We believe that AFN following RTSP is an uncommon (2.2%) complication from which patients have an excellent chance of recovery.

Stroke is the fifth leading cause of death and the first cause of long-term disability in Puerto Rico. Trained staff reviewed and independently validated the medical records of patients who had been hospitalized with possible stroke at any of the 20 largest hospitals located in Puerto Rico during 2007, 2009, and 2011. The mean age of the 5005 newly diagnosed stroke patients (51·2% female) was 70 years. At the time of hospitalization, women were 4½ years older, were less likely to be married (60·2% vs. 39·9%, P < 0·001), smoked less (5·8% vs. 13·4%, P < 0·001), and had significantly higher proportion of diabetes (56·0% vs. 54·8%), hypertension (89·1% vs. 85·0%), and low density lipoprotein-cholesterol (LDL-Chol) > 100 mg/dL (65·7% vs. 57·5%) P < 0·05. Ischemic stroke represented 75% of all types of strokes. Atrial fibrillation was mentioned in 7·9% of the medical records. The risk for dying before discharge was similar for both genders, but was 40% higher for women than for men at one-year follow-up: age-adjusted odds ratio = 1·4 (95% confidence interval = 1·2-1·5).

Background: Sex is a contributing factor to inequalities in stroke care. In line with the aims of the FL-PR CReSD Study to assess Get With The Guidelines-Stroke (GWTG-S) quality improvement data, we sought to compare stroke performance metrics by sex among 9 GWTG-S participating Puerto Rico hospitals from 2010-2014. Methods: Age and NIHSS-adjusted hierarchical generalized linear models, stratified by sex, were evaluated for the following GWTG-S performance metrics: IV tPA treatment, early antithrombotic therapy, DVT prophylaxis, antithrombotic therapy at discharge, anticoagulation therapy for atrial fibrillation (AF) at discharge, statin medication at discharge, smoking cessation counseling, defect-free care (compliance with all performance measures), in addition to CT scan ≤25 minutes and door-to-IV tPA administration ≤60 minutes of hospital arrival. Results: Among 3,277 acute ischemic stroke cases, 48% were women. As compared to men, women were older (72±14 vs. 68±13 years, P<0.0001) with higher NIHSS scores (10±8.5 vs. 9±7.7, P=0.005). Women were less likely to receive IV tPA ≤ 4.5 hours among eligible patients arriving ≤ 3.5 hours (OR 0.71, 95% CI 0.51-0.98, P=0.04), early antithrombotic therapy (OR 0.86, 95% CI 0.75-0.97, P=0.02), DVT prophylaxis (OR 0.93, 95% CI 0.88-0.99, P=0.03), statin medication at discharge (OR 0.85, 95% CI 0.78-0.93, P=0.0001), and anticoagulation for AF at discharge (OR 0.67, 95% CI 0.49-0.92, P=0.01) despite having higher rates of AF at admission (11% vs. 7%, P=0.001). Rates of IV tPA for patients arriving ≤ 2 hours, antithrombotic therapy at discharge, and smoking cessation counseling showed no sex differences. While women were less likely to have a CT scan ≤ 25 minutes of hospital arrival compared to men (OR 0.83, 95% CI 0.74-0.93, P=0.002), no difference was found in door-to-IV tPA administration ≤ 60 minutes. Although an overall temporal improvement in defect-free care was observed from 2010-2014 (31% to 63%, P<.0001), women were less likely to receive this measure than men (OR 0.91, 95% CI 0.85-0.97, P=0.007). Conclusions: Overall, stroke care remains lower for Puerto Rican women than men. Continued adoption of the GWTG-S quality improvement program may help reduce sex disparities in quality of care across the island.

Introduction: An endogenous inhibitor of Na,K-ATPase (CTS) is increased in Dahl salt-sensitive (DS) rats and in human cardiovascular pathologies. Hypothesis: Chronic hypertension is a major cause of CTS release which will not be corrected by treatment, and that effectively treated hypertensive patients (HT) will have increased plasma CTS, compared to ischemic stroke patients (STR) after thrombolytic treatment and controls ( CTL). Methods: Forty (40) subjects (age and sex matched) were recruited and grouped into three groups: STR (n = 13), HT (n = 13), and CTL (n = 14). Plasma was collected 1-2 days after diagnosis of ischemic stroke and thrombolytic treatment. CTS levels was determined in all groups by measuring the bufadienolide CTS marinobufagenin (MBG) using a fluoroimmunoassay. Fisher Exact test, Kruskal-Wallis test, and Mann-Whitney test with Bonferroni correction were used, when appropriate, to analyze all data. Results: Participants mean age was 61 ± 12 years; 56% were male. CTS levels within the normal range (200-400 pmoles/L) were found in 62% of the whole cohort. Median plasma CTS was significantly higher in HT as compared to CTL (437.6 vs. 326.8 pmoles/L, p= 0.018) and STR (437.6 vs. 286.9 pmoles/L, p=0.005). Blood pressure did not differ between HT and CTL groups (p>0.05). Extreme CTS values (> 1,000 pmoles/L) were observed in four HT and one CTL, despite normal BP. Conclusion: As predicted, HT patients had high CTS levels compared to CTL suggesting a strong relationship between hypertension and CTS. Plasma CTS may be lowered by thrombolytic but not anti-hypertension therapy. Further studies are required to define the role of CTS in human pathological states.

Background: Stroke mortality varies considerably according to race/ethnicity and place of residence. However, limited information is available about contemporary in-hospital death rates and one-year mortality in Hispanics hospitalized with acute stroke. We sought to examine the clinical characteristics, in-hospital, and one-year mortality death rates of Puerto Rican Hispanic patients hospitalized with an acute stroke. Design/Methods: Observational study using data from the Puerto Rico Stroke Registry. The study population consisted of patients hospitalized with an initial (first) acute stroke in 11 medical centers of Puerto Rico in 2007. In-hospital mortality was calculated as the percentage of patients hospitalized with an initial acute stroke who died during the index hospitalization, one-year all-cause mortality was determined through the review of death records in the Puerto Rico Department of Health Vital Statistics Records. Results: Of the 1528 consecutive patients hospitalized with an acute stroke, 1299 (85%) had an ischemic stroke. The mean age was 70 (+/- 28) years, and 53% were women. Patients hospitalized with an acute stroke had a considerable prevalence of comorbidities: 86% had hypertension, 52% had diabetes, 26% had hyperlipidemia, and 9% were current smokers. The overall in-hospital mortality rate was 11% and the one-year all-cause mortality rate was 26%. In comparison with men, women were older (71 years vs. 68 years), more likely to be hypertensive (89% vs. 83%, p=0.001), had similar odds of dying during hospitalization (OR=1.1 [95%CI= 0.8-1.6]), and more likely to die one year after hospital discharge (OR=1.3 [95%CI= 1.1-1.5]). Discussion: Our findings indicate a high in-hospital and one year mortality rates after an initial acute stroke in Hispanic Puerto Ricans. Given the high, short and long-term, death rates associated with acute stroke, monitoring the clinical characteristics, death rates and factors associated with an increased risk of dying remains warranted.