Objective To determine stroke prevalence, mechanisms, and long-term outcome in a cohort of Hispanic patients with systemic lupus erythematosus (SLE). Methods We analyzed demographical data, the timing between SLE diagnosis and stroke onset, stroke type, recurrence, and outcomes from an institutional database of 4451 patients with SLE followed from 1993 to 2018. Results We observed 139 strokes (3.1%), for an incidence rate of 1.25 per 1000 person-years: 81 (58.3%) acute ischemic stroke (AIS), 19 (13.7%) subarachnoid hemorrhage (SAH), 17 (12.2%) cerebral venous thrombosis, 13 (9.4%) intracerebral hemorrhage (ICH), and 9 (6.5%) transient ischemic attack. Median time from SLE diagnosis to acute stroke was 60 months (interquartile range 12–132 months). AIS had a bimodal presentation with 26% occurring within the first year and 30% >10 years after SLE diagnosis. In contrast, 75% of ICH cases occurred >3 years (and 34% >10 years) after SLE diagnosis. The most important cause of AIS was secondary antiphospholipid syndrome (48%). Hypertension was associated with 69% of ICH cases, while aneurysmal rupture was observed in 78% of SAH cases. Excellent recovery at hospital discharge was observed in 65%. Stroke recurrence was observed in 7%. The long-term all-cause fatality rate was 8%. Conclusions The prevalence of stroke in this cohort was 3.1%. Ischemic strokes had a bimodal presentation, occurring either early after SLE diagnosis or after a several-year delay. Half of the hemorrhagic strokes occurred >10 years after the diagnosis of SLE. Clinical outcome was usually good with a relatively low recurrence rate.

Background and objective: Assessing the effect of chronic sleep deprivation on essential neuropsychological tests, including executive functions for performance such as selective attention, inhibitory control, processing velocity, and working memory among internal medicine residents with chronic sleep deprivation in a highly demanding academic program. Methods: We conducted a prospective study measuring neuropsychological performance among internal medicine postgraduate year 1 residents in Mexico City. The study was conducted from 2012 to 2013. We used Stroop test, as well as Wechsler Adult Intelligence Scale (WAIS III) to evaluate executive functions. We performed neuropsychological assessments at the beginning of residency, and again 12 months after the baseline assessment. Results: Chronic sleep deprivation causes an alteration in selective attention, working memory, processing speed, and inhibition. This results in longer time to perform a task, as well as impaired attention during performance of a task. Conclusions: Our findings suggest that limiting the workload of residents and giving them longer off-duty hours would reflect on better and safer patient care. Nevertheless, it is still controversial that medical errors due to fatigue cause damages to patients.