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DE Rubeis G, Zilahi DE Gyurgyokai S, Fabiano S, Bertaccini L, Wlderk A, Pezzella FR, Anticoli S, Biondi-Zoccai G, Versaci F, Saba L, Pampana E. Intraprocedural continuous saline infusion lines significantly reduce the incidence of acute kidney injury during endovascular procedures for stroke and myocardial infarction: evidence from a systematic review and meta-regression. Minerva Med 2024:S0026-4806.23.09093-6. [PMID: 38563606 DOI: 10.23736/s0026-4806.23.09093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Contrast media used in mechanical therapies for stroke and myocardial infarction represent a significant cause of acute kidney injury (AKI) in acute medical scenarios. Although the continuous saline infusion line (CSIL) is a standard procedure to prevent thrombus formation within the catheter during neurovascular interventions of mechanical thrombectomy (MT), it is not utilized in percutaneous coronary interventions (PCI). METHODS A systematic review of the incidence of AKI after MT for stroke treatment was performed. These data were compared with those reported in the literature regarding the incidence of AKI after PCI for acute myocardial infarction. A random-effect model meta-regression was performed to explore the effects of CSIL on AKI incidence, using clinical details as covariates. RESULTS A total of 18 and 33 studies on MT and PCI were included, respectively, with 69,464 patients (30,138 [43.4%] for MT and 39,326 [56.6%] for PCI). The mean age was 63.6 years±5.8 with male 66.6%±12.8. Chronic kidney disease ranged 2.0-50.3%. Diabetes prevalence spanned 11.1% to 53.0%. Smoking status had a prevalence of 7.5-72.0%. Incidence of AKI proved highly variable (I2=98%, Cochrane's Q 2985), and appeared significantly lower in the MT subgroup than in the PCI subgroups (respectively 8.3% [95% confidence interval: 4.7-11.9%] vs. 14.7 [12.6-16.8%], P<0.05). Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001-1.16]; P=0.03). CONCLUSIONS Implementation of CSIL during endovascular procedures in acute settings was associated with a significant decrease in the risk of AKI, and its safety should be routinely considered in such interventions.
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Affiliation(s)
- Gianluca DE Rubeis
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy -
| | | | - Sebastiano Fabiano
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Bertaccini
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Wlderk
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesca R Pezzella
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Sabrina Anticoli
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Francesco Versaci
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Luca Saba
- Unit of UTIC, Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Enrico Pampana
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
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2
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Magliozzi A, Crupi D, Pezzella FR, Anticoli S, Marano M, Mangiardi M. Multiple faces of the stroke: when it is a mimic. Minerva Cardiol Angiol 2023; 71:126-127. [PMID: 36786507 DOI: 10.23736/s2724-5683.22.06188-9] [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: 02/15/2023]
Affiliation(s)
- Alessandro Magliozzi
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Domenica Crupi
- Stroke Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | | | | | - Massimo Marano
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
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3
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Stasolla A, Prosperini L, Haggiag S, Pezzella FR, Pingi A, Cozzolino V, Pampana E, Cotroneo E, Tortorella C, Menniti A, Gasperini C. Non-traumatic acute myelopathies: Clinical and imaging features in a real world emergency setting. Neuroradiol J 2022; 35:727-735. [PMID: 35575188 PMCID: PMC9626837 DOI: 10.1177/19714009221096823] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aetiologic diagnosis of non-traumatic acute myelopathies (AMs), and their differentiation from other mimicking conditions (i.e. 'mimics'), are clinically challenging, especially in the emergency setting. Here, we sought to identify: (i) red flags suggesting diagnoses alternative to AMs and (ii) clinical signs and magnetic resonance imaging (MRI) features differentiating non-compressive from compressive AMs. MATERIALS AND METHODS We retrospectively retrieved MRI scans of spinal cord dictated at emergency room from January 2016 to December 2020 in the suspicion of AMs. Patients with traumatic myelopathies and those with subacute/chronic myelopathies (i.e. MRI scans acquired >48 h from symptom onset) were excluded from analysis. RESULTS Our search retrieved 105 patients; after excluding 16 cases of traumatic myelopathies and 14 cases of subacute/chronic myelopathies, we identified 30 cases with non-compressive AMs, 30 cases with compressive AMs and 15 mimics. The presence of pyramidal signs (p = 0.012) and/or pain (p = 0.048) correctly identified 88% of cases with AMs. We failed to identify clinical indicators for distinguishing non-compressive and compressive AMs, although cases with inflammatory AMs were younger than cases with all the remaining conditions (p < 0.05). Different MRI patterns could be described according to the final diagnosis: among non-compressive AMs, inflammatory lesions were more often posterior or central; vascular malformation had a fairly widespread distribution; spine ischaemia was more often central. Anterior or lateral compression were more often associated with neoplasms and disc herniation , whereas hemorrhages and infections produced spine compression on all sides. CONCLUSION We propose a simple clinical indicator (i.e. pyramidal signs and/or pain) to distinguish AMs from their mimics in an emergency setting. Urgent spinal cord MRI remains essential to discriminate compressive and non-compressive aetiologies.
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Affiliation(s)
| | | | | | | | | | | | | | - Enrico Cotroneo
- Neuroradiology Unit, S. Camillo-Forlanini Hospital
- Neurology Unit, S. Camillo-Forlanini Hospital
- Stroke Unit, S. Camillo-Forlanini Hospital
- Neurosurgery Unit, S. Camillo-Forlanini Hospital
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4
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Testa A, Biondi-Zoccai G, Anticoli S, Pezzella FR, Mangiardi M, DI Giosa A, Marchegiani G, Frati G, Sciarretta S, Perrotta A, Peruzzi M, Cavarretta E, Gaspardone A, Mariano E, Federici M, Montone RA, Dei Giudici A, Versaci B, Versaci F. Cluster analysis of weather and pollution features and its role in predicting acute cardiac or cerebrovascular events. Minerva Med 2022; 113:825-832. [PMID: 35156790 DOI: 10.23736/s0026-4806.22.08036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite mounting evidence, the impact of the interplay between weather and pollution features on the risk of acute cardiac and cerebrovascular events has not been entirely appraised. The aim of this study was to perform a comprehensive cluster analysis of weather and pollution features in a large metropolitan area, and their association with acute cardiac and cerebrovascular events. METHODS Anonymized data on acute myocardial infarction (AMI) and acute cerebrovascular events were obtained from 3 tertiary care centers from a single large metropolitan area. Weather and pollution data were obtained averaging measurements from several city measurement stations managed by the competent regional agency for enviromental protection, and from the Metereological Center of Italian Military Aviation. Unsupervised machine learning was performed with hierarchical clustering to identify specific days with distinct weather and pollution features. Clusters were then compared for rates of acute cardiac and cerebrovascular events with Poisson models. RESULTS As expected, significant pairwise correlations were found between weather and pollution features. Building upon these correlations, hierarchical clustering, from a total of 1169 days, generated 4 separate clusters: mostly winter days with low temperatures and high ozone concentrations (cluster 1, N.=60, 5.1%), days with moderately high temperatures and low pollutants concentrations (cluster 2, N.=419, 35.8%), mostly summer and spring days with high temperatures and high ozone concentrations (cluster 3, N.=673, 57.6%), and mostly winter days with low temperatures and low ozone concentrations (cluster 4, N.=17, 1.5%). Overall cluster-wise comparisons showed significant differences in adverse cardiac and cerebrovascular events (P<0.001), as well as in cerebrovascular events (P<0.001) and strokes (P=0.001). Between-cluster comparisons showed that cluster 1 was associated with an increased risk of any event, cerebrovascular events, and strokes in comparison to cluster 2, cluster 3 and cluster 4 (all P<0.05), as well as AMI in comparison to cluster 3 (P=0.047). In addition, cluster 2 was associated with a higher risk of strokes in comparison to cluster 4 (P=0.030). Analysis adjusting for season confirmed the increased risk of any event, cerebrovascular events and strokes for cluster 1 and cluster 2. CONCLUSIONS Unsupervised machine learning can be leveraged to identify specific days with a unique clustering of adverse weather and pollution features which are associated with an increased risk of acute cardiovascular events, especially cerebrovascular events. These findings may improve collective and individual risk prediction and prevention.
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Affiliation(s)
- Alberto Testa
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Mediterranea Cardiocentro, Naples, Italy - .,Scuola Superiore di Study Avanzati, Sapienza University, Rome, Italy
| | | | | | | | | | | | - Giacomo Frati
- Mediterranea Cardiocentro, Naples, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | | | - Mariangela Peruzzi
- IRCCS Neuromed, Pozzilli, Isernia, Italy.,Department of Clinical, Internal Anestesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Elena Cavarretta
- Mediterranea Cardiocentro, Naples, Italy.,Scuola Superiore di Study Avanzati, Sapienza University, Rome, Italy
| | | | - Enrica Mariano
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Angela Dei Giudici
- Cardiologic Intensive Care Unit, Hemodynamic and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Francesco Versaci
- Cardiologic Intensive Care Unit, Hemodynamic and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
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5
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Versaci F, Anticoli S, Pezzella FR, Mangiardi M, DI Giosa A, Marchegiani G, Calcagno S, DI Pietro R, Frati G, Sciarretta S, Perrotta A, Peruzzi M, Cavarretta E, Roever L, Antonazzo B, Ronzoni S, Versaci B, Biondi-Zoccai G. Impact of weather and pollution on the rate of cerebrovascular events in a large metropolitan area. Panminerva Med 2022; 64:17-23. [PMID: 35330556 DOI: 10.23736/s0031-0808.21.04525-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite mounting evidence, there is uncertainty on the impact of the interplay between weather and pollution features on the risk of acute cerebrovascular events (CVE). We aimed at appraising role of weather and pollution on the daily risk of CVE. METHODS Anonymized data from a hub CVE center in a large metropolitan area were collected and analyzed according to weather (temperature, pressure, humidity, and rainfall) and pollution (carbon monoxide [CO], nitrogen dioxide [NO2], nitrogen oxides [NOX], ozone [O3], and particulate matter [PM]) on the same and the preceding days. Poisson regression and time series analyses were used to appraise the association between environmental features and daily CVE, distinguishing also several subtypes of events. RESULTS We included a total of 2534 days, with 1363 days having ≥1 CVE, from 2012 to 2017. Average daily rate was 1.56 (95% confidence interval: 1.49; 1.63) for CVE, with other event rates ranging between 1.42 for stroke and 0.01 for ruptured intracranial aneurysm. Significant associations were found between CVE and temperature, pressure, CO, NO2, NOX, O3, and PM <10 µm (all P<0.05), whereas less stringent associations were found for humidity, rainfall, and PM <2.5 µm. Time series analysis exploring lag suggested that associations were stronger at same-day analysis (lag 0), but even environmental features predating several days or weeks were significantly associated with events. Multivariable analysis suggested that CO (point estimate 1.362 [1.011; 1.836], P=0.042) and NO2 (1.011 [1.005; 1.016], P<0.001) were the strongest independent predictors of CVE. CONCLUSIONS Environmental features are significantly associated with CVE, even several days before the actual event. Levels of CO and NO2 can be potentially leveraged for population-level interventions to reduce the burden of CVE.
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Affiliation(s)
- Francesco Versaci
- Unit of UTIC, Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | | | | | | | | | - Simone Calcagno
- Division of Cardiology, San Paolo Hospital, Civitavecchia, Rome, Italy
| | - Riccardo DI Pietro
- Unit of UTIC, Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | - Mariangela Peruzzi
- Mediterranea Cardiocentro, Naples, Italy.,Department of Clinical, Internal Anestesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | | | | | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
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Doehner W, Mazighi M, Hofmann BM, Lautsch D, Hindricks G, Bohula EA, Byrne RA, Camm AJ, Casadei B, Caso V, Cognard C, Diener HC, Endres M, Goldstein P, Halliday A, Hopewell JC, Jovanovic DR, Kobayashi A, Kostrubiec M, Krajina A, Landmesser U, Markus HS, Ntaios G, Pezzella FR, Ribo M, Rosano GMC, Rubiera M, Sharma M, Touyz RM, Widimsky P. Cardiovascular care of patients with stroke and high risk of stroke: The need for interdisciplinary action: A consensus report from the European Society of Cardiology Cardiovascular Round Table. Eur J Prev Cardiol 2020; 27:682-692. [PMID: 31569966 PMCID: PMC7227126 DOI: 10.1177/2047487319873460] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Comprehensive stroke care is an interdisciplinary challenge. Close collaboration of cardiologists and stroke physicians is critical to ensure optimum utilisation of short- and long-term care and preventive measures in patients with stroke. Risk factor management is an important strategy that requires cardiologic involvement for primary and secondary stroke prevention. Treatment of stroke generally is led by stroke physicians, yet cardiologists need to be integrated care providers in stroke units to address all cardiovascular aspects of acute stroke care, including arrhythmia management, blood pressure control, elevated levels of cardiac troponins, valvular disease/endocarditis, and the general management of cardiovascular comorbidities. Despite substantial progress in stroke research and clinical care has been achieved, relevant gaps in clinical evidence remain and cause uncertainties in best practice for treatment and prevention of stroke. The Cardiovascular Round Table of the European Society of Cardiology together with the European Society of Cardiology Council on Stroke in cooperation with the European Stroke Organisation and partners from related scientific societies, regulatory authorities and industry conveyed a two-day workshop to discuss current and emerging concepts and apparent gaps in stroke care, including risk factor management, acute diagnostics, treatments and complications, and operational/logistic issues for health care systems and integrated networks. Joint initiatives of cardiologists and stroke physicians are needed in research and clinical care to target unresolved interdisciplinary problems and to promote the best possible outcomes for patients with stroke.
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Affiliation(s)
- Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), partner site Berlin, Universitätsmedizin Berlin, Germany
- BCRT – Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
- Wolfram Doehner, Department of Cardiology (Virchow Klinikum), BCRT – Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Föhrerstr. 15, 13353 Berlin, Germany.
| | - Mikael Mazighi
- Department of Neurology, Lariboisière Hospital, University of Paris, France
| | | | | | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, University of Leipzig, Germany
| | - Erin A Bohula
- Cardiovascular Division, Harvard Medical School, USA
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich, Germany
| | - A John Camm
- Molecular and Clinical Sciences Research Institute, St George's University of London, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, University of Oxford, UK
- British Heart Foundation Centre of Research Excellence, Oxford
| | - Valeria Caso
- Santa Maria della Misericordia Hospital, University of Perugia, Italy
| | | | | | - Matthias Endres
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
| | | | - Alison Halliday
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, UK
| | - Jemma C Hopewell
- CTSU Nuffield Department of Population Health, University of Oxford, UK
| | | | - Adam Kobayashi
- Kazimierz Pulaski University of Technology and Humanities, Poland
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - Antonin Krajina
- Department of Radiology, Charles University and University Hospital, Hradec Kralove Czech Republic
| | - Ulf Landmesser
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Germany
- Berlin Institute of Health (BIH), Germany
| | | | - George Ntaios
- Department of Medicine, University of Thessaly, Greece
| | | | - Marc Ribo
- Stroke Unit, Vall d'Hebron University Hospital, Spain
| | - Giuseppe MC Rosano
- IRCCS San Raffaele Hospital Roma, Italy
- Cardiovascular and Cell Sciences Institute, St George's University of London, UK
| | - Marta Rubiera
- Stroke Unit, Vall d'Hebron University Hospital, Spain
| | - Mike Sharma
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Canada
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Petr Widimsky
- Cardicenter, Charles University, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Prague, Czech Republic
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7
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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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8
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Abstract
The use of telemedicine, especially as it is relates to telestroke, has significantly expanded over the past one or two decades. The fact that stroke therapy is a time-critical disease process, coupled with the relative paucity of stroke-trained practitioners, makes telestroke an attractive technique of care. The authors' objective was to summarize the evidence that support the reliability of telemedicine for diagnosis and efficacy in acute stroke treatment in collaboration between hospitals in two different countries.
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9
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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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10
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Pezzella FR, Di Rezze S, Chianese M, Fabbrini G, Vanacore N, Colosimo C, Meco G. Hedonistic homeostatic dysregulation in Parkinson’s disease: a short screening questionnaire. Neurol Sci 2003; 24:205-6. [PMID: 14598089 DOI: 10.1007/s10072-003-0132-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F R Pezzella
- Dipartimento di Scienze Neurologiche, Università di Roma La Sapienza, Rome, Italy
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11
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Abstract
Multiple system atrophy (MSA) is a neurodegenerative disease of undetermined aetiology that occurs sporadically and manifests itself as a combination of parkinsonian, autonomic, cerebellar and pyramidal signs. Despite the lack of any effective therapy to reverse this condition, some of the symptoms may be, at least temporarily, improved with adequate symptomatic therapies. Medical treatment is largely aimed at mitigating the parkinsonian and autonomic features. The therapeutic results of levodopa therapy in cases of MSA are difficult to interpret because of their variability. Nevertheless, the statement that patients with MSA are non or poorly levodopa-responsive is misleading. Clinical and pathologically proven series document about 40-60% levodopa efficacy in patients with MSA presenting with predominant parkinsonian features. Unfortunately, other antiparkinsonian compounds (dopamine agonists, amantadine) are not more effective than levodopa. Orthostatic hypotension (OH) can be suspected from the patient's history and subsequently documented in the clinic by measuring lying and standing blood pressure. The diagnosis ideally should be confirmed in the laboratory with additional tests to determine the cause and evaluate the functional deficit, so as to aid treatment. A variety of pharmacological agents with different mechanisms of action have been used in MSA to reduce OH when this is symptomatic. OH can also be alleviated by avoiding aggravating factors, such as the effects of food, micturition, exposure to a warm environment and physiological diurnal changes and by using other non-pharmacological strategies. The treatment of the very common genito-urinary symptoms (incontinence, retention, impotence) should also be considered in order to improve the quality of life of these patients.
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Affiliation(s)
- C Colosimo
- Dipartimento di Scienze Neurologiche, Università La Sapienza, Rome, Italy.
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