients with VAD admitted between June 2017 and February 2020 were evaluated clinically and with TCD; sonographic curves, microembolic signals (MES), and the breath-holding index (BHI) test were applied. Covariates found on univariate screen (P < .25) were included in a multivariable linear regression to identify independent predictors of IEs. Results: Of 88 patients with 100 VAD, 75 (85.2%) were females with a mean age 37.9 ± 7.5 years. All patients received antiplatelet treatment. TCD monitoring lasted an average of 21 ± 2.1 minutes. TCD was abnormal in 23 cases (26.1%); 21 patients had abnormal sonographic curves in the vertebral/basilar arteries, while in 4 cases, MES were present and in 5 (4.5%), BHI was abnormal. None of the patients with a normal TCD had an IE. Six strokes occurred during follow up. On univariate analysis, male sex, diabetes, dyslipidemia, a previous myocardial infarct, migraine, time of consultation to the ER, bilateral VAD, MES, BHI abnormalities, post stenotic flow in the basilar artery (PFB), and basilar/vertebral velocities were significantly associated with the risk of IEs. In the multivariate analysis, only the presence of PFB was a significant predictor of IE (OR: 68.6, 95% CI 5-937, <.001). Conclusions: TCD in VAD predicts patients at high risk of IE.Item Trombolisis endovenosa con tenecteplase en ventana extendida tras selección por CT y AngioCT: Caso clínico(2021) Montecinos, Claudio; Angel, María José; Navia, VíctorWe report a 78-year-old man with a basal Rankin score of 2 points, last seen 10 hours before in good conditions, who arrived at the emergency department with left hemiparesis, hypoesthesia, and spacial neglect. Neuroimaging was compatible with stroke in the territory of the right middle cerebral artery. Due to the evolution time of the stroke, usual thrombolysis was contraindicated. Therefore, a thrombolysis with Tenecteplase was used with reversal of symptoms without symptomatic bleeding and with recovery of baseline functionality.Item Trombolisis endovenosa post reversión de acenocumarol con complejo de protrombina. Caso clínico(Sociedad Médica de Santiago, 2019) Navia, Víctor; Riveros, René; Brunser, AlejandroWe report an 89-year-old male under oral anticoagulant therapy with a therapeutic international normalized ratio, presenting at the emergency room with right side hemiparesis and aphasia. Neuroimaging was compatible with an acute middle cerebral artery ischemic stroke. Anticoagulation was reverted with the use of four factor prothrombin complex, followed by thrombolysis with alteplase, with a favorable evolution, returning to his basal functional status.