MUÑOZ VENTURELLI, PAULA ANDREA
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MUÑOZ VENTURELLI, PAULA ANDREA
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Email
paumunoz@udd.cl
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Scopus Author ID
56071369200

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Disparities in Stroke Incidence Over Time by Sex and Age in Latin America and the Caribbean Region 1997 to 2021: A Systematic Review and Meta‐Analysis

2023 , Marilaura Nuñez , Carlos Delfino , Claudia Asenjo‐Lobos , SCHILLING REDLICH, ANDREA INGRID , LAVADOS GERMAIN, PABLO MANUEL , Craig S. Anderson , MUÑOZ VENTURELLI, PAULA ANDREA

Background High‐income country studies show unfavorable trends in stroke incidence (SI) in younger populations. We aimed to estimate temporal change in SI disaggregated by age and sex in Latin America and the Caribbean region. Methods and Results A search strategy was used in MEDLINE, WOS, and LILACS databases from 1997 to 2021, including prospective population‐based observational studies with first‐ever stroke incidence in Latin America. Reports without data broken down by age and sex were excluded. Risk of bias was assessed with The Joanna Briggs Institute's guide. The main outcomes were incidence rate ratio and relative temporal trend ratio of SI, comparing time periods before 2010 with after 2010. Pooled relative temporal trend ratios considering only studies with 2 periods in the same population were calculated by random‐effects meta‐analysis. Meta‐regression analysis was used to evaluate incidence rate determinants. From 9242 records identified, 6 studies were selected including 4483 first‐ever stroke in 4 101 084 individuals. Crude incidence rate ratio in younger subjects (<55 years) comparing before 2010:after 2010 periods showed an increase in SI in the past decade (incidence rate ratio, 1.37 [95% CI, 1.23–1.50]), in contrast to a decrease in older people during the same period (incidence rate ratio, 0.83 [95% CI, 0.76–0.89]). Overall relative temporal trend ratio (<55:≥55 years) was 1.65 (95 CI%, 1.50–1.80), with higher increase in young women (pooled relative temporal trend ratio, 3.08 [95% CI, 1.18–4.97]; P for heterogeneity <0.001). Conclusions An unfavorable change in SI in young people, especially in women, was detected in population‐based studies in the past decade in Latin America and the Caribbean. Further investigation of the explanatory variables is required to ameliorate stroke prevention and inform local decision‐makers. Registration URL: https://www.crd.york.ac.uk/prospero/ Identifier: CRD42022332563.

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Cervical Artery Dissection in Postpartum Women after Cesarean and Vaginal Delivery

2022 , Francisca Urrutia , MAZZON AGURTO, ENRICO , BRUNSER, ALEJANDRO , DIAZ TAPIA, VIOLETA DEL CARMEN , CALDERON GIADROSIC, JUAN FRANCISCO , STECHER GUZMAN, XIMENA PATRICIA , Tomas Bernstein , Paulo Zuñiga , SCHILLING REDLICH, ANDREA INGRID , MUÑOZ VENTURELLI, PAULA

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In-Hospital Acute Ischemic Stroke is Associated with Worse Outcome: Experience of a Single Center in Santiago Chile

2021 , BRUNSER RABOVICH, ALEJANDRO MICHEL , Patricia Araneda , NAVIA GONZALEZ, VICTOR HUGO , MAZZON AGURTO, ENRICO , Gabriel Cavada , MUÑOZ VENTURELLI, PAULA ANDREA , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , LAVADOS GERMAIN, PABLO MANUEL

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Long-term Adherence to National Guidelines for Secondary Prevention of Ischemic Stroke: A Prospective Cohort Study in a Public Hospital in Chile

2014 , MUÑOZ VENTURELLI, PAULA ANDREA , Claudio Sacks , Eva Madrid , LAVADOS GERMAIN, PABLO MANUEL

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Heart rate and cardiac autonomic responses to concomitant deep breathing, hand grip exercise, and circulatory occlusion in healthy young adult men and women

2021 , David C. Andrade , Claudia Melipillan , Camilo Toledo , Angélica Rios-Gallardo , Noah J. Marcus , Fernando C. Ortiz , Gonzalo Martinez , MUÑOZ VENTURELLI, PAULA ANDREA , Rodrigo Del Rio

Abstract Background Deep breathing (DB) and handgrip (HG) exercise -with and without circulatory occlusion (OC) in muscle-, have been shown to have beneficial effects on cardiovascular function; however, the combination of these maneuvers on heart rate (HR) and cardiac sympathovagal balance have not been previously investigated. Therefore, the aim of the present study was to evaluate the effect of simultaneous DB, HG, and OC maneuvers on the sympathovagal balance in healthy women and men subjects. Methods and results Electrocardiogram and ventilation were measured in 20 healthy subjects (Women: n = 10; age = 27 ± 4 years; weight = 67.1 ± 8.4 kg; and height = 1.6 ± 0.1 m. Men: n = 10; age = 27 ± 3 years; weight = 77.5 ± 10.1 kg; and height = 1.7 ± 0.1 m) at baseline and during DB, DB + HG, or DB + HG + OC protocols. Heart rate (HR) and respiratory rate were continuously recorded, and spectral analysis of heart rate variability (HRV) were calculated to indirectly estimate cardiac autonomic function. Men and women showed similar HR responses to DB, DB + HG and DB + HG + OC. Men exhibited a significant HR decrease following DB + HG + OC protocol which was accompanied by an improvement in cardiac autonomic control evidenced by spectral changes in HRV towards parasympathetic predominance (HRV High frequency: 83.95 ± 1.45 vs. 81.87 ± 1.50 n.u., DB + HG + OC vs. baseline; p < 0.05). In women, there was a marked decrease in HR after completion of both DB + HG and DB + HG + OC tests which was accompanied by a significant increase in cardiac vagal tone (HRV High frequency: 85.29 ± 1.19 vs. 77.93 ± 0.92 n.u., DB + HG vs. baseline; p < 0.05). No adverse effects or discomfort were reported by men or women during experimental procedures. Independent of sex, combination of DB, HG, and OC was tolerable and resulted in decreases in resting HR and elevations in cardiac parasympathetic tone. Conclusions These data indicate that combined DB, HG and OC are effective in altering cardiac sympathovagal balance and reducing resting HR in healthy men and women.

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Intensive Care Unit Admission for Patients in the INTERACT2 ICH Blood Pressure Treatment Trial: Characteristics, Predictors, and Outcomes

2017 , Katja E. Wartenberg , Xia Wang , MUÑOZ VENTURELLI, PAULA ANDREA , Alejandro A. Rabinstein , LAVADOS GERMAIN, PABLO MANUEL , Craig S. Anderson , Thompson Robinson

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Recommendations for Implementing the INTERACT3 Care Bundle for Intracerebral Hemorrhage in Latin America: Results of a Delphi Method

2024 , Ma. Ignacia Allende , MUÑOZ VENTURELLI, PAULA ANDREA , GONZALEZ MC CAWLEY, FRANCISCA , Francisca Bascur , Craig S. Anderson , Menglu Ouyang , CABIESES VALDES, BALTICA BEATRIZ , OBACH KING, ALEXANDRA ALICE , Vanessa Cano-Nigenda , Antonio Arauz

<b><i>Introduction:</i></b> The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3) showed that the implementation of a care bundle improves outcomes after acute intracerebral hemorrhage (ICH). We aimed to establish consensus-based recommendations for the broader integration of the care bundle across Latin American countries (LAC). <b><i>Methods:</i></b> A 3-phase Delphi study allowed a panel of 32 healthcare workers from 14 LAC to sequentially rank statements relevant to 7 domains (training, resources/infrastructure, patient education, blood pressure, temperature, glycemic control, and anticoagulation reversal). The pre-defined consensus threshold was 75%. <b><i>Results:</i></b> A total of 43 statements reached consensus by the third round, with 12 new statements emerging through rounds. The highest-ranked statements in each domain emphasized critical aspects, but successful implementation requires appropriate resourcing. Key priorities were continuous training of all healthcare workers in ICH management, establishing protocols aligned with available resources, and collaborative interdisciplinary care supported by institutional networks. Statements related to anticoagulation reversal had the highest priority. <b><i>Conclusions:</i></b> Consensus statements are provided to facilitate integration of the INTERACT3 care bundle to reduce disparities in ICH outcomes in LAC.

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Seasonal trend of cervical artery dissection in a Chilean cohort

2019 , RECULE GONZALEZ, FRANCISCA , MAZZON AGURTO, ENRICO , DIAZ TAPIA, VIOLETA DEL CARMEN , Rocha, Diego , BRUNSER RABOVICH, ALEJANDRO MICHEL , De La Barra, Camila , Zuniga, Paulo , Dominga Garcia, Maria , Gabriel Cavada , MUÑOZ VENTURELLI, PAULA ANDREA , Zeballos, Shirley , Charaf, Yusef

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Statistical analysis plan of the head position in acute ischemic stroke trial pilot (HEADPOST pilot)

2017 , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , Hisatomi Arima , Craig S Anderson , BRUNSER, ALEJANDRO , MUÑOZ VENTURELLI, PAULA ANDREA , Laurent Billot , LAVADOS GERMAIN, PABLO MANUEL

Background The HEADPOST Pilot is a proof-of-concept, open, prospective, multicenter, international, cluster randomized, phase IIb controlled trial, with masked outcome assessment. The trial will test if lying flat head position initiated in patients within 12 h of onset of acute ischemic stroke involving the anterior circulation increases cerebral blood flow in the middle cerebral arteries, as measured by transcranial Doppler. The study will also assess the safety and feasibility of patients lying flat for ≥24 h. The trial was conducted in centers in three countries, with ability to perform early transcranial Doppler. A feature of this trial was that patients were randomized to a certain position according to the month of admission to hospital. Objective To outline in detail the predetermined statistical analysis plan for HEADPOST Pilot study. Methods All data collected by participating researchers will be reviewed and formally assessed. Information pertaining to the baseline characteristics of patients, their process of care, and the delivery of treatments will be classified, and for each item, appropriate descriptive statistical analyses are planned with comparisons made between randomized groups. For the outcomes, statistical comparisons to be made between groups are planned and described. Results This statistical analysis plan was developed for the analysis of the results of the HEADPOST Pilot study to be transparent, available, verifiable, and predetermined before data lock. Conclusions We have developed a statistical analysis plan for the HEADPOST Pilot study which is to be followed to avoid analysis bias arising from prior knowledge of the study findings. Trial registration The study is registered under HEADPOST-Pilot, ClinicalTrials.gov Identifier NCT01706094.

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Implementation of Low-Intensity Thrombolysis Monitoring Care in Routine Practice: Process Evaluation of the Optimal Post rtPA-IV Monitoring in Acute Ischemic Stroke Study in the USA

2024 , Menglu Ouyang , Francisca González , Michelle Montalbano , April Pruski , Stephen Jan , Xia Wang , Brenda Johnson , Debbie V. Summers , Pooja Khatri , Alejandra Malavera , Michael Iacobelli , Roland Faigle , MUÑOZ VENTURELLI, PAULA ANDREA , Francisca Urrutia Goldsack , Diana Day , Thompson G. Robinson , Alice C. Durham , Ahtasam Ebraimo , Lili Song , Yi Sui , Wan Asyraf Wan Zaidi , Richard I. Lindley , Candice Delcourt , Victor Cruz Urrutia , Craig S. Anderson , Hueiming Liu

<b><i>Introduction:</i></b> The ongoing OPTIMISTmain study, an international, multicenter, stepped-wedge cluster randomized trial, aims to determine effectiveness and safety of low-intensity versus standard monitoring in thrombolysis-treated patients with mild-to-moderate acute ischemic stroke (AIS). An embedded process evaluation explored integration and impact of the intervention on care processes at participating US sites. <b><i>Methods:</i></b> A mixed-methods approach with quantitative and qualitative data was collected between September 2021 and November 2022. Implementer surveys were undertaken at pre- and post-intervention phases to understand the perceptions of low-intensity monitoring strategy. A sample of stroke care nurses were invited to participate in semi-structured interviews at an early stage of post-intervention. Qualitative data were analyzed deductively using the normalization process theory; quantitative data were tabulated. <b><i>Results:</i></b> Interviews with 21 nurses at 8 hospitals have shown low-intensity monitoring was well accepted as there were less time constraints and reduced workload for each patient. There were initial safety concerns over missing deteriorating patients and difficulties in changing established routines. Proper training, education, and communication, and changing the habits and culture of care, were key elements to successfully adopting the new monitoring care into routine practice. Similar results were found in the post-intervention survey (42 nurses from 13 hospitals). Nurses reported time being freed up to provide patient education (56%), daily living care (50%), early mobilization (26%), mood/cognition assessment (44%), and other aspects (i.e., communication, family support). <b><i>Conclusions:</i></b> Low-intensity monitoring for patients with mild-to-moderate AIS, facilitated by appropriate education and organizational support, appears feasible and acceptable at US hospitals.

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