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Camuffo L, Mengato D, Nobili A, Santalucia P, Proietti M, Venturini F. Interprofessional collaborative practice is strong in young health professionals: evidence from an Italian Winter School attended by hospital pharmacists and internal medicine physicians. Eur J Hosp Pharm 2024; 31:183-184. [PMID: 37495272 PMCID: PMC10895176 DOI: 10.1136/ejhpharm-2023-003900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Affiliation(s)
- Laura Camuffo
- Hospital Pharmacy Department, Azienda Ospedale - Università Padova, Padova, Italy
| | - Daniele Mengato
- Hospital Pharmacy Department, Azienda Ospedale - Università Padova, Padova, Italy
| | | | - Paola Santalucia
- Società Italiana di Simulazione in Medicina (SIMMED), Naples, Italy
| | - Marco Proietti
- Società Italiana di Medicina Interna (SIMI), Rome, Lazio, Italy
| | - Francesca Venturini
- Hospital Pharmacy Department, Azienda Ospedale - Università Padova, Padova, Italy
- SIFaCT, Società Italiana di Farmacia Clinica e Terapia, Torino, Italy
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2
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Parati G, Goncalves A, Soergel D, Bruno RM, Caiani EG, Gerdts E, Mahfoud F, Mantovani L, McManus RJ, Santalucia P, Kahan T. New perspectives for hypertension management: progress in methodological and technological developments. Eur J Prev Cardiol 2023; 30:48-60. [PMID: 36073370 DOI: 10.1093/eurjpc/zwac203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/21/2022] [Accepted: 09/05/2022] [Indexed: 01/14/2023]
Abstract
Hypertension is the most common and preventable risk factor for cardiovascular disease (CVD), accounting for 20% of deaths worldwide. However, 2/3 of people with hypertension are undiagnosed, untreated, or under treated. A multi-pronged approach is needed to improve hypertension management. Elevated blood pressure (BP) in childhood is a predictor of hypertension and CVD in adulthood; therefore, screening and education programmes should start early and continue throughout the lifespan. Home BP monitoring can be used to engage patients and improve BP control rates. Progress in imaging technology allows for the detection of preclinical disease, which may help identify patients who are at greatest risk of CV events. There is a need to optimize the use of current BP control strategies including lifestyle modifications, antihypertensive agents, and devices. Reducing the complexity of pharmacological therapy using single-pill combinations can improve patient adherence and BP control and may reduce physician inertia. Other strategies that can improve patient adherence include education and reassurance to address misconceptions, engaging patients in management decisions, and using digital tools. Strategies to improve physician therapeutic inertia, such as reminders, education, physician-peer visits, and task-sharing may improve BP control rates. Digital health technologies, such as telemonitoring, wearables, and other mobile health platforms, are becoming frequently adopted tools in hypertension management, particularly those that have undergone regulatory approval. Finally, to fight the consequences of hypertension on a global scale, healthcare system approaches to cardiovascular risk factor management are needed. Government policies should promote routine BP screening, salt-, sugar-, and alcohol reduction programmes, encourage physical activity, and target obesity control.
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Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | | | - David Soergel
- Cardiovascular, Renal, and Metabolic Drug Development, Novartis, Basel, CH 4056, Switzerland
| | - Rosa Maria Bruno
- Paris Cardiovascular Research Centre (PARCC-INSERM U970) & Université de Paris, Paris 75015, France
| | - Enrico Gianluca Caiani
- Politecnico di Milano, Electronics, Information and Bioengineering Department, Institute of Electronics, Computer and Telecommunication Engineering (IEIIT), National Research Council of Italy (CNR), Milan 20133 & 24-10129, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen NO-5020, Norway
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg 66123, Germany
| | - Lorenzo Mantovani
- Value-based Healthcare Unit, IRCCS MultiMedica Research Hospital, University of Milan, Milan, Italy
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6HD, UK
| | - Paola Santalucia
- Italian Association Against Thrombosis and Cardiovascular Diseases (ALT Onlus), Milan 20123, Italy
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm SE 182 88, Sweden.,Department of Cardiology, Danderyd University Hospital Corp, Stockholm SE 182 88, Sweden
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3
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Lanza G, Orso M, Alba G, Bevilacqua S, Capoccia L, Cappelli A, Carrafiello G, Cernetti C, Diomedi M, Dorigo W, Faggioli G, Giannace V, Giannandrea D, Giannetta M, Lanza J, Lessiani G, Marone EM, Mazzaccaro D, Migliacci R, Nano G, Pagliariccio G, Petruzzellis M, Plutino A, Pomatto S, Pulli R, Reale N, Santalucia P, Sirignano P, Ticozzelli G, Vacirca A, Visco E. Guideline on carotid surgery for stroke prevention: updates from the Italian Society of Vascular and Endovascular Surgery. A trend towards personalized medicine. J Cardiovasc Surg (Torino) 2022; 63:471-491. [PMID: 35848869 DOI: 10.23736/s0021-9509.22.12368-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND This guideline (GL) on carotid surgery as updating of "Stroke: Italian guidelines for Prevention and Treatment" of the ISO-SPREAD Italian Stroke Organization-Group, has recently been published in the National Guideline System and shared with the Italian Society of Vascular and Endovascular Surgery (SICVE) and other Scientific Societies and Patient's Association. METHODS GRADE-SIGN version, AGREE quality of reporting checklist. Clinical questions formulated according to the PICO model. Recommendations developed based on clinical questions by a multidisciplinary experts' panel and patients' representatives. Systematic reviews performed for each PICO question. Considered judgements filled by assessing the evidence level, direction, and strength of the recommendations. RESULTS The panel provided indications and recommendations for appropriate, comprehensive, and individualized management of patients with carotid stenosis. Diagnostic and therapeutic processes of the best medical therapy, carotid endarterectomy (CEA), carotid stenting (CAS) according to the evidences and the judged opinions were included. Symptomatic carotid stenosis in elective and emergency, asymptomatic carotid stenosis, association with ischemic heart disease, preoperative diagnostics, types of anesthesia, monitoring in case of CEA, CEA techniques, comparison between CEA and CAS, post-surgical carotid restenosis, and medical therapy are the main topics, even with analysis of uncertainty areas for risk-benefit assessments in the individual patient (personalized medicine [PM]). CONCLUSIONS This GL updates on the main recommendations for the most appropriate diagnostic and medical-surgical management of patients with atherosclerotic carotid artery stenosis to prevent ischemic stroke. This GL also provides useful elements for the application of PM in good clinical practice.
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Affiliation(s)
- Gaetano Lanza
- Department of Vascular Surgery, IRCCS MultiMedica, Castellanza Hospital, Castellanza, Varese, Italy
| | - Massimiliano Orso
- Experimental Zooprophylactic Institute of Umbria and Marche, Perugia, Italy
| | - Giuseppe Alba
- Unit of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Sergio Bevilacqua
- Department of Cardiac Anesthesia and Resuscitation, Careggi University Hospital, Florence, Italy
| | - Laura Capoccia
- Department of Vascular and Endovascular Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Alessandro Cappelli
- Unit of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giampaolo Carrafiello
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Carlo Cernetti
- Department of Cardiology and Hemodynamics, San Giacomo Apostolo Hospital, Castelfranco Veneto, Treviso, Italy
- Cardiology and Hemodynamics Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Marina Diomedi
- Stroke Unit, Tor Vergata Polyclinic Hospital, Tor Vergata University, Rome, Italy
| | - Walter Dorigo
- Department of Vascular Surgery, Careggi Polyclinic Hospital, University of Florence, Florence, Italy
| | - Gianluca Faggioli
- Department of Vascular Surgery, Alma Mater Studiorum University, Bologna, Italy
| | - Vanni Giannace
- Unit of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - David Giannandrea
- Department of Neurology, USL Umbria 1, Hospitals of Gubbio, Gualdo Tadino and Città di Castello, Perugia, Italy
| | - Matteo Giannetta
- Department of Vascular Surgery, IRCCS San Donato Hospitals, San Donato Polyclinic Hospital, Milan, Italy
| | - Jessica Lanza
- Department of Vascular Surgery, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy -
| | - Gianfranco Lessiani
- Unit of Vascular Medicine and Diagnostics, Department of Internal Medicine, Villa Serena Hospital, Città Sant'Angelo, Pesaro, Italy
| | - Enrico M Marone
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Daniela Mazzaccaro
- Department of Vascular Surgery, IRCCS San Donato Hospitals, San Donato Polyclinic Hospital, Milan, Italy
| | - Rino Migliacci
- Department of Internal Medicine, Valdichiana S. Margherita Hospital, USL Toscana Sud-Est, Cortona, Arezzo, Italy
| | - Giovanni Nano
- Department of Vascular Surgery, IRCCS San Donato Hospitals, San Donato Polyclinic Hospital, Milan, Italy
| | - Gabriele Pagliariccio
- Department of Emergency Vascular Surgery, Ospedali Riuniti University of Ancona, Ancona, Italy
| | | | - Andrea Plutino
- Stroke Unit, Ospedali Riuniti Marche Nord, Ancona, Italy
| | - Sara Pomatto
- Department of Vascular Surgery, Sant'Orsola Malpighi Polyclinic Hospital, University of Bologna, Bologna, Italy
| | - Raffaele Pulli
- Department of Vascular Surgery, University of Bari, Bari, Italy
| | | | | | - Pasqualino Sirignano
- Department of Vascular and Endovascular Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Giulia Ticozzelli
- First Department of Anesthesia and Resuscitation, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Andrea Vacirca
- Unit of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCSS Sant'Orsola Polyclinic Hospital, University of Bologna, Bologna, Italy
| | - Emanuele Visco
- Department of Cardiology and Hemodynamics, San Giacomo Apostolo Hospital, Castelfranco Veneto, Treviso, Italy
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4
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Sonaglioni A, Albini A, Noonan DM, Brucato A, Lombardo M, Santalucia P. A Case of Acute Pericarditis After COVID-19 Vaccination. Front Allergy 2022; 2:733466. [PMID: 35387019 PMCID: PMC8974729 DOI: 10.3389/falgy.2021.733466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
A two-dose regimen of Pfizer-BioNTech COVID-19 vaccination confers 95% protection against COronaVIrus Disease 19 (COVID-19) and the safety profile is adequate. To the submission date, there were no reports in literature of acute pericarditis after BNT162b2 vaccination. However, pericarditis has been reported as a rare event associated with COVID-19 infection, which could be due to the pro-inflammatory effects of the spike protein. Recent evidence of post-vaccine myocarditis has been published. Herein we describe the case of a middle-aged healthy women who developed symptoms and signs of acute pericarditis 7-10 days after the second dose of Pfizer-BioNTech COVID-19 vaccination. Although a direct effect cannot be stated, it is important to report a potential adverse vaccine reaction effect that could be associated with the expression of SARS-CoV-2 spike protein induced from the mRNA of the vaccine.
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Affiliation(s)
- Andrea Sonaglioni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Adriana Albini
- Scientific and Technological Pole, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Douglas M Noonan
- Scientific and Technological Pole, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy.,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Antonio Brucato
- Dipartimento Scienze Biomediche e Cliniche Luigi Sacco, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy
| | - Michele Lombardo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Paola Santalucia
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
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5
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Raggi A, Monasta L, Beghi E, Caso V, Castelpietra G, Mondello S, Giussani G, Logroscino G, Magnani FG, Piccininni M, Pupillo E, Ricci S, Ronfani L, Santalucia P, Sattin D, Schiavolin S, Toppo C, Traini E, Steinmetz J, Nichols E, Ma R, Vos T, Feigin V, Leonardi M. Incidence, prevalence and disability associated with neurological disorders in Italy between 1990 and 2019: an analysis based on the Global Burden of Disease Study 2019. J Neurol 2022; 269:2080-2098. [PMID: 34498172 PMCID: PMC9938710 DOI: 10.1007/s00415-021-10774-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Neurological conditions are highly prevalent and disabling, in particular in the elderly. The Italian population has witnessed sharp ageing and we can thus expect a rising trend in the incidence, prevalence and disability of these conditions. METHODS We relied on the Global Burden of Disease 2019 study to extract Italian data on incidence, prevalence and years lived with a disability (YLDs) referred to a broad set of neurological disorders including, brain and nervous system cancers, stroke, encephalitis, meningitis, tetanus, traumatic brain injury, and spinal cord injury. We assessed changes between 1990 and 2019 in counts and age-standardized rates. RESULTS The most prevalent conditions were tension-type headache, migraine, and dementias, whereas the most disabling were migraine, dementias and traumatic brain injury. YLDs associated with neurological conditions increased by 22.5%, but decreased by 2.3% in age-standardized rates. The overall increase in prevalence and YLDs counts was stronger for non-communicable diseases with onset in old age compared to young to adult-age onset ones. The same trends were in the opposite direction when age-standardized rates were taken into account. CONCLUSIONS The increase in YLDs associated with neurological conditions is mostly due to population ageing and growth: nevertheless, lived disability and, as a consequence, impact on health systems has increased. Actions are needed to improve outcome and mitigate disability associated with neurological conditions, spanning among diagnosis, treatment, care pathways and workplace interventions.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Lorenzo Monasta
- S.C.R. Epidemiologia Clinica e Ricerca Sui Servizi Sanitari, IRCCS Materno Infantile “Burlo Garofolo”, Trieste, Italy
| | - Ettore Beghi
- Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Valeria Caso
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Università di Perugia, Perugia, Italy
| | - Giulio Castelpietra
- Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giorgia Giussani
- Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Giancarlo Logroscino
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, Università di Bari Aldo Moro, Bari, Italy
| | - Francesca Giulia Magnani
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Marco Piccininni
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabetta Pupillo
- Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Stefano Ricci
- Neurology and Stroke Unit, USL Umbria 1, Gubbio and Cittá di Castello Hospital, Perugia, Italy
| | - Luca Ronfani
- S.C.R. Epidemiologia Clinica e Ricerca Sui Servizi Sanitari, IRCCS Materno Infantile “Burlo Garofolo”, Trieste, Italy
| | - Paola Santalucia
- Neurology and Stroke Unit, Ospedale San Giuseppe-Multimedica, Milan, Italy
| | - Davide Sattin
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Eugenio Traini
- S.C.R. Epidemiologia Clinica e Ricerca Sui Servizi Sanitari, IRCCS Materno Infantile “Burlo Garofolo”, Trieste, Italy,Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jaimie Steinmetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Emma Nichols
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Rui Ma
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, Australia
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
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Sonaglioni A, Cara MD, Nicolosi GL, Eusebio A, Bordonali M, Santalucia P, Lombardo M. Rapid Risk Stratification of Acute Ischemic Stroke Patients in the Emergency Department: The Incremental Prognostic Role of Left Atrial Reservoir Strain. J Stroke Cerebrovasc Dis 2021; 30:106100. [PMID: 34525440 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To determine the prognostic value of positive global left atrial strain (LA-GSA+), measured by two-dimensional speckle tracking echocardiography (2D-STE) in a population of acute ischemic stroke (AIS) patients without atrial fibrillation (AF), in the setting of Emergency Department (ED). METHODS All consecutive AIS patients with sinus rhythm on ECG and without AF history entered this prospective study. All patients underwent complete blood tests and transthoracic echocardiography implemented with 2D-STE analysis of LA strain parameters within 6-12 h after symptoms onset. At 6-months follow-up, we evaluated the composite endpoint of all-cause mortality plus cardiovascular re-hospitalizations. RESULTS A total of 102 AIS patients (76.4 ± 10.8 yrs, 47% males) were prospectively included. LA-GSA+ was markedly reduced in AIS patients (20.8 ± 7.7%), without any statistically significant difference between the stroke subtypes. At 6-months follow-up, 7 deaths and 27 re-hospitalizations occurred. On multivariate Cox regression analysis, variables independently associated with outcome were: LA-GSA+ (per unit) (HR 0.29, 95% CI 0.19-0.39) and C-reactive protein (CRP) (per 0.1 mg/dl) (HR 1.45, 95% CI 1.15-1.75) as continuous variables; statin therapy (HR 0.45, 95%CI 0.28-0.62), and type 2 diabetes (HR 1.65, 95% CI 1.15-2.35) as categorical variables. A LA-GSA+ ≤20.0% predicted the occurrence of the above-mentioned outcome at 6-months follow-up with 94% sensitivity and 81% specificity (AUC=0.84). Interestingly, GSA+ showed a strong inverse correlation with CRP levels (r = -0.86). CONCLUSIONS A LA-GSA+ ≤20% reflects a more advanced atrial cardiomyopathy and might provide a rapid and reliable prognostic risk stratification of AIS patients without AF history in the setting of ED.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy.
| | - Marianna Di Cara
- Emergency Medicine Unit, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
| | | | - Alessandro Eusebio
- Emergency Medicine Unit, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
| | - Marco Bordonali
- Emergency Medicine Unit, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
| | - Paola Santalucia
- Department of Neurology, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
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7
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van der Worp HB, Hofmeijer J, Jüttler E, Lal A, Michel P, Santalucia P, Schönenberger S, Steiner T, Thomalla G. European Stroke Organisation (ESO) guidelines on the management of space-occupying brain infarction. Eur Stroke J 2021; 6:III. [PMID: 34414304 DOI: 10.1177/23969873211027001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
Space-occupying brain oedema is a potentially life-threatening complication in the first days after large hemispheric or cerebellar infarction. Several treatment strategies for this complication are available, but the size and quality of the scientific evidence on which these strategies are based vary considerably. The aim of this Guideline document is to assist physicians in their management decisions when treating patients with space-occupying hemispheric or cerebellar infarction. These Guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. A working group identified 13 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. An expert consensus statement was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high-quality evidence to recommend surgical decompression to reduce the risk of death and to increase the chance of a favourable outcome in adult patients aged up to and including 60 years with space-occupying hemispheric infarction who can be treated within 48 hours of stroke onset, and low-quality evidence to support this treatment in older patients. There is continued uncertainty about the benefit and risks of surgical decompression in patients with space-occupying hemispheric infarction if this is done after the first 48 hours. There is also continued uncertainty about the selection of patients with space-occupying cerebellar infarction for surgical decompression or drainage of cerebrospinal fluid. These Guidelines further provide details on the management of specific subgroups of patients with space-occupying hemispheric infarction, on the value of monitoring of intracranial pressure, and on the benefits and risks of medical treatment options. We encourage new high-quality studies assessing the risks and benefits of different treatment strategies for patients with space-occupying brain infarction.
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Affiliation(s)
- H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands.,Department of Clinical Neurophysiology, University of Twente, Enschede, the Netherlands
| | - Eric Jüttler
- Department of Neurology, Kliniken Ostalb, Aalen, Germany
| | - Avtar Lal
- European Stroke Organisation, Basel, Switzerland
| | - Patrik Michel
- Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques CHUV, Lausanne, Switzerland
| | - Paola Santalucia
- Neurology-Stroke Unit, San Giuseppe Hospital-Multimedica, Milan, Italy
| | | | - Thorsten Steiner
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Götz Thomalla
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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8
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van der Worp HB, Hofmeijer J, Jüttler E, Lal A, Michel P, Santalucia P, Schönenberger S, Steiner T, Thomalla G. European Stroke Organisation (ESO) guidelines on the management of space-occupying brain infarction. Eur Stroke J 2021; 6:XC-CX. [PMID: 34414308 PMCID: PMC8370072 DOI: 10.1177/23969873211014112] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/13/2021] [Indexed: 01/29/2023] Open
Abstract
Space-occupying brain oedema is a potentially life-threatening complication in the first days after large hemispheric or cerebellar infarction. Several treatment strategies for this complication are available, but the size and quality of the scientific evidence on which these strategies are based vary considerably. The aim of this Guideline document is to assist physicians in their management decisions when treating patients with space-occupying hemispheric or cerebellar infarction. These Guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. A working group identified 13 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. An expert consensus statement was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high-quality evidence to recommend surgical decompression to reduce the risk of death and to increase the chance of a favourable outcome in adult patients aged up to and including 60 years with space-occupying hemispheric infarction who can be treated within 48 hours of stroke onset, and low-quality evidence to support this treatment in older patients. There is continued uncertainty about the benefit and risks of surgical decompression in patients with space-occupying hemispheric infarction if this is done after the first 48 hours. There is also continued uncertainty about the selection of patients with space-occupying cerebellar infarction for surgical decompression or drainage of cerebrospinal fluid. These Guidelines further provide details on the management of specific subgroups of patients with space-occupying hemispheric infarction, on the value of monitoring of intracranial pressure, and on the benefits and risks of medical treatment options. We encourage new high-quality studies assessing the risks and benefits of different treatment strategies for patients with space-occupying brain infarction.
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Affiliation(s)
- H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
- Department of Clinical Neurophysiology, University of Twente, Enschede, the Netherlands
| | - Eric Jüttler
- Department of Neurology, Kliniken Ostalb, Aalen, Germany
| | - Avtar Lal
- European Stroke Organisation, Basel, Switzerland
| | - Patrik Michel
- Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques CHUV, Lausanne, Switzerland
| | - Paola Santalucia
- Neurology-Stroke Unit, San Giuseppe Hospital-Multimedica, Milan, Italy
| | | | - Thorsten Steiner
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Götz Thomalla
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Sangalli D, Martinelli-Boneschi F, Versino M, Colombo I, Ciccone A, Beretta S, Marcheselli S, Altavilla R, Roncoroni M, Beretta S, Lorusso L, Cavallini A, Prelle A, Guidetti D, La Gioia S, Santalucia P, Zanferrari C, Grampa G, D'Adda E, Peverelli L, Colombo A, Salmaggi A. Impact of SARS-CoV-2 infection on acute intracerebral haemorrhage in northern Italy. J Neurol Sci 2021; 426:117479. [PMID: 34004463 PMCID: PMC8096523 DOI: 10.1016/j.jns.2021.117479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/06/2021] [Accepted: 05/02/2021] [Indexed: 11/16/2022]
Abstract
Introduction Growing evidence has been published as to the impact of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) on cerebrovascular events over the last few months, with considerable attention paid to ischemic strokes. Conversely, little is known about the clinical course of intracerebral haemorrhage (ICH) and simultaneous SARS-CoV-2 infection. Method The Italian Society of Hospital Neurosciences (SNO) promoted a multicentre, retrospective, observational study (SNO-COVID-19), involving 20 Neurological Departments in Northern Italy. Clinical data on patients with acute cerebrovascular diseases, admitted from March 1st to April 30th, 2020, were collected. A comparison was made of the demographical and clinical features of both SARS-CoV-2 positive and negative patients with ICH. Results 949 patients were enrolled (average age 73.4 years; 52.7% males); 135 patients had haemorrhagic stroke and 127 (13.4%) had a primary ICH. Only 16 patients with ICH (12.6%) had laboratory confirmed SARS-CoV-2 infection, both symptomatic and asymptomatic. SARS-CoV-2 related pneumonia or respiratory distress (OR 5.4), lobar location (OR 5.0) and previous antiplatelet or anticoagulant treatment (OR 2.9) were the only factors significantly associated with increased mortality in ICH. SARS-CoV-2 infection, regardless of respiratory involvement, led to a non-significantly increased risk of in-hospital death (37.5% vs 23.4%, p = 0.2). Discussion ICH patients with COVID-19 did not experience an increase in mortality as striking as ischemic stroke. The inflammatory response and respiratory complications could justify the slight increase of death in ICH. Bleeding sites and previous antiplatelet or anticoagulant treatment were the only other predictors of a worse outcome.
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Affiliation(s)
- Davide Sangalli
- Neurological Department, "Alessandro Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900 Lecco, Italy.
| | - Filippo Martinelli-Boneschi
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Via Francesco Sforza 35, 20122 Milan, Italy; Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST SetteLaghi, Ospedale di Circolo, DMC, University of Insubria, Varese, Italy
| | - Irene Colombo
- Neurology and Stroke Unit, Ospedale di Desio, ASST, Monza, MB, Italy
| | - Alfonso Ciccone
- Department of Neurosciences, Carlo Poma Hospital, ASST di Mantova, Mantua, Italy
| | - Simone Beretta
- Department of Neurology, San Gerardo Hospital, ASST Monza, University of Milano Bicocca, Monza, NeuroMi (Milan Center for Neuroscience), Milan, Italy
| | - Simona Marcheselli
- Neurologia d'urgenza e Stroke Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Riccardo Altavilla
- Neurology and Stroke Unit, P.O. San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mauro Roncoroni
- Neurology and Stroke Unit, P.O. Saronno, ASST Valle Olona, Varese, Italy
| | - Sandro Beretta
- Neurology, Vimercate Hospital, ASST Vimercate, Vimercate, MB, Italy
| | - Lorenzo Lorusso
- Neurological Department, San Leopoldo Mandic Hospital, ASST Lecco, Merate, Italy
| | - Anna Cavallini
- Neurologia d'Urgenza e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | | | - Donata Guidetti
- Neurology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Sara La Gioia
- Department of neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Santalucia
- Neurology and Stroke Unit, San Giuseppe-Multimedica Hospital, Milan, Italy
| | - Carla Zanferrari
- Neurology and Stroke Unit, PO Vizzolo Predabissi, ASST Melegnano Martesana, Milan, Italy
| | | | - Elisabetta D'Adda
- Neurology Unit, Ospedale Maggiore di Crema, ASST Crema, Crema, Italy
| | | | | | - Andrea Salmaggi
- Neurological Department, "Alessandro Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900 Lecco, Italy
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10
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Casolla B, de Leciñana MA, Neves R, Pfeilschifter W, Svobodova V, Jung S, Kemmling A, Mikulik R, Santalucia P. Simulation training programs for acute stroke care: Objectives and standards of methodology. Eur Stroke J 2021; 5:328-335. [PMID: 33598550 DOI: 10.1177/2396987320971105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/09/2020] [Indexed: 01/22/2023] Open
Abstract
The European Stroke Organisation (ESO) Simulation Committee was established in 2017 with the intent to promote simulation education and training in the stroke field. The application of simulation methodology in education and training improves healthcare professional performances in real clinical practice and patient outcomes. We evaluated the implementation of simulation training in stroke medicine, how it can significantly affect stroke pathways and quality of care. We herewith describe simulation techniques in the acute stroke setting. Simulation programs place the trainees in a safe environment, allowing both role-playings for decision making training and procedural simulation for technical skills improvement. This paper includes the position of the Committee on the key points, principles, and steps in order to set up and promote simulation programs in European stroke centers. Stroke is an emergency, and hyperacute phase management requires knowledge, expertise, optimal multidisciplinary team working, and timely actions in a very narrow time window. The ESO Simulation Committee promotes the implementation of simulation training in stroke care according to a specific and validated methodology.
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Affiliation(s)
- Barbara Casolla
- Department of Neurology, Stroke Unit, Univ. Lille, Inserm U1172, CHU Lille, Lille, France
| | - Maria Alonso de Leciñana
- Department of Neurology, Stroke Center, University Hospital La Paz, Universidad Autónoma, Madrid, Spain
| | - Raquel Neves
- Royal Heath Group Czech Rehabilitation Hospital, Abu Dhabi, United Arab Emirates
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Veronica Svobodova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Simon Jung
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - André Kemmling
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Robert Mikulik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.,Neurology Department, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Paola Santalucia
- Department of Neurology and Strategic Direction, Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
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11
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Beghi E, Feigin V, Caso V, Santalucia P, Logroscino G. COVID-19 Infection and Neurological Complications: Present Findings and Future Predictions. Neuroepidemiology 2020; 54:364-369. [PMID: 32610334 PMCID: PMC7445369 DOI: 10.1159/000508991] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023] Open
Abstract
The present outbreak caused by SARS-CoV-2, an influenza virus with neurotropic potential, presents with neurological manifestations in a large proportion of the affected individuals. Disorders of the central and peripheral nervous system are all present, while stroke, ataxia, seizures, and depressed level of consciousness are more common in severely affected patients. People with these severe complications are most likely elderly with medical comorbidities, especially hypertension and other vascular risk factors. However, postinfectious complications are also expected. Neurological disorders as sequelae of influenza viruses have been repeatedly documented in the past and include symptoms, signs, and diseases occurring during the acute phase and, not rarely, during follow-up. Postinfectious neurological complications are the result of the activation of immune mechanisms and can explain the insurgence of immune-mediated diseases, including the Guillain-Barré syndrome and other diseases of the central and peripheral nervous system that in the past occurred as complications of viral infections and occasionally with vaccines. For these reasons, the present outbreak calls for the introduction of surveillance systems to monitor changes in the frequency of several immune-mediated neurological diseases. These changes will determine a reorganization of the measures apt to describe the interaction between the virus, the environment, and the host in areas of different dimensions, from local communities to regions with several millions of inhabitants. The public health system, mainly primary care, needs to be strengthened to ensure that research and development efforts are directed toward right needs and directions. To cope with the present pandemic, better collaboration is required between international organizations along with more research funding, and tools in order to detect, treat, and prevent future epidemics.
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Affiliation(s)
- Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy,
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences School of Public Health and Psychosocial Studies Faculty of Health and Environmental Sciences AUT University Auckland, Auckland, New Zealand
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro"Bari, "Pia Fondazione Cardinale G. Panico", Tricase, Italy
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12
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Monasta L, Abbafati C, Logroscino G, Remuzzi G, Perico N, Bikbov B, Tamburlini G, Beghi E, Traini E, Redford SB, Ariani F, Borzì AM, Bosetti C, Carreras G, Caso V, Castelpietra G, Cirillo M, Conti S, Cortesi PA, Damiani G, D'Angiolella LS, Fanzo J, Fornari C, Gallus S, Giussani G, Gorini G, Grosso G, Guido D, La Vecchia C, Lauriola P, Leonardi M, Levi M, Madotto F, Mondello S, Naldi L, Olgiati S, Palladino R, Piccinelli C, Piccininni M, Pupillo E, Raggi A, Rubino S, Santalucia P, Vacante M, Vidale S, Violante FS, Naghavi M, Ronfani L. Italy's health performance, 1990-2017: findings from the Global Burden of Disease Study 2017. Lancet Public Health 2019; 4:e645-e657. [PMID: 31759893 PMCID: PMC7098474 DOI: 10.1016/s2468-2667(19)30189-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Through a comprehensive analysis of Italy's estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we aimed to understand the patterns of health loss and response of the health-care system, and offer evidence-based policy indications in light of the demographic transition and government health spending in the country. METHODS Estimates for Italy were extracted from GBD 2017. Data on Italy are presented for 1990 and 2017, on prevalence, causes of death, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth and at age 65 years, healthy life expectancy, and Healthcare Access and Quality (HAQ) Index. We compared the estimates for Italy with those of 15 other western European countries. FINDINGS The quality of the universal health system and healthy behaviours contribute to favourable overall health, even in comparison with other western European countries. In 2017, life expectancy and HAQ Index score in Italy were among the highest globally, with life expectancy at birth reaching 85·3 years for females and 80·8 for males in 2017, ranking Italy eighth globally for females and sixth for males, and an HAQ Index score of 94·9 in 2016 compared with 81·54 in 1990, keeping Italy ranked as ninth globally. Between 1990 and 2017 age-standardised death rates for cardiovascular diseases decreased by 53·7% (95% uncertainty interval -56·1 to -51·4), for neoplasms decreased by 28·2% (-32·3 to -24·6), and for transport injuries decreased by 62·1% (-64·6 to -59·2). However, population ageing is causing an increase in the burden of specific diseases, such as Alzheimer's disease and other dementias (DALYs increased by 77·9% [68·4 to 87·2]) and pancreatic (DALYs increased by 39·7% [28·4 to 51·7]) and uterine cancers (DALYs increased by 164·7% [129·7 to 202·5]). Behavioural risk factors, which are potentially modifiable, still have a strong effect, particularly on cardiovascular diseases and neoplasms. For instance, in 2017, 44 400 (41 200 to 47 800) cancer deaths were attributed to smoking, 12 000 (9600 to 14 800) to alcohol use, and 9500 (5400 to 14 200) to high body-mass index, while 47 000 (31 100 to 65 700) deaths due to cardiovascular diseases could be attributed to high LDL cholesterol, 28 700 (19 700 to 38 500) to diets low in whole grains, and 15 900 (8500 to 24 900) to low physical activity. INTERPRETATION Italy provides an interesting example of the results that can be achieved by a mix of relatively healthy lifestyles and a universal health system. Two main issues require attention, population ageing and gradual decrease of public health financing, which both pose several challenges to the future of Italy's health status. Our findings should be useful to Italy's policy makers and health system experts elsewhere. FUNDING Bill & Melinda Gates Foundation.
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13
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Vinciguerra L, Cantone M, Lanza G, Bramanti A, Santalucia P, Puglisi V, Pennisi G, Bella R. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res 2019. [PMID: 31695483 DOI: 10.2147/jpr.s209485.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5-1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.
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Affiliation(s)
- Luisa Vinciguerra
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.,Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Alessia Bramanti
- Institute of Applied Sciences and Intelligent Systems (ISASI), IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Paola Santalucia
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Valentina Puglisi
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technology, Section of Neurosciences, University of Catania, Catania, Italy
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14
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Cantone M, Lanza G, Bella R, Pennisi G, Santalucia P, Bramanti P, Pennisi M. Fear and disgust: case report of two uncommon emotional disturbances evoked by visual disperceptions after a right temporal-insular stroke. BMC Neurol 2019; 19:193. [PMID: 31409291 PMCID: PMC6693272 DOI: 10.1186/s12883-019-1417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/25/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Emotional processes and responses are underestimated in stroke patients because the massive clinical picture of large hemispheric strokes often hides these symptoms. We report on a patient with peculiar unpleasant emotional responses after temporal stroke. CASE PRESENTATION We describe a 62-years old man with significant unpleasant emotional responses that occurred after an acute episode of confusional state, disorientation, agitation, vertigo, postural instability, vomiting, and photophobia. Since then, he complained that vision of pictures containing curved/multicolored lines or tangles was associated with an uncomfortable feeling of fear and disgust, lasting few minutes, so that he avoided looking at them. Notably, he also showed an abnormal facial expression of disgust and fear, together with neurovegetative reaction and horripilation, at the presentation of pictures of objects or animals containing curved, multicolored, or tangled lines. A post-acute infarction of the right temporal-insular region, together with mild periventricular white matter changes, were evident at the brain magnetic resonance imaging. CONCLUSIONS The anterior insula is crucial in transforming unpleasant sensory input into visceromotor reactions and the accompanying feeling of disgust. It is also known that temporal pole modulates visceral emotional functions in response to emotionally evocative perceptual stimuli. In the present case, the ischemic lesion of anterior part of the insula and temporal pole may have caused a decoupling of emotional and visceral response to complex visual stimuli. Further reports will provide a significant contribution to the taxonomy of these complex and relatively uncommon non-motor post-stroke symptoms that negatively affect quality of life.
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Affiliation(s)
- Mariagiovanna Cantone
- Department of Neurology, “Sant’Elia” Hospital, ASP Caltanissetta, Via Luigi Russo, 6, 93100 Caltanissetta, Italy
| | - Giuseppe Lanza
- 0000 0004 1757 1969grid.8158.4Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95125 Catania, Italy
- Department of Neurology IC, Oasi ResearchInstitute - IRCCS. Via Conte Ruggero, 73 - 94018 Troina, Italy
| | - Rita Bella
- 0000 0004 1757 1969grid.8158.4Department of Medical and Surgical Sciences and Advanced Technologies Section of Neurosciences, University of Catania, Via Santa Sofia, 78, 95125 Catania, Italy
| | - Giovanni Pennisi
- 0000 0004 1757 1969grid.8158.4Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95125 Catania, Italy
| | - Paola Santalucia
- grid.419419.0IRCCS Centro Neurolesi Bonino-Pulejo, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
| | - Placido Bramanti
- grid.419419.0IRCCS Centro Neurolesi Bonino-Pulejo, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
| | - Manuela Pennisi
- 0000 0004 1757 1969grid.8158.4Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia, 78, 95125 Catania, Italy
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15
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Cantone M, Lanza G, Bella R, Pennisi G, Santalucia P, Bramanti P, Pennisi M. Fear and disgust: case report of two uncommon emotional disturbances evoked by visual disperceptions after a right temporal-insular stroke. BMC Neurol 2019. [PMID: 31409291 DOI: 10.1186/s12883-019-1417-0.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional processes and responses are underestimated in stroke patients because the massive clinical picture of large hemispheric strokes often hides these symptoms. We report on a patient with peculiar unpleasant emotional responses after temporal stroke. CASE PRESENTATION We describe a 62-years old man with significant unpleasant emotional responses that occurred after an acute episode of confusional state, disorientation, agitation, vertigo, postural instability, vomiting, and photophobia. Since then, he complained that vision of pictures containing curved/multicolored lines or tangles was associated with an uncomfortable feeling of fear and disgust, lasting few minutes, so that he avoided looking at them. Notably, he also showed an abnormal facial expression of disgust and fear, together with neurovegetative reaction and horripilation, at the presentation of pictures of objects or animals containing curved, multicolored, or tangled lines. A post-acute infarction of the right temporal-insular region, together with mild periventricular white matter changes, were evident at the brain magnetic resonance imaging. CONCLUSIONS The anterior insula is crucial in transforming unpleasant sensory input into visceromotor reactions and the accompanying feeling of disgust. It is also known that temporal pole modulates visceral emotional functions in response to emotionally evocative perceptual stimuli. In the present case, the ischemic lesion of anterior part of the insula and temporal pole may have caused a decoupling of emotional and visceral response to complex visual stimuli. Further reports will provide a significant contribution to the taxonomy of these complex and relatively uncommon non-motor post-stroke symptoms that negatively affect quality of life.
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Affiliation(s)
- Mariagiovanna Cantone
- Department of Neurology, "Sant'Elia" Hospital, ASP Caltanissetta, Via Luigi Russo, 6, 93100, Caltanissetta, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95125, Catania, Italy. .,Department of Neurology IC, Oasi ResearchInstitute - IRCCS. Via Conte Ruggero, 73 - 94018, Troina, Italy.
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies Section of Neurosciences, University of Catania, Via Santa Sofia, 78, 95125, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95125, Catania, Italy
| | - Paola Santalucia
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Provinciale Palermo, Contrada Casazza, 98124, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Provinciale Palermo, Contrada Casazza, 98124, Messina, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia, 78, 95125, Catania, Italy
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Franchi C, Antoniazzi S, Ardoino I, Proietti M, Marcucci M, Santalucia P, Monzani V, Mannucci PM, Nobili A. Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation. Am J Med 2019; 132:e634-e647. [PMID: 31075225 DOI: 10.1016/j.amjmed.2019.03.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. METHODS We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. RESULTS Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95% confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1%; 95% CI, 0%-31.5%) and with direct oral anticoagulants (DOACs) (20%; 95% CI, 0%-39.8%) increased more in the intervention than in the control arm. CONCLUSIONS This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03188211.
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Affiliation(s)
- Carlotta Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital, University of Milan, Milan, Italy
| | - Ilaria Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Marco Proietti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paola Santalucia
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; IRCCS Centro Neurolesi Bonino Pulejo-Ospedale Piemonte, Messina, Italy
| | - Valter Monzani
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Paciaroni M, Agnelli G, Caso V, Silvestrelli G, Seiffge DJ, Engelter S, De Marchis GM, Polymeris A, Zedde ML, Yaghi S, Michel P, Eskandari A, Antonenko K, Sohn SI, Cappellari M, Tassinari T, Tassi R, Masotti L, Katsanos AH, Giannopoulos S, Acciarresi M, Alberti A, Venti M, Mosconi MG, Vedovati MC, Pierini P, Giustozzi M, Lotti EM, Ntaios G, Kargiotis O, Monaco S, Lochner P, Bandini F, Liantinioti C, Palaiodimou L, Abdul-Rahim AH, Lees K, Mancuso M, Pantoni L, Rosa S, Bertora P, Galliazzo S, Ageno W, Toso E, Angelini F, Chiti A, Orlandi G, Denti L, Flomin Y, Marcheselli S, Mumoli N, Rimoldi A, Verrengia E, Schirinzi E, Del Sette M, Papamichalis P, Komnos A, Popovic N, Zarkov M, Rocco A, Diomedi M, Giorli E, Ciccone A, Mac Grory BC, Furie KL, Bonetti B, Saia V, Guideri F, Acampa M, Martini G, Grifoni E, Padroni M, Karagkiozi E, Perlepe K, Makaritsis K, Mannino M, Maccarrone M, Ulivi L, Giannini N, Ferrari E, Pezzini A, Doronin B, Volodina V, Baldi A, D’Amore C, Deleu D, Corea F, Putaala J, Santalucia P, Nardi K, Risitano A, Toni D, Tsivgoulis G. Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention. Stroke 2019; 50:2168-2174. [PMID: 31234756 DOI: 10.1161/strokeaha.119.025350] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background and Purpose—
Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non–vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention.
Methods—
Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment.
Results—
Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9%) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95% CI, 1.95–5.85), atrial enlargement (OR, 6.64; 95% CI, 4.63–9.52), hyperlipidemia (OR, 2.40; 95% CI, 1.83–3.16), and CHA
2
DS
2
-VASc score (OR, 1.72 for each point increase; 95% CI, 1.58–1.88) were associated with ischemic events. Among the CHA
2
DS
2
-VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95% CI, 0.33–0.61).
Conclusions—
In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA
2
DS
2
-VASc score were associated with increased risk of cerebrovascular events.
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Affiliation(s)
- Maurizio Paciaroni
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | - Giancarlo Agnelli
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | - Valeria Caso
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | | | - David Julian Seiffge
- University Center for Medicine of Aging and Rehabilitation, University of Basel, Felix-Platter Hospital, Switzerland (D.J.S., S.E., G.M.D.M., A. Polymeris)
| | - Stefan Engelter
- University Center for Medicine of Aging and Rehabilitation, University of Basel, Felix-Platter Hospital, Switzerland (D.J.S., S.E., G.M.D.M., A. Polymeris)
| | - Gian Marco De Marchis
- University Center for Medicine of Aging and Rehabilitation, University of Basel, Felix-Platter Hospital, Switzerland (D.J.S., S.E., G.M.D.M., A. Polymeris)
| | - Alexandros Polymeris
- University Center for Medicine of Aging and Rehabilitation, University of Basel, Felix-Platter Hospital, Switzerland (D.J.S., S.E., G.M.D.M., A. Polymeris)
| | - Maria Luisa Zedde
- Neurology Unit, Stroke Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy (M.L.Z.)
| | | | - Patrik Michel
- Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Centre Cérébrovasculaire, Service de Neurologie, Lausanne, Switzerland (P.M., A.E.)
| | - Ashraf Eskandari
- Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Centre Cérébrovasculaire, Service de Neurologie, Lausanne, Switzerland (P.M., A.E.)
| | - Kateryna Antonenko
- Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine (K.A.)
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (S.I.S.)
| | - Manuel Cappellari
- Struttura Semplice Ospedaliera Stroke Unit, Unità Organica Neurologia, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., B.B.)
| | - Tiziana Tassinari
- Stroke Unit, Department of Neurology, Santa Corona Hospital, Pietra Ligure, Savona, Italy (T.T., V.S.)
| | - Rossana Tassi
- Stroke Unit, AOU Senese, Siena, Italy (R.T., F.G., M.A., G.M.)
| | - Luca Masotti
- Internal Medicine, San Giuseppe Hospital, Empoli, Italy (L.M., E. Grifoni)
| | | | | | - Monica Acciarresi
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | - Andrea Alberti
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | - Michele Venti
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | - Maria Giulia Mosconi
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | - Maria Cristina Vedovati
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | - Patrizia Pierini
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | - Michela Giustozzi
- From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)
| | - Enrico Maria Lotti
- U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Italy (E.M.L., M. Padroni)
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece (G.N., E.K., K.P., K.M.)
| | | | - Serena Monaco
- Stroke Unit, Ospedale Civico, Palermo, Italy (S.M., M. Mannino)
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany (P.L.)
| | - Fabio Bandini
- Department of Neurology, Ospedale San Paolo, Savona, Italy (F.B.)
| | - Chrysoula Liantinioti
- Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (C.L., L.P., G.T.)
| | - Lina Palaiodimou
- Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (C.L., L.P., G.T.)
| | - Azmil H. Abdul-Rahim
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., K.L.)
| | - Kennedy Lees
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., K.L.)
| | - Michelangelo Mancuso
- Clinica Neurologica–Azienda Ospedaliero-Universitaria, Pisa, Italy (M. Mancuso, M. Maccarrone, L.U., N.G., E.F.)
| | - Leonardo Pantoni
- Neurology, L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy (L.P., S.R., P.B.)
| | - Silvia Rosa
- Neurology, L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy (L.P., S.R., P.B.)
| | - Pierluigi Bertora
- Neurology, L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy (L.P., S.R., P.B.)
| | - Silvia Galliazzo
- Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo Varese, Italy (S.G., W.A.)
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo Varese, Italy (S.G., W.A.)
| | - Elisabetta Toso
- Division of Cardiology, University of Torino, Città della Salute e della Scienza Hospital, Italy (E.T., F.A.)
| | - Filippo Angelini
- Division of Cardiology, University of Torino, Città della Salute e della Scienza Hospital, Italy (E.T., F.A.)
| | - Alberto Chiti
- S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Italy (G.S., A.C.)
| | | | - Licia Denti
- Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Italy (L.D.)
| | - Yuriy Flomin
- Stroke and Neurorehabilitation Unit, MC Universal Clinic Oberig, Kyiv, Ukraine (Y.F.)
| | - Simona Marcheselli
- Stroke Unit, Metropolitan Hospital, Piraeus, Greece (O.K.)
- Neurologia d’urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy (S.M.)
| | - Nicola Mumoli
- Department of Internal Medicine, Magenta Hospital, Italy (N.M., A.R., E.V.)
| | - Alexandra Rimoldi
- Department of Internal Medicine, Magenta Hospital, Italy (N.M., A.R., E.V.)
| | - Elena Verrengia
- Department of Internal Medicine, Magenta Hospital, Italy (N.M., A.R., E.V.)
| | - Erika Schirinzi
- Struttura Complessa di Neurologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.S., M.D.S.)
| | - Massimo Del Sette
- Struttura Complessa di Neurologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.S., M.D.S.)
| | - Panagiotis Papamichalis
- Internist-Intensive Care Specialist, Intensive Care Unit, General Hospital of Larissa, Greece (P.P., A.K.)
| | - Apostolos Komnos
- Internist-Intensive Care Specialist, Intensive Care Unit, General Hospital of Larissa, Greece (P.P., A.K.)
| | - Nemanja Popovic
- Clinic of Neurology, Clinical Center Vojvodina, University of Novi Sad, Serbia (N.P., M.Z.)
| | - Marija Zarkov
- Clinic of Neurology, Clinical Center Vojvodina, University of Novi Sad, Serbia (N.P., M.Z.)
| | - Alessandro Rocco
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy (A.R., M.D.)
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy (A.R., M.D.)
| | - Elisa Giorli
- Stroke Unit, Department of Neurology, Sant’Andrea Hospital, La Spezia, Italy (E. Giorli)
| | - Alfonso Ciccone
- Neurologia, Ospedale Apuano, Massa Carrara, Italy (A.C., G.O.)
| | - Brian C. Mac Grory
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (B.C.M.G., K.L.F.)
| | - Karen L. Furie
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (B.C.M.G., K.L.F.)
| | - Bruno Bonetti
- Struttura Semplice Ospedaliera Stroke Unit, Unità Organica Neurologia, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., B.B.)
| | - Valentina Saia
- Stroke Unit, Department of Neurology, Santa Corona Hospital, Pietra Ligure, Savona, Italy (T.T., V.S.)
| | | | - Maurizio Acampa
- Stroke Unit, AOU Senese, Siena, Italy (R.T., F.G., M.A., G.M.)
| | | | - Elisa Grifoni
- Internal Medicine, San Giuseppe Hospital, Empoli, Italy (L.M., E. Grifoni)
| | - Marina Padroni
- U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Italy (E.M.L., M. Padroni)
| | - Efstathia Karagkiozi
- Department of Medicine, University of Thessaly, Larissa, Greece (G.N., E.K., K.P., K.M.)
| | - Kalliopi Perlepe
- Department of Medicine, University of Thessaly, Larissa, Greece (G.N., E.K., K.P., K.M.)
| | | | - Marina Mannino
- Stroke Unit, Ospedale Civico, Palermo, Italy (S.M., M. Mannino)
| | - Miriam Maccarrone
- Clinica Neurologica–Azienda Ospedaliero-Universitaria, Pisa, Italy (M. Mancuso, M. Maccarrone, L.U., N.G., E.F.)
| | - Leonardo Ulivi
- Clinica Neurologica–Azienda Ospedaliero-Universitaria, Pisa, Italy (M. Mancuso, M. Maccarrone, L.U., N.G., E.F.)
| | - Nicola Giannini
- Clinica Neurologica–Azienda Ospedaliero-Universitaria, Pisa, Italy (M. Mancuso, M. Maccarrone, L.U., N.G., E.F.)
| | - Elena Ferrari
- Clinica Neurologica–Azienda Ospedaliero-Universitaria, Pisa, Italy (M. Mancuso, M. Maccarrone, L.U., N.G., E.F.)
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy (A. Pezzini)
| | - Boris Doronin
- Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital No. 1, Novosibirsk State Medical University, Russia (B.D., V.V.)
| | - Vera Volodina
- Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital No. 1, Novosibirsk State Medical University, Russia (B.D., V.V.)
| | - Antonio Baldi
- Stroke Unit, Ospedale di Portogruaro, Venice, Italy (A.B., C.D.)
| | - Cataldo D’Amore
- Stroke Unit, Ospedale di Portogruaro, Venice, Italy (A.B., C.D.)
| | - Dirk Deleu
- Neurology, Hamad Medical Corporation, Doha, Qatar (D.D.)
| | - Francesco Corea
- Unità Organica Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy (F.C.)
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Finland (J.P.)
| | - Paola Santalucia
- Neurologia, Ospedale Piemonte, Istituto di Ricovero e Cura a Carattere Scientifico Bonino Pulejo, Messina, Italy (P.S.)
| | | | - Angela Risitano
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (A.R., D.T.)
| | - Danilo Toni
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (A.R., D.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (C.L., L.P., G.T.)
- Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece (G.T.)
- Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
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Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, Abd-Allah F, Abdelalim A, Abraha HN, Abu-Rmeileh NME, Adebayo OM, Adeoye AM, Agarwal G, Agrawal S, Aichour AN, Aichour I, Aichour MTE, Alahdab F, Ali R, Alvis-Guzman N, Anber NH, Anjomshoa M, Arabloo J, Arauz A, Ärnlöv J, Arora A, Awasthi A, Banach M, Barboza MA, Barker-Collo SL, Bärnighausen TW, Basu S, Belachew AB, Belayneh YM, Bennett DA, Bensenor IM, Bhattacharyya K, Biadgo B, Bijani A, Bikbov B, Bin Sayeed MS, Butt ZA, Cahuana-Hurtado L, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Castro F, Catalá-López F, Chaiah Y, Chiang PPC, Choi JYJ, Christensen H, Chu DT, Cortinovis M, Damasceno AAM, Dandona L, Dandona R, Daryani A, Davletov K, de Courten B, De la Cruz-Góngora V, Degefa MG, Dharmaratne SD, Diaz D, Dubey M, Duken EE, Edessa D, Endres M, FARAON EMERITOJOSEA, Farzadfar F, Fernandes E, Fischer F, Flor LS, Ganji M, Gebre AK, Gebremichael TG, Geta B, Gezae KE, Gill PS, Gnedovskaya EV, Gómez-Dantés H, Goulart AC, Grosso G, Guo Y, Gupta R, Haj-Mirzaian A, Haj-Mirzaian A, Hamidi S, Hankey GJ, Hassen HY, Hay SI, Hegazy MI, Heidari B, Herial NA, Hosseini MA, Hostiuc S, Irvani SSN, Islam SMS, Jahanmehr N, Javanbakht M, Jha RP, Jonas JB, Jozwiak JJ, Jürisson M, Kahsay A, Kalani R, Kalkonde Y, Kamil TA, Kanchan T, Karch A, Karimi N, Karimi-Sari H, Kasaeian A, Kassa TD, Kazemeini H, Kefale AT, Khader YS, Khalil IA, Khan EA, Khang YH, Khubchandani J, Kim D, Kim YJ, Kisa A, Kivimäki M, Koyanagi A, Krishnamurthi RK, Kumar GA, Lafranconi A, Lewington S, Li S, Lo WD, Lopez AD, Lorkowski S, Lotufo PA, Mackay MT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Manafi N, Mansournia MA, Mehndiratta MM, Mehta V, Mengistu G, Meretoja A, Meretoja TJ, Miazgowski B, Miazgowski T, Miller TR, Mirrakhimov EM, Mohajer B, Mohammad Y, Mohammadoo-khorasani M, Mohammed S, Mohebi F, Mokdad AH, Mokhayeri Y, Moradi G, Morawska L, Moreno Velásquez I, Mousavi SM, Muhammed OSS, Muruet W, Naderi M, Naghavi M, Naik G, Nascimento BR, Negoi RI, Nguyen CT, Nguyen LH, Nirayo YL, Norrving B, Noubiap JJ, Ofori-Asenso R, Ogbo FA, Olagunju AT, Olagunju TO, Owolabi MO, Pandian JD, Patel S, Perico N, Piradov MA, Polinder S, Postma MJ, Poustchi H, Prakash V, Qorbani M, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MA, Reis C, Remuzzi G, Renzaho AM, Ricci S, Roberts NLS, Robinson SR, Roever L, Roshandel G, Sabbagh P, Safari H, Safari S, Safiri S, Sahebkar A, Salehi Zahabi S, Samy AM, Santalucia P, Santos IS, Santos JV, Santric Milicevic MM, Sartorius B, Sawant AR, Schutte AE, Sepanlou SG, Shafieesabet A, Shaikh MA, Shams-Beyranvand M, Sheikh A, Sheth KN, Shibuya K, Shigematsu M, Shin MJ, Shiue I, Siabani S, Sobaih BH, Sposato LA, Sutradhar I, Sylaja PN, Szoeke CEI, Te Ao BJ, Temsah MH, Temsah O, Thrift AG, Tonelli M, Topor-Madry R, Tran BX, Tran KB, Truelsen TC, Tsadik AG, Ullah I, Uthman OA, Vaduganathan M, Valdez PR, Vasankari TJ, Vasanthan R, Venketasubramanian N, Vosoughi K, Vu GT, Waheed Y, Weiderpass E, Weldegwergs KG, Westerman R, Wolfe CDA, Wondafrash DZ, Xu G, Yadollahpour A, Yamada T, Yatsuya H, Yimer EM, Yonemoto N, Yousefifard M, Yu C, Zaidi Z, Zamani M, Zarghi A, Zhang Y, Zodpey S, Feigin VL, Vos T, Murray CJL. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18:439-458. [PMID: 30871944 PMCID: PMC6494974 DOI: 10.1016/s1474-4422(19)30034-1] [Citation(s) in RCA: 1622] [Impact Index Per Article: 324.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/17/2018] [Accepted: 01/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. METHODS We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. FINDINGS In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (-39·3 to -33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (-37·2 to -31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (-10·7 to -5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. INTERPRETATION Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. FUNDING Bill & Melinda Gates Foundation.
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19
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Arcoraci V, Squadrito F, Altavilla D, Bitto A, Minutoli L, Penna O, Amato A, Bruno R, Tripodi VF, Alibrandi A, Ingrassia PL, Santalucia P, Fodale V. Medical simulation in pharmacology learning and retention: A comparison study with traditional teaching in undergraduate medical students. Pharmacol Res Perspect 2019; 7:e00449. [PMID: 30651989 PMCID: PMC6327107 DOI: 10.1002/prp2.449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/12/2018] [Indexed: 12/05/2022] Open
Abstract
The purpose of the study was to determine whether low-high fidelity medical simulation improves learning and long-lasting retention of pharmacology knowledge, compared to lecture alone, in undergraduate medical students. Ninety students, before a 45-minute lecture, were randomized into three groups - sham (S), low (LF), and high fidelity (HF) simulation - to participate in an interactive simulation session. To evaluate immediate and long-lasting retention, a 20-item structured questionnaire on inotropic agents was administered to 90 students before and after a 45-minute lecture, after simulation, and 3 months later. In all groups, the rate of correct answers increased after lecture, while no difference was observed between different groups (P = 0.543). After simulation, students in the HF group provided more correct answers compared to S or LF group (P > 0.001). After 3 months, a significant decrease in the number of correct answers was observed in S (P < 0.001) and LF (P < 0.001) groups, but not in the HF group (P = 0.066). Moreover, HF simulation resulted in an increased number of correct answers compared to the LF (P < 0.001) or S simulation (P < 0.001). These data suggest that advanced medical simulation teaching applied to pharmacology is associated with more effective learning and long-lasting retention compared to lecture alone.
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Affiliation(s)
- Vincenzo Arcoraci
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Francesco Squadrito
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Domenica Altavilla
- Department of Biomedical and Dental Sciences and Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Alessandra Bitto
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Letteria Minutoli
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Olivia Penna
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”Section of AnesthesiologyUniversity of MessinaMessinaItaly
| | - Antonio Amato
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”Section of AnesthesiologyUniversity of MessinaMessinaItaly
| | - Rosario Bruno
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”Section of AnesthesiologyUniversity of MessinaMessinaItaly
| | - Vincenzo Francesco Tripodi
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”Section of AnesthesiologyUniversity of MessinaMessinaItaly
| | - Angela Alibrandi
- Department of EconomicsUnit of Statistical and Mathematical SciencesUniversity of MessinaMessinaItaly
| | - Pier Luigi Ingrassia
- SIMNOVA Simulation Centre in Medicine and Health ScienceUniversity of Piemonte OrientaleNovaraItaly
| | | | - Vincenzo Fodale
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”Section of AnesthesiologyUniversity of MessinaMessinaItaly
- Skill‐Lab for Simulation Based Medical EducationDegree Course In Medicine and SurgeryUniversity of MessinaMessinaItaly
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20
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Vinciguerra L, Cantone M, Lanza G, Bramanti A, Santalucia P, Puglisi V, Pennisi G, Bella R. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res 2019; 12:2941-2950. [PMID: 31695483 PMCID: PMC6814312 DOI: 10.2147/jpr.s209485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 02/05/2023] Open
Abstract
Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5-1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.
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Affiliation(s)
- Luisa Vinciguerra
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
- Correspondence: Luisa Vinciguerra Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124Messina, ItalyTel +39 090 6012 8395Fax +39 090 6012 8850 Email
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Department of Neurology IC, Oasi Research Institute – IRCCS, Troina, Italy
| | - Alessia Bramanti
- Institute of Applied Sciences and Intelligent Systems (ISASI), IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Paola Santalucia
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Valentina Puglisi
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technology, Section of Neurosciences, University of Catania, Catania, Italy
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21
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Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, Parmar PG, Abajobir AA, Abate KH, Abd-Allah F, Abejie AN, Abyu GY, Ademi Z, Agarwal G, Ahmed MB, Akinyemi RO, Al-Raddadi R, Aminde LN, Amlie-Lefond C, Ansari H, Asayesh H, Asgedom SW, Atey TM, Ayele HT, Banach M, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Basu S, Bedi N, Behzadifar M, Béjot Y, Bennett DA, Bensenor IM, Berhe DF, Boneya DJ, Brainin M, Campos-Nonato IR, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Christensen H, Criqui MH, Damasceno A, Dandona L, Dandona R, Davletov K, de Courten B, deVeber G, Dokova K, Edessa D, Endres M, Faraon EJA, Farvid MS, Fischer F, Foreman K, Forouzanfar MH, Gall SL, Gebrehiwot TT, Geleijnse JM, Gillum RF, Giroud M, Goulart AC, Gupta R, Gupta R, Hachinski V, Hamadeh RR, Hankey GJ, Hareri HA, Havmoeller R, Hay SI, Hegazy MI, Hibstu DT, James SL, Jeemon P, John D, Jonas JB, Jóźwiak J, Kalani R, Kandel A, Kasaeian A, Kengne AP, Khader YS, Khan AR, Khang YH, Khubchandani J, Kim D, Kim YJ, Kivimaki M, Kokubo Y, Kolte D, Kopec JA, Kosen S, Kravchenko M, Krishnamurthi R, Kumar GA, Lafranconi A, Lavados PM, Legesse Y, Li Y, Liang X, Lo WD, Lorkowski S, Lotufo PA, Loy CT, Mackay MT, Abd El Razek HM, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Mantovani LG, Martins SCO, Mate KK, Mazidi M, Mehata S, Meier T, Melaku YA, Mendoza W, Mensah GA, Meretoja A, Mezgebe HB, Miazgowski T, Miller TR, Ibrahim NM, Mohammed S, Mokdad AH, Moosazadeh M, Moran AE, Musa KI, Negoi RI, Nguyen M, Nguyen QL, Nguyen TH, Tran TT, Nguyen TT, Anggraini Ningrum DN, Norrving B, Noubiap JJ, O’Donnell MJ, Olagunju AT, Onuma OK, Owolabi MO, Parsaeian M, Patton GC, Piradov M, Pletcher MA, Pourmalek F, Prakash V, Qorbani M, Rahman M, Rahman MA, Rai RK, Ranta A, Rawaf D, Rawaf S, Renzaho AMN, Robinson SR, Sahathevan R, Sahebkar A, Salomon JA, Santalucia P, Santos IS, Sartorius B, Schutte AE, Sepanlou SG, Shafieesabet A, Shaikh MA, Shamsizadeh M, Sheth KN, Sisay M, Shin MJ, Shiue I, Silva DAS, Sobngwi E, Soljak M, Sorensen RJD, Sposato LA, Stranges S, Suliankatchi RA, Tabarés-Seisdedos R, Tanne D, Nguyen CT, Thakur JS, Thrift AG, Tirschwell DL, Topor-Madry R, Tran BX, Nguyen LT, Truelsen T, Tsilimparis N, Tyrovolas S, Ukwaja KN, Uthman OA, Varakin Y, Vasankari T, Venketasubramanian N, Vlassov VV, Wang W, Werdecker A, Wolfe CDA, Xu G, Yano Y, Yonemoto N, Yu C, Zaidi Z, El Sayed Zaki M, Zhou M, Ziaeian B, Zipkin B, Vos T, Naghavi M, Murray CJL, Roth GA. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med 2018; 379:2429-2437. [PMID: 30575491 PMCID: PMC6247346 DOI: 10.1056/nejmoa1804492] [Citation(s) in RCA: 810] [Impact Index Per Article: 135.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).
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22
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Schramm P, Navia P, Papa R, Zamarro J, Tomasello A, Weber W, Fiehler J, Michel P, Pereira VM, Krings T, Gralla J, Santalucia P, Pierot L, Lo TH. ADAPT technique with ACE68 and ACE64 reperfusion catheters in ischemic stroke treatment: results from the PROMISE study. J Neurointerv Surg 2018; 11:226-231. [PMID: 30061367 PMCID: PMC6582710 DOI: 10.1136/neurintsurg-2018-014122] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 02/04/2023]
Abstract
Background and purpose The recent randomized trials demonstrated the benefit of mechanical thrombectomy in stroke therapy. However, treatment using different strategies is an ongoing area of investigation. The PROMISE study analyzed the safety and effectiveness of the Penumbra System with the ACE68 and ACE64 reperfusion catheters in aspiration thrombectomy of stroke, using A Direct Aspiration First Pass Technique (ADAPT). Methods PROMISE was a prospective study which enrolled 204 patients with intracranial anterior circulation large vessel occlusion (LVO) ischemic stroke in 20 centers from February 2016 to May 2017. Initial treatment was with the ACE68/ACE64 catheters within 6 hours of symptom onset. Imaging and safety review was performed by an independent Core Laboratory and a Clinical Events Committee. The primary angiographic outcome was revascularization to mTICI 2b-3 at immediate post-procedure and the primary clinical outcome was 90-day modified Rankin Scale (mRS) score ≤2. Safety assessment included device- and procedure-related serious adverse events (SAEs), symptomatic intracranial hemorrhage (sICH), mortality, and embolization of new territory (ENT). Results Enrolled patients had a median age of 74 (IQR 65–80) years and a median admission NIHSS of 16 (IQR 11–20). The post-procedure mTICI 2b-3 revascularization rate was 93.1% and the 90-day mRS 0–2 rate was 61%. Device- and procedure-related SAEs at 24 hours occurred in 1.5% and 3.4%, respectively, 90-day mortality was 7.5%, sICH occurred in 2.9% while ENT occurred in 1.5%. Conclusions For frontline therapy of LVO stroke, the ACE68/ACE64 catheters for aspiration thrombectomy were found to be safe and showed similar efficacy to randomized trials using other revascularization techniques. Clinical Trial Registration NCT02678169; Pre-results.
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Affiliation(s)
- Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Pedro Navia
- Radiology-Interventional Neuroradiology, Hospital Universitario Donostia, San Sebastian, Spain
| | - Rosario Papa
- Radiology, Universita degli Studi di Messina, Messina, Italy
| | - Joaquin Zamarro
- Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Alejandro Tomasello
- Department of Radiology, Section of Interventional Neuroradiology, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Werner Weber
- Radiology and Neuroradiology, Ruhr-University Bochum, University Medical Center Langendreer, Bochum, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | - Vitor M Pereira
- Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jan Gralla
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Paola Santalucia
- IRCCS Centro Neurolesi Bonino Pulejo, Piemonte Hospital, Messina, Italy
| | | | - T H Lo
- Department of Interventional Radiology and Interventional Neuroradiology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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23
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Proietti M, Antoniazzi S, Monzani V, Santalucia P, Franchi C, Fenoglio LM, Melchio R, Fabris F, Sartori MT, Manfredini R, De Giorgi A, Fabbian F, Biolo G, Zanetti M, Altamura N, Sabbà C, Suppressa P, Bandiera F, Usai C, Murialdo G, Fezza F, Marra A, Castelli F, Cattaneo F, Beccati V, di Minno G, Tufano A, Contaldi P, Lupattelli G, Bianconi V, Cappellini D, Hu C, Minonzio F, Fargion S, Burdick L, Francione P, Peyvandi F, Rossio R, Colombo G, Monzani V, Ceriani G, Lucchi T, Brignolo B, Manfellotto D, Caridi I, Corazza GR, Miceli E, Padula D, Fraternale G, Guasti L, Squizzato A, Maresca A, Liberato NL, Tognin T, Rozzini R, Bellucci FB, Muscaritoli M, Molfino A, Petrillo E, Dore M, Mete F, Gino M, Franceschi F, Gabrielli M, Perticone F, Perticone M, Bertolotti M, Mussi C, Borghi C, Strocchi E, Durazzo M, Fornengo P, Dallegri F, Ottonello LC, Salam K, Caserza L, Barbagallo M, Di Bella G, Annoni G, Bruni AA, Odetti P, Nencioni A, Monacelli F, Napolitano A, Brucato A, Valenti A, Castellino P, Zanoli L, Mazzeo M. Use of oral anticoagulant drugs in older patients with atrial fibrillation in internal medicine wards. Eur J Intern Med 2018; 52:e12-e14. [PMID: 29657108 DOI: 10.1016/j.ejim.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Marco Proietti
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli - Sacco University Hospital, University of Milan, Milan, Italy
| | - Valter Monzani
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Santalucia
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; IRCCS Centro Neurolesi Bonino Pulejo - Ospedale Piemonte, Messina, Italy
| | - Carlotta Franchi
- Unit of Pharmacoepidemiological Research in Older People, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Luigi M Fenoglio
- Azienda Ospedaliera Santa Croce e Carle di Cuneo - Medicina Interna, Italy
| | - Remo Melchio
- Azienda Ospedaliera Santa Croce e Carle di Cuneo - Medicina Interna, Italy
| | - Fabrizio Fabris
- Azienda Ospedaliera Universitaria di Padova - Clinica Medica I, Italy
| | | | - Roberto Manfredini
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale S. Anna - Clinica Medica, Italy
| | - Alfredo De Giorgi
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale S. Anna - Clinica Medica, Italy
| | - Fabio Fabbian
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale S. Anna - Clinica Medica, Italy
| | - Gianni Biolo
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara - Clinica Medica, Italy
| | - Michela Zanetti
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara - Clinica Medica, Italy
| | - Nicola Altamura
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara - Clinica Medica, Italy
| | - Carlo Sabbà
- Azienda Ospedaliero-Universitaria Policlinico di Bari - Medicina Interna, Italy
| | - Patrizia Suppressa
- Azienda Ospedaliero-Universitaria Policlinico di Bari - Medicina Interna, Italy
| | | | - Carlo Usai
- Azienda Ospedaliero-Universitaria di Sassari - Medicina Interna, Italy
| | - Giovanni Murialdo
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Francesca Fezza
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Alessio Marra
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Francesca Castelli
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Federico Cattaneo
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Valentina Beccati
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Giovanni di Minno
- Azienda Ospedaliera Universitaria Federico II di Napoli - Medicina Interna, Italy
| | - Antonella Tufano
- Azienda Ospedaliera Universitaria Federico II di Napoli - Medicina Interna, Italy
| | - Paola Contaldi
- Azienda Ospedaliera Universitaria Federico II di Napoli - Medicina Interna, Italy
| | - Graziana Lupattelli
- Ospedale "Santa Maria della Misericordia", S. Andrea delle Fratte di Perugia - Medicina Interna, Italy
| | - Vanessa Bianconi
- Ospedale "Santa Maria della Misericordia", S. Andrea delle Fratte di Perugia - Medicina Interna, Italy
| | - Domenica Cappellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna, Italy
| | - Cinzia Hu
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna, Italy
| | - Francesca Minonzio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna, Italy
| | - Silvia Fargion
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Indirizzo Metabolico, Italy
| | - Larry Burdick
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Indirizzo Metabolico, Italy
| | - Paolo Francione
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Indirizzo Metabolico, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Ematologia non tumorale e Coagulopatie, Italy
| | - Raffaella Rossio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Ematologia non tumorale e Coagulopatie, Italy
| | - Giulia Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Ematologia non tumorale e Coagulopatie, Italy
| | - Valter Monzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Alta Intensità Di Cura, Italy
| | - Giuliana Ceriani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Alta Intensità Di Cura, Italy.
| | - Tiziano Lucchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Geriatria, Italy
| | - Barbara Brignolo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Geriatria, Italy
| | - Dario Manfellotto
- Ospedale San Giovanni Calibita Fatebenefratelli di Roma - Medicina Interna, Italy
| | - Irene Caridi
- Ospedale San Giovanni Calibita Fatebenefratelli di Roma - Medicina Interna, Italy
| | | | - Emanuela Miceli
- IRCCS Fondazione Policlinico San Matteo di Pavia - Clinica Medica I, Italy
| | - Donatella Padula
- IRCCS Fondazione Policlinico San Matteo di Pavia - Clinica Medica I, Italy
| | - Giacomo Fraternale
- IRCCS Fondazione Policlinico San Matteo di Pavia - Clinica Medica I, Italy
| | - Luigina Guasti
- Ospedale di Circolo e Fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette-Laghi, Varese, Università degli Studi dell'Insubria Varese - Medicina Interna 1, Italy
| | - Alessandro Squizzato
- Ospedale di Circolo e Fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette-Laghi, Varese, Università degli Studi dell'Insubria Varese - Medicina Interna 1, Italy
| | - Andrea Maresca
- Ospedale di Circolo e Fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette-Laghi, Varese, Università degli Studi dell'Insubria Varese - Medicina Interna 1, Italy
| | - Nicola Lucio Liberato
- Azienda Socio-Sanitaria Territoriale di Pavia Ospedale Civile "C. Mira" di Casorate Primo - Medicina Interna, Italy
| | - Tiziana Tognin
- Azienda Socio-Sanitaria Territoriale di Pavia Ospedale Civile "C. Mira" di Casorate Primo - Medicina Interna, Italy
| | - Renzo Rozzini
- Fondazione Poliambulanza Istituto Ospedaliero di Brescia - Geriatria, Italy
| | | | - Maurizio Muscaritoli
- Dipartimento di Medicina Clinica, Sapienza Università di Roma, Policlinico Umberto I di Roma - Medicina Interna e Nutrizione Clinica, Italy
| | - Alessio Molfino
- Dipartimento di Medicina Clinica, Sapienza Università di Roma, Policlinico Umberto I di Roma - Medicina Interna e Nutrizione Clinica, Italy
| | - Enrico Petrillo
- Dipartimento di Medicina Clinica, Sapienza Università di Roma, Policlinico Umberto I di Roma - Medicina Interna e Nutrizione Clinica, Italy
| | - Maurizio Dore
- Ospedale degli Infermi Di Rivoli - Medicina Generale, Italy
| | - Francesca Mete
- Ospedale degli Infermi Di Rivoli - Medicina Generale, Italy
| | - Miriam Gino
- Ospedale degli Infermi Di Rivoli - Medicina Generale, Italy
| | - Francesco Franceschi
- Fondazione Policlinico Universitario "Agostino Gemelli" di Roma - Medicina D'Urgenza e Pronto Soccorso, Italy
| | - Maurizio Gabrielli
- Fondazione Policlinico Universitario "Agostino Gemelli" di Roma - Medicina D'Urgenza e Pronto Soccorso, Italy
| | - Francesco Perticone
- Azienda Ospedaliero Universitaria "Mater Domini" di Catanzaro - Geriatria, Italy
| | - Maria Perticone
- Azienda Ospedaliero Universitaria "Mater Domini" di Catanzaro - Geriatria, Italy
| | - Marco Bertolotti
- Nuovo Ospedale Civile S. Agostino Estense di Modena - Geriatria e Post-Acuzie Geriatria, Italy
| | - Chiara Mussi
- Nuovo Ospedale Civile S. Agostino Estense di Modena - Geriatria e Post-Acuzie Geriatria, Italy
| | - Claudio Borghi
- Azienda Ospedaliero Universitaria - Policlinico S.Orsola-Malpighi di Bologna - Medicina Interna, Italy
| | - Enrico Strocchi
- Azienda Ospedaliero Universitaria - Policlinico S.Orsola-Malpighi di Bologna - Medicina Interna, Italy
| | - Marilena Durazzo
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino - Presidio Molinette, Medicina Interna 3, Italy
| | - Paolo Fornengo
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino - Presidio Molinette, Medicina Interna 3, Italy
| | - Franco Dallegri
- Ospedale Policlinico San Martino, Genova - Medicina Interna, Italy
| | | | - Kassem Salam
- Ospedale Policlinico San Martino, Genova - Medicina Interna, Italy
| | - Lara Caserza
- Ospedale Policlinico San Martino, Genova - Medicina Interna, Italy
| | - Mario Barbagallo
- Azienda Ospedaliera Universitaria Policlinico P. Giaccone di Palermo - Geriatria, Italy
| | - Giovanna Di Bella
- Azienda Ospedaliera Universitaria Policlinico P. Giaccone di Palermo - Geriatria, Italy
| | - Giorgio Annoni
- Ospedale S.Gerardo di Monza, Azienda Socio-Sanitaria Territoriale di Monza, Clinica Geriatrica Università degli Studi di Milano-Bicocca - Clinica Geriatrica, Italy
| | - Adriana Antonella Bruni
- Ospedale S.Gerardo di Monza, Azienda Socio-Sanitaria Territoriale di Monza, Clinica Geriatrica Università degli Studi di Milano-Bicocca - Clinica Geriatrica, Italy
| | - Patrizio Odetti
- Ospedale Policlinico San Martino, Genova - Clinica Geriatrica, Italy
| | - Alessio Nencioni
- Ospedale Policlinico San Martino, Genova - Clinica Geriatrica, Italy
| | | | | | - Antonio Brucato
- Ospedale Papa Giovanni XXIII di Bergamo - Medicina Interna, Italy
| | - Anna Valenti
- Ospedale Papa Giovanni XXIII di Bergamo - Medicina Interna, Italy
| | - Pietro Castellino
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" di Catania - Medicina Interna, Italy
| | - Luca Zanoli
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" di Catania - Medicina Interna, Italy
| | - Marco Mazzeo
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" di Catania - Medicina Interna, Italy
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Franchi C, Cartabia M, Santalucia P, Baviera M, Mannucci PM, Fortino I, Bortolotti A, Merlino L, Monzani V, Clavenna A, Roncaglioni MC, Nobili A. Emergency department visits in older people: pattern of use, contributing factors, geographical differences and outcomes. Aging Clin Exp Res 2017; 29:319-326. [PMID: 26931325 DOI: 10.1007/s40520-016-0550-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Abstract
AIMS To assess the pattern of use of Emergency Departments (EDs), factors contributing to the visits, geographical distribution and outcomes in people aged 65 years or more living in the Italian Lombardy Region in 2012. METHODS Based on an administrative database the study population was divided into groups according to the number of ED visits. A multinomial logistic regression model was performed to compare the characteristics of each group. The Getis-Ord's G statistic was used to evaluate the clusters of high and low visit prevalence odd ratios (OR) at district level. To estimate the severity of the disease leading to ED attendance, visits were stratified based on the level of emergency and outcome. RESULTS About 2 million older people were included in the analyses: 78 % had no ED visit, 15 % only 1, 7 % 2 or more. Male sex, age 85 years or more, high number of drugs, ED visits and hospital admissions in the previous year and the location of an ED within 10 km from the patient's place were all factors associated with a higher risk to have more ED visits. Clusters of high and low prevalence of visits were found for occasional users. Overall, 83 % of ED visit with a low emergency triage code at admission had as visit outcome discharge at home. CONCLUSIONS In older people several variables were associated with an increased risk to have a high number of ED visits. Most of the visits were done for non-urgent problems and significant geographic differences were observed for occasional users.
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Affiliation(s)
- Carlotta Franchi
- Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy.
| | - Massimo Cartabia
- Laboratory of Mother and Child Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Paola Santalucia
- Scientific Direction, IRCCS-Maggiore Hospital Foundation, Milan, Italy
| | - Marta Baviera
- Laboratory of General Practice Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS-Maggiore Hospital Foundation, Milan, Italy
| | - Ida Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | | | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Valter Monzani
- Emergency Division, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milan, Italy
| | - Antonio Clavenna
- Laboratory of Mother and Child Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Maria Carla Roncaglioni
- Laboratory of General Practice Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Alessandro Nobili
- Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy
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Lanza G, Setacci C, Ricci S, Castelli P, Cremonesi A, Lanza J, Novali C, Pratesi C, Santalucia P, Speziale F, Zaninelli A, Gensini GF. An update of the Italian Stroke Organization–Stroke Prevention Awareness Diffusion Group guidelines on carotid endarterectomy and stenting: A personalized medicine approach. Int J Stroke 2017; 12:560-567. [DOI: 10.1177/1747493017694395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although proof-based medicine has generated much valid evidence for the drawing up of guidelines and recommendations for best clinical practice in symptomatic and asymptomatic carotid stenosis, whether and when it is better to employ endarterectomy or stenting as the intervention of choice still remain matters of debate. Moreover, guidelines have been targeted up to now to the ‘representative’ patient, as resulting from the statistical analyses of the studies conducted on the safety and efficacy of both interventions as well as on medical therapy alone. The Italian Stroke Organization (ISO) and Stroke Prevention and Awareness Diffusion (SPREAD) group has thus decided to update its statements for an 8th edition. To this end, a multidisciplinary team of authors representing Italian scientific societies in the neurology, neuroradiology, vascular and endovascular surgery, interventional cardiology, and general medicine fields re-examined the literature available on stroke. Analyses and considerations on patient subgroups have allowed to model the risks/benefits of endarterectomy and stenting in the individual. Accordingly, the guideline's original methodology has been revised to follow the new SIGN (Scottish Intercollegiate Guideline Network) Grade-like approach, integrating it with new considerations on Precision, or Personalized Medicine. Therefore, this guideline offers recommendations on precision medicine for the single patient, and can be followed in addition to the more standard guidelines.
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Affiliation(s)
- Gaetano Lanza
- Department of Vascular Surgery, IRCCS MultiMedica Hospital, Castellanza, Italy
| | - Carlo Setacci
- Department of Surgery, University of Siena, Siena, Italy
| | - Stefano Ricci
- Department of Neurology, ASL 1, Città di Castello e Branca, Italy
| | - Patrizio Castelli
- Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Alberto Cremonesi
- Department of Medical and Surgical Cardiology, Cecilia Hospital, Cotignola, Italy
| | - Jessica Lanza
- Department of Vascular Surgery, University of Pavia, Pavia, Italy
| | - Claudio Novali
- Department of Vascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Pratesi
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | - Paola Santalucia
- Scientific Direction and Emergency Medicine Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Toni D, Carolei A, Caso V, Consoli D, Del Sette M, Inzitari D, Melis M, Micieli G, Provinciali L, Ricci S, Santalucia P, Toso V. Use of rivaroxaban in patients with stroke. Neurol Sci 2017; 38:745-754. [PMID: 28238163 DOI: 10.1007/s10072-017-2855-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/15/2017] [Indexed: 11/28/2022]
Abstract
Rivaroxaban, an inhibitor of Factor Xa, is a direct oral anti-coagulant that has been found to be non-inferior to warfarin in preventing cerebral ischemia in patients with non-valvular atrial fibrillation and in the subgroup of patients with a history of the previous stroke or transient ischemic attack. Vascular neurologists in daily clinical practice may encounter patients taking rivaroxaban or patients who may benefit from its use. In this paper, we review the current clinical indications, contraindications, and clinical management guidelines for rivaroxaban while providing a special focus on neurological aspects and expert opinions on rivaroxaban therapy management in various situations that a neurologist may encounter when treating patients with an ischemic stroke (including those requiring intravenous or intra-arterial reperfusion therapy) and patients with an intracerebral hemorrhage. Since data from clinical trials and real-life data are missing in some clinical situations, strong recommendations are not always available. Nevertheless, practical guidelines should be adopted to maximize benefits from this oral anti-coagulant.
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Affiliation(s)
- Danilo Toni
- Unità di Trattamento Neurovascolare, University La Sapienza Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Antonio Carolei
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | | | - Domenico Consoli
- U.O. Neurologia e Stroke Unit, PO "G. Jazzolino", Vibo Valentia, VV, Italy
| | - Massimo Del Sette
- S.C. Neurologia, Ente Ospedaliero Ospedali Galliera Genova, Genoa, Italy
| | - Domenico Inzitari
- Department of NEUROFARBA, Neuroscience SectionUniversity of Florence, Florence, Italy.,Institute of Neuroscience, Italian National Research Council, Florence, Italy
| | - Maurizio Melis
- SC Neurologia e Stroke UnitAzienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Giuseppe Micieli
- Dipartimento di Neurologia d'Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | | | - Stefano Ricci
- UO Neurologia, USL Umbria 1, Sedi di Città di Castello e Branca, Trento, Italy
| | | | - Vito Toso
- Italian Stroke Organisation, Florence, Italy
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Santalucia P, Zaninelli A, Ragazzoni L, Gensini GF. SIMMED SIMulation in MEDicine, Italian Society for simulation in medicine position paper: executive summary. Intern Emerg Med 2016; 11:537-44. [PMID: 26613931 DOI: 10.1007/s11739-015-1341-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Paola Santalucia
- Scientific Direction, Foundation IRCCS Maggiore Hospital, Policlinico, Milan, Italy.
| | | | - Luca Ragazzoni
- CRIMEDIN-Center for Research on Emergency Medicine and Disaster Medicine, University of Piemonte Orientale "A. Avogadro", Novara, Italy
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Santalucia P, Franchi C, Djade CD, Tettamanti M, Pasina L, Corrao S, Salerno F, Marengoni A, Marcucci M, Nobili A, Mannucci PM. Gender difference in drug use in hospitalized elderly patients. Eur J Intern Med 2015. [PMID: 26209883 DOI: 10.1016/j.ejim.2015.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The aims of this study were to evaluate whether or not there are gender differences in drug use at hospital admission and prescription at discharge and to evaluate the effect of hospitalization on medication patterns in the elderly. METHOD In-patients aged >65years included in the REPOSI registry during a recruitment period of 3years (2008-2010-2012) were analyzed in order to evaluate drug use at hospital admission and prescription at discharge according to gender. RESULTS A total of 3473 patients, 52% women and 48% men, were considered. Polypharmacy (>5 drugs) is more frequent in men both at hospital admission and discharge. At hospital discharge, the number of prescriptions increased in both sexes at all age groups. Neuropsychiatric drugs were significantly more prescribed in women (p<0.0001). At admission men were more likely to be on antiplatelets (41.7% vs 36.7%; p=0.0029), ACE-inhibitors (28.7% vs 24.7%; p=0.0072) and statins (22.9% vs 18.3%; p=0.0008). At discharge, antiplatelets (43.7% vs 37.3%; p=0.0003) and statins (25,2% vs 19.6%; p<0.0001) continued to be prescribed more often in men, while women were given beta-blockers more often than men (21.8% vs 18.9%; p=0.0340). Proton pump inhibitors were the most prescribed drugs regardless of gender. At discharge, the medication pattern did not change according to gender. CONCLUSION Our study showed a gender difference in overall medications pattern in the hospitalized elderly. Hospitalization, while increasing the number of prescriptions, did not change drug distribution by sex.
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Affiliation(s)
- Paola Santalucia
- Scientific Direction, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Carlotta Franchi
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Codjo D Djade
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mauro Tettamanti
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Luca Pasina
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Salvatore Corrao
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Francesco Salerno
- Internal Medicine I, Policlinico IRCCS San Donato, University of Milan, Milan, Italy
| | - Alessandra Marengoni
- Geriatric Unit Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - Maura Marcucci
- Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Geriatrics, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Santalucia P, Baviera M, Cortesi L, Tettamanti M, Marzona I, Nobili A, Riva E, Fortino I, Bortolotti A, Merlino L, Roncaglioni MC. Epidemiologic Trends in Hospitalized Ischemic Stroke from 2002 to 2010: Results from a Large Italian Population-Based Study. J Stroke Cerebrovasc Dis 2015; 24:1917-23. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/10/2015] [Accepted: 05/06/2015] [Indexed: 01/08/2023] Open
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Abstract
Simulation is a frontier for disseminating knowledge in almost all the fields of medicine and it is attracting growing interest because it offers a means of developing new teaching and training models, as well as of verifying what has been learned in a critical setting that simulates clinical practice. The role of simulation in neurology, until now limited by the obvious physical limitations of the dummies used to train students and learners, is now increasing since, today, it allows anamnestic data to be related to the instrumental evidence necessary for diagnosis and therapeutic decision-making, i.e., to the findings of neurophysiological investigations (EEG, carotid and vertebral echography and transcranial Doppler, for example) and neuroradiological investigations (CT, MRI imaging), as well as vital parameter monitoring (ECG, saturimetry, blood pressure, respiratory frequency, etc.). Simulation, by providing learners with opportunities to discuss, with experts, different profiles of biological parameters (both during the simulation itself and in the subsequent debriefing session), is becoming an increasingly important tool for training those involved in evaluation of critical neurological patients (stroke, Guillan Barrè syndrome, myasthenia, status epilepticus, headache, vertigo, confusional status, etc.) and complex cases. In this SIMMED (Italian Society for Simulation in Medicine) position paper, the applications (present and, possibly, future) of simulation in neurology are reported.
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Affiliation(s)
- Giuseppe Micieli
- Department of Emergency Neurology, CESMO Mondino Simulation Centre, C. Mondino National Neurological Institute, Pavia, Italy.
| | - Anna Cavallini
- Department of Emergency Neurology, CESMO Mondino Simulation Centre, C. Mondino National Neurological Institute, Pavia, Italy
| | - Paola Santalucia
- Department of Emergency Neurology, CESMO Mondino Simulation Centre, C. Mondino National Neurological Institute, Pavia, Italy
- Scientific Direction and Emergency Department, IRCCS Foundation Maggiore Hospital Policlinico, Milan, Italy
| | - Gianfranco Gensini
- Department of Emergency Neurology, CESMO Mondino Simulation Centre, C. Mondino National Neurological Institute, Pavia, Italy
- Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Fondazione Don Carlo Gnocchi IRCCS, Florence, Italy
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Lanza G, Ricci S, Setacci C, Castelli P, Novalil C, Pratesi C, Speziale F, Cremonesi A, Morlacchi E, Lanza J, Santalucia P, Zaninelli A, Gensini GF. An Update on Italian Stroke Organization Guidelines on Carotid Endarterectomy and Stenting. Int J Stroke 2014; 9 Suppl A100:14-9. [DOI: 10.1111/ijs.12226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
Abstract
One hundred and fifty-three authors, 45 Italian scientific societies, and two Italian patients' associations participated in drafting the Italian Stroke Organization document, which has become the national guideline for the prevention and treatment of stroke in Italy. For the surgical therapy section of the Italian Stroke Organization document, the main trials on carotid endoarterectomy and stenting were critically reviewed in order to formulate recommendations for these procedures. Recommendations are presented here for the referral of patients to either carotid endarterectomy or stenting on the basis of whether carotid stenosis is symptomatic or asymptomatic.
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Affiliation(s)
- Gaetano Lanza
- Department of Vascular Surgery, IRCCS MultiMedica Hospital, Castellanza, Italy
| | - Stefano Ricci
- Department of Neurology, ASL 1, Città di Castello e Branca, Italy
| | - Carlo Setacci
- Vascular Endovascular Surgery Unit, Department of Surgery, University of Siena, Siena, Italy
| | - Patrizio Castelli
- Vascular Endovascular Surgery Unit, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Claudio Novalil
- Department of Vascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Pratesi
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | - Francesco Speziale
- Vascular Surgery Department, Policlinico Umberto I, ‘La Sapienza’ University, Rome, Italy
| | - Alberto Cremonesi
- Department of Medical and Surgical Cardiology, Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Ernesto Morlacchi
- Department of Vascular Surgery, IRCCS MultiMedica Hospital, Castellanza, Italy
| | - Jessica Lanza
- Vascular Endovascular Surgery Unit, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Paola Santalucia
- Scientific Direction and Emergency Medicine Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
We describe the current and future objectives of the Women Stroke Association, a nonprofit multidisciplinary organization promoting research awareness on medical, psychological, and social issues concerning women affected by cerebrocardiovascular disease. In this paper, we deal with only cerebrovascular disease, whereas cardiovascular disorders will be addressed in a future paper. Gender differences in the clinical presentation of cerebrovascular diseases have been repeatedly suggested, and some treatment options may not be as effective and safe in men and women. For many years, women have either been underrepresented or excluded from randomized clinical trials, and the majority of therapeutic research has been carried on predominantly male populations. Furthermore, gender differences have been shown to contribute to different responses to cerebrovascular drugs in women when compared with men, regarding pharmacokinetics, pharmacodynamics, and physiology. In this statement, we discuss main research fields relevant to Women Stroke Association's mission and commitment, highlighting opportunities and critical from the women's health perspective. Future directions and goals of the Women Stroke Association arise from these considerations and represent the association's commitment to combating stroke.
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Affiliation(s)
| | - Paola Santalucia
- 2 Direzione Scientifica and U.O. Medicina d'Urgenza, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Rita Vadalà
- 3 NeuroRadiology, IRCCS Fondazione S Lucia, Rome, Italy
| | | | - Maria Luisa Zedde
- 5 Neurology Department, Arcispedale Santa Maria Nuova, Reggio nell'Emilia, Italy
| | - Maria Sessa
- 6 Stroke Unit - Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Anticoli
- 1 Stroke Unit - Department of Emergency Medicine, AO S Camillo Forlanini, Rome, Italy
| | - Valeria Caso
- 7 Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
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Corrao S, Santalucia P, Argano C, Djade CD, Barone E, Tettamanti M, Pasina L, Franchi C, Kamal Eldin T, Marengoni A, Salerno F, Marcucci M, Mannucci PM, Nobili A. Gender-differences in disease distribution and outcome in hospitalized elderly: data from the REPOSI study. Eur J Intern Med 2014; 25:617-23. [PMID: 25051903 DOI: 10.1016/j.ejim.2014.06.027] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/16/2014] [Accepted: 06/26/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Women live longer and outnumber men. On the other hand, older women develop more chronic diseases and conditions such as arthritis, osteoporosis and depression, leading to a greater number of years of living with disabilities. The aim of this study was to describe whether or not there are gender differences in the demographic profile, disease distribution and outcome in a population of hospitalized elderly people. METHODS Retrospective observational study including all patients recruited for the REPOSI study in the year 2010. Analyses are referred to the whole group and gender categorization was applied. RESULTS A total of 1380 hospitalized elderly subjects, 50.5% women and 49.5% men, were considered. Women were older than men, more often widow and living alone or in nursing homes. Disease distribution showed that malignancy, diabetes, coronary artery disease, chronic kidney disease and chronic obstructive pulmonary disease were more frequent in men, but hypertension, osteoarthritis, anemia and depression were more frequent in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment evaluated by the Short Blessed Test (SBT), mood disorders by the Geriatric Depression Scale (GDS) and disability in daily life measured by Barthel Index (BI) were worse in women. In-hospital and 3-month mortality rates were higher in men. CONCLUSIONS Our study showed a gender dimorphism in the demographic and morbidity profiles of hospitalized elderly people, emphasizing once more the need for a personalized process of healthcare.
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Affiliation(s)
- S Corrao
- Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS), University of Palermo, Italy; Department of Internal Medicine 2, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - P Santalucia
- Scientific Direction, IRCCS Foundation Maggiore Hospital Policlinico, Milan, Italy; Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - C Argano
- Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS), University of Palermo, Italy
| | - C D Djade
- Scientific Direction, IRCCS Foundation Maggiore Hospital Policlinico, Milan, Italy; Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - E Barone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS), University of Palermo, Italy
| | - M Tettamanti
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - L Pasina
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - C Franchi
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - T Kamal Eldin
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - A Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Italy
| | - F Salerno
- Medicina Interna, IRCCS Policlinico San Donato, Department of Medical and Surgery Sciences, University of Milano, Italy
| | - M Marcucci
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Department of Internal Medicine, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milano, Italy
| | - P M Mannucci
- Scientific Direction, IRCCS Foundation Maggiore Hospital Policlinico, Milan, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Santalucia P, Pezzella FR, Caso V. Call for Research on Women on behalf of Women Stroke Association. Eur J Intern Med 2014; 25:e52. [PMID: 24581793 DOI: 10.1016/j.ejim.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 01/29/2014] [Accepted: 02/03/2014] [Indexed: 11/27/2022]
Affiliation(s)
- P Santalucia
- Scientific Direction and Emergency Dpt., Fondazione IRCCS Ospedale Maggiore Cà Granda Policlinico, Milan, Italy.
| | - F R Pezzella
- Stroke Unit, AO S. Camillo Forlanini, Rome, Italy
| | - V Caso
- Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
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Baviera M, Santalucia P, Cortesi L, Marzona I, Tettamanti M, Avanzini F, Nobili A, Riva E, Caso V, Fortino I, Bortolotti A, Merlino L, Roncaglioni MC. Sex differences in cardiovascular outcomes, pharmacological treatments and indicators of care in patients with newly diagnosed diabetes: Analyses on administrative database. Eur J Intern Med 2014; 25:270-5. [PMID: 24556165 DOI: 10.1016/j.ejim.2014.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 01/27/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The impact of diabetes on cardiovascular disease in both sexes is known, but the specifics have not been fully clarified. We investigated whether sex-related differences exist in terms of management and hospitalization in patients with newly diagnosed diabetes. METHODS We examined the rates of hospitalization for cardiovascular causes, mortality, treatments and management of patients with diabetes compared to subjects without, from administrative database. Interaction between sex and diabetes on clinical outcomes were calculated using a Cox regression model. Pharmacological treatments and recommended examinations by sex were calculated using logistic regression. RESULTS From 2002 to 2006, 158,426 patients with diabetes and 314,115 subjects without were identified and followed up for a mean of 33 months (± 17.5). Diabetes confers a higher risk for all clinical outcomes. Females with diabetes have a risk profile for hospitalization for coronary heart disease comparable to males without (4.6% and 5.3%). Interaction between sex and diabetes shows that females with diabetes had an added 19% higher risk of total death (95% CI 1.13-1.24). No differences were observed in hospitalizations, although females with diabetes were less likely to undergo revascularization after myocardial infarction. Females received cardiovascular prevention drugs less frequently than males and had a slight tendency to get fewer examinations. CONCLUSION Diabetes is linked to a higher increase of mortality in females relative to males. This might reflect sex differences in the use of revascularization procedures or therapeutic regimens. Closer attention and implementation of standard care for females are necessary from the onset of diabetes.
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Affiliation(s)
- Marta Baviera
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy.
| | - Paola Santalucia
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Scientific Direction and Emergency Medicine Dept, Milan, Italy
| | - Laura Cortesi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy
| | - Irene Marzona
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy
| | - Mauro Tettamanti
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of Geriatric Neuropsychiatry, Milan, Italy
| | - Fausto Avanzini
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy
| | - Alessandro Nobili
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory for Quality Assessment of Geriatric Therapies and Services, Milan, Italy
| | - Emma Riva
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of Geriatric Neuropsychiatry, Milan, Italy
| | - Valeria Caso
- Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Ida Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | | | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Maria Carla Roncaglioni
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy
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Perlini S, Salinaro F, Santalucia P, Musca F. Simulation-guided cardiac auscultation improves medical students' clinical skills: the Pavia pilot experience. Intern Emerg Med 2014; 9:165-72. [PMID: 22767224 DOI: 10.1007/s11739-012-0811-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 06/21/2012] [Indexed: 11/27/2022]
Abstract
Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p < 0.001 vs. baseline). Rather unexpectedly, before the tutorial, the performance of VI-year students and of residents was not significantly different from their III-year colleagues, since the two groups correctly identified 14.2 and 16.2 % of the diagnoses, respectively. After the tutorial, the VI-year students and the residents also improved their overall performance (to 73.1 and 76.1 %, respectively; p < 0.001 for both when compared to before the tutorial). The persistence of this capability after 3 years was remarkable, since the 85 students who repeated the test without any further exposure to the 10-h teaching session with Harvey(©) correctly identified 68.4 % of the possible cardiac diagnoses (p < 0.001 vs. baseline). These data underscore the importance of clinical training in order to improve auscultation skills in our academic setting, prompting to redesign teaching curricula. Simulation-based cardiac auscultation should be considered as the "missing link" between formal lecturing and bedside teaching of heart sounds and murmurs.
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Affiliation(s)
- Stefano Perlini
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy,
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Santalucia P, Pezzella FR, Sessa M, Monaco S, Torgano G, Anticoli S, Zanoli E, Maimone Baronello M, Paciaroni M, Caso V. Sex differences in clinical presentation, severity and outcome of stroke: results from a hospital-based registry. Eur J Intern Med 2013; 24:167-71. [PMID: 23167980 DOI: 10.1016/j.ejim.2012.10.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/16/2012] [Accepted: 10/17/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Sex related differences in cardiovascular disease and stroke are issues of increasing interest. The aim of this study was to evaluate for sex differences in clinical presentation, severity of stroke and outcome in a population of patients admitted to 4 public and 1 private hospitals in three different regions of Italy. METHODS All hospital admissions for ischemic and haemorrhagic stroke (ICD-IX code 434 and 431 respectively) between January 1st and December 31st, 2011 at five different hospitals located in three different regions of Italy: Milan (North), Rome and Perugia (Center), and Palermo (South) have been recorded and sex-differences have been evaluated. RESULTS A total of 1272 stroke patients were included in the analysis: 1152 ischemic and 120 haemorrhagic strokes, 567 women and 705 men. Compared to men, women were significantly older (mean age 75.2 SD 13.7 vs 71.5 SD 12.5 years, P<0.001) and their stroke severities at onset, measured by NIHSS, were also compared to men (10 SD 8 vs 8 SD 7, P<0.001). Female sex was associated with a worse functional prognosis measured by modified Rankin Scale score (mRS≥3), as well as in-hospital mortality, without reaching statistical significance. There were no observed significant differences between sexes regarding the number of patients treated with thrombolytic therapy. Analysis of the distribution of risk factors between sexes showed a prevalence of atrial fibrillation in women (29% vs 21%, P=0.003). CONCLUSIONS Both stroke severity and functional outcome were worse in women.
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Affiliation(s)
- P Santalucia
- Scientific Direction and Emergency Medicine Dpt., Fondazione IRCCS Ospedale Maggiore Cà Granda Policlinico, Milan, Italy.
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Caso V, Santalucia P, Acciarresi M, Pezzella FR, Paciaroni M. Antiplatelet treatment in primary and secondary stroke prevention in women. Eur J Intern Med 2012; 23:580-5. [PMID: 22939800 DOI: 10.1016/j.ejim.2012.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/05/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
Stroke is a leading cause of death worldwide and the first cause of disability in the Western world. Over the last 20 years, antiplatelet agents have reduced overall stroke rates in primary and secondary prevention in men. However, this has not been the case for women. In this narrative review, the most widely used antiplatelet therapies for primary and secondary prevention in stroke, excluding cardioembolic stroke, will be outlined. First, the largest randomised controlled trials will be analysed as well as the enrolment percentages of women. Second, analyses on sex-interaction effects in each study will be examined. Moreover, the Authors will discuss the need to develop targeted antiplatelet therapies specifically for women. Based on current results, the most randomised clinical trials and meta-analyses on antiplatelet agents in cerebrovascular disease have not performed sub-analyses on sex-related differences and this is mainly because women were underrepresented. Despite this, antiplatelet agents are considered to be equally effective for both sexes in primary and secondary stroke prevention. Finally, aspirin is the most widely studied antiplatelet in women and has been shown to provide greater benefit for women as primary prevention of ischemic stroke without a significant increased risk in haemorrhage.
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Affiliation(s)
- Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, Perugia, Italy
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Abstract
Evaluation of: Pan A, Okereke OI, Sun Q et al. Depression and incident stroke in women. Stroke 42(10), 2770-2775 (2011). In the Nurses' Health Study, 80,574 women aged between 54 and 79 years, without a history of stroke, were followed-up from 2000 to 2006. In this cohort, depressive symptoms were assessed at multiple time points utilizing the Mental Health Index score (1992, 1996 and 2000), and clinically significant depressive symptoms were defined as a score ≤ 52. A survey was carried out regarding antidepressant medication use biennially beginning in 1996, and physician-diagnosed depression was reported biennially from 2000. During this 6-year follow-up, 1033 incident strokes were documented. Having a history of depression was associated with an increased risk for total stroke, as well as the use of antidepressant medications with or without history of depression.
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Affiliation(s)
- Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy.
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Abstract
Posterior circulation stroke accounts for about 20% of all ischemic strokes in a variety of syndromic pictures ranging from lacunar and limited infarcts to more extensive involvement. Furthermore, infarcts in the vertebrobasilar (VB) region are frequently multiple and not univocally identifiable in one single clinical entity; the prognosis is sometimes unpredictable and very often is unfavorable having a high early mortality rate. The basilar artery (BA), which is the main vessel of the posterior circulation, supplies most of the brainstem and occipital lobes and part of the cerebellum and thalami, its occlusion (BAO) is the most severe occurrence in the posterior circulation infarct context. The optimum management of BAO is still under debate and in the absence of randomized studies the most appropriate approach is still unclear. In the previous chapters, single territory infarcts involving the posterior circulation have been discussed. The present chapter will discuss extended infarcts in the VB territory due to different degrees of VB involvement or to BAO.
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Affiliation(s)
- Paola Santalucia
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
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41
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Acciarresi M, De Rango P, Pezzella FR, Santalucia P, Amici S, Paciaroni M, Mommi V, Agnelli G, Caso V. Secondary Stroke Prevention in Women. Womens Health (Lond Engl) 2011; 7:391-7. [DOI: 10.2217/whe.11.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In a meta-analysis of results from 21 randomized trials comparing antiplatelet therapy with placebo in 18,270 patients with prior stroke or transient ischemic attack, antiplatelet therapy was associated with a 28% relative odds reduction in nonfatal strokes and a 16% reduction in fatal strokes, while another trial for secondary prevention with atorvastastin 80 mg showed a 16% risk reduction in time to first occurrence of stroke (adjusted hazard ratio: 0·84, 95% CI: 0·71–0·99). However, few studies have examined the sex differences regarding the efficacy of these treatments. Specifically, recent studies have reported higher rates of perioperative complications during endarterectomy in women. Nonetheless, to date, the data on the effects of carotid artery stenting in women, coming from diverse studies and meta-analyses, have been limited owing to the small number of female patients examined. Owing to this, the evidence of the benefit for women is unclear. Peculiar pathophysiological aspects of stroke, the higher stroke risk in some specific periods in life (e.g., pregnancy, puerperium and older age) and worse documented stroke outcome in women suggest that sex does matter in stroke management. Thus, future randomized controlled trials need to be sex-balanced, in order to better understand the efficacy of appropriate secondary stroke prevention therapy in women.
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Affiliation(s)
- Monica Acciarresi
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Paola De Rango
- Vascular & Endovascular Surgery Division, Hospital SM Misericordia, Perugia, Italy
| | | | - Paola Santalucia
- Neuroradiology Department, Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milano, Italy
| | - Serena Amici
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Maurizio Paciaroni
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Valeria Mommi
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Giancarlo Agnelli
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Valeria Caso
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
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Abstract
Intracerebral hemorrhage (ICH) accounts for between 10% to 30% of first-ever strokes; outcomes are significantly worse than with ischemic stroke with a 30-day mortality rate up to 50%, furthermore, half of the deaths occur in the acute phase. Intracerebral hemorrhage (ICH) is classified as primary or secondary according to the underlying etiology. Primary ICH (about 80%) comes from the spontaneous rupture of small vessels more often in relation to long-standing or uncontrolled arterial hypertension and is generally located in the basal ganglia and internal capsula. Secondary ICH (about 20%) is often associated with vascular abnormalities, tumors, and anticoagulant therapy or coagulation disorders, more frequently located in cerebral lobes or subtentorial (cerebellum or pons). Rapid recognition and diagnosis of ICH as well as identification of early prognostic indicators are essential for planning the level of care and avoiding acute rapid progression during the first hours. Hematoma size has been identified as one of the most important predictors of 30-day mortality and its expansion is highly predictive of neurological deterioration. Blood pressure management remains, although controversial, the first-line medical approach along with possible new and effective treatments coming from the numerous between pilot and larger randomized medical trials for ICH completed in the past decade.
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Affiliation(s)
- Paola Santalucia
- Istituto Auxologico Italiano, IRCCS, U. O. Cardiologia Ospedale San Luca, Via Spagnoletto 3, 20149, Milano, Italy.
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Goulene K, Gori C, Santalucia P, Leonetti G, Stramba-Badiale M. P-300 Disability and mortality after stroke in patients with atrial fibrillation. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b136-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- K. Goulene
- Istituto Auxologico Italiano
,
Milan, Italy
| | - C. Gori
- Istituto Auxologico Italiano
,
Milan, Italy
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Abstract
A 26-year-old man with Marfan's syndrome had postural headache. Brain MRI with gadolinium showed diffuse pachymeningeal enhancement. MRI myelography revealed bilateral multiple large meningeal diverticula at sacral nerve roots level. He was suspected to have spontaneous intracranial hypotension syndrome. Eight days later headache improved with bed rest and hydration. One month after the onset he was asymptomatic and 3 months later brain MRI showed no evidence of diffuse pachymeningeal enhancement. The 1-year follow-up revealed no neurological abnormalities. The intracranial hypotension syndrome likely resulted from a CSF leak from one of the meningeal diverticula. In conclusion patients with spinal meningeal diverticula (frequently seen in Marfan's syndrome) might be at increased risk of developing CSF leaks, possibly secondary to Valsalva maneuver or minor unrecognized trauma.
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Affiliation(s)
- E Ferrante
- Departments of Neurosciences and Internal Medicine, Niguarda Cà Granda Hospital, Milan, Italy.
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Santalucia P, Feldmann E. Concussion and head injury. Med Health R I 2000; 83:173-7. [PMID: 10893929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Carolei A, Marini C, Di Napoli M, Di Gianfilippo G, Santalucia P, Baldassarre M, De Matteis G, di Orio F. High stroke incidence in the prospective community-based L'Aquila registry (1994-1998). First year's results. Stroke 1997; 28:2500-6. [PMID: 9412640 DOI: 10.1161/01.str.28.12.2500] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Changes in stroke incidence are likely to occur as a consequence of aging of the population, but evidence for this hypothesis is lacking. METHODS A prospective community-based registry of first-ever strokes (1994 to 1998) classified according to the International Classification of Diseases, 9th Revision (ICD-9) was established in the L'Aquila district, central Italy, with a total population of 297,838 (1991 census). Patients were identified by active monitoring of multiple sources, including general practitioners. RESULTS In 1994, 819 patients (398 men and 421 women; mean +/- SD age, 74.8 +/- 11.3 years) suffered from a first-ever stroke. Eighty-nine percent of the patients had neuroimaging studies of the brain and were reclassified with the recent Application of the International Classification of Diseases to Neurology (ICD-10 NA). The occurrence of subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction, and ill-defined events was 2.9%, 14.9%, 80.2%, and 2.0%, respectively. Crude annual incidence of first-ever stroke was 2.75/1000 (95% confidence interval [CI], 2.57 to 2.94) and 24.23/1000 (95% CI, 21.65 to 27.10) in patients older than 80 years. Incidence rates were higher in men and steeply increased with age. The standardized rate was 2.37/1000 for the Italian and 2.28/1000 for the European population. The 30-day case-fatality rate was 25.6% (95% CI, 22.8% to 28.7%). The occurrence of death, disability, and full recovery at 1 year was 36.9%, 38.9%, and 24.2%, respectively. No differences were found in stroke incidence and case-fatality according to income and urban or rural residences. CONCLUSIONS In our population-based study, we found a high stroke incidence notably in the older age subgroups, suggesting that rather than declining, stroke is only being postponed until later in life.
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Affiliation(s)
- A Carolei
- Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila-Collemaggio, Italy
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Marini C, Santalucia P, Di Napoli M, Triggiani L, Carolei A. High stroke incidence in the l'aquila registry: Two-year results. J Stroke Cerebrovasc Dis 1997. [DOI: 10.1016/s1052-3057(97)80123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Marini C, Santalucia P, Di Napoli M, Triggiani L, Carolei A. 3-07-03 Risk factors and outcome of cerebral ischemia in patients over 80. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Santalucia P, Marini C, Di Napoli M, Euforbio M, Mearelli S, Carolei A. 5-07-04 Atrial fibrillation as a pathogenic determinant of cerebral ischemia. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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De Matteis G, Vellante M, Marrelli A, Villante U, Santalucia P, Tuzi P, Prencipe M. Geomagnetic activity, humidity, temperature and headache: is there any correlation? Headache 1994; 34:41-3. [PMID: 8132439 DOI: 10.1111/j.1526-4610.1994.hed3401041.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Meterological factors influence several biological functions. Geomagnetic activity (GMA) can be considered a trigger factor of migraine attacks. We studied the possible relationship between 40 migraine patients and some meteorological factors: humidity, temperature and geomagnetic activity in particular. All frequency changes of geomagnetic activity, temperature and humidity values are recorded daily. The study was performed from March to June 1988 over a geographically small area in order to avoid climatic and environmental influences. Our results indicate a significant correlation between geomagnetic activity and migraine attack frequency. Controversial opinions concerning the modalities of data collection and the possible relationships between environment and headache raise the need of further studies.
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Affiliation(s)
- G De Matteis
- Department of Neurology, University of L'Aquila, Italy
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