Risultati per: Passo 12. Ripulire in modo mirato le cartelle cliniche degli assisiti

Giù anche le terapie intensive, -28,6. Nessun ingresso pediatrico

Cartabellotta, meno ricoveri ma più 27,2% decessi

Stroke, Volume 54, Issue Suppl_1, Page A12-A12, February 1, 2023. Introduction:High blood pressure after endovascular thrombectomy (EVT) can cause cerebral hyperemia and disrupt the blood-brain barrier. However, its role in cerebral edema development is incompletely understood. In this study, we examined the relationship between post-EVT systolic blood pressure (SBP) trajectories and cerebral edema.Methods:We prospectively enrolled patients with large-vessel occlusion stroke who underwent EVT. Cerebrospinal fluid (CSF) volume was measured using a deep-learning algorithm on CT images at baseline, 24 hours, and 72 hours after stroke. The ratio of CSF volumes between hemispheres was calculated. Automated segmentation of infarct regions on follow-up scans was used to measure net water uptake (NWU), the ratio of density within infarcted tissue relative to the mirrored contralateral region. Latent variable mixture modeling (LVMM) divided patients into SBP trajectory groups during the first 72 hours post-EVT (Fig. 1A). Measures of edema (change in CSF ratio, NWU) were compared between groups.Results:One hundred patients (mean age 70 ± 16, mean NIHSS 15) were analyzed. Edema was assessed by a gradual increase in NWU (20.5, 27.0) at 24 and 72 hours, respectively, and by a reduction in CSF ratio (0.95, 0.78, 0.68) in the affected hemisphere at baseline, 24 hours, and 72 hours, respectively. LVMM identified five SBP trajectories. Higher SBP trajectories were associated with higher NWU (Fig. 1B) but not lower CSF ratio at 24 hours (p

Stroke, Volume 54, Issue Suppl_1, Page AWP214-AWP214, February 1, 2023. Approximately 30% of subarachnoid hemorrhage (SAH) patients who survive the initial ictus develop delayed cerebral ischemia (DCI) 4 to 10 days following SAH. Multiple clinical studies indicate the cause of DCI is multifactorial and includes vasospasm. 12/15-Lipoxygenase (LOX), enzymes that metabolize arachidonic acid into bioactive lipid metabolites, such as 12-HETE and 15-HETE, are expressed in several cell types of the brain including neurons, and microglia. Previous work has shown that 12/15-LOX has detrimental effects on brain vasculature and neurons, triggers inflammation, and thrombosis. In a previous study, inhibition of 12/15-LOX was beneficial in reducing early brain injury in mice after SAH. We hypothesize that inhibition of 12/15-LOX would attenuate delay vasospasm and reduce DCI in SAH mice. C57BL/6 mice of both sexes were randomized into Sham+Vehicle, SAH+Vehicle, SAH+ML351. Vehicle and ML351 (LOX inhibitor, 25mg/kg) were intravenously injected 15 minutes after SAH. 12/15-LOX-/-mice of both sexes were randomized into sham or SAH. Behavior was assessed daily until euthanasia on day 5 for analysis of vasospasm. Following SAH, there, there was an increased expression of 12/15-LOX in brain endothelial cells. Inhibition of 12/15-LOX in C57BL/6 males reduced large artery vasospasm and microvessel constriction, improved functional outcome, and lowered DCI incidence. In female C57BL/6 mice, inhibition of 12/15-LOX also reduced vasospasm and microvessel constriction, and ameliorated behavioral deficits. 12/15-LOX-/-displayed better behavior and have less delayed vasospasm. The findings of this study suggest that inhibition of 12/15-LOX is therapeutically beneficial for male and female mice after SAH via preventing delay vasospasm and DCI.

Stroke, Volume 54, Issue Suppl_1, Page A30-A30, February 1, 2023. Introduction:Atrial fibrillation (AF) is a major risk factor for cerebral ischemic stroke. However, it is not known whether AF predicts the development of central retinal artery occlusion (CRAO), a form of ischemic stroke affecting the retina.Methods:A retrospective cohort study was undertaken using data from the California Healthcare Cost and Utilization Project (HCUP) State Inpatient and State Emergency Department Datasets (SID/SEDDs). Patients 18 years and older discharged from non-federal hospitals between 2005 and 2011 who did not have a history of CRAO were analyzed. The exposure variable was AF and the endpoint was CRAO, each identified using validated ICD-9-CM diagnosis codes. Association between AF and CRAO was modeled using a Fine-Gray method with death as a competing risk with adjustment for age, biological sex, race, and vascular co-morbidities.Results:A total of 12,181,778 patients were included, among these 806,397 with AF and 11,375,381 without AF. In total, 309 patients had CRAO. In an unadjusted analysis, there was a higher risk of CRAO in patients with versus without AF (HR 2.24 (95% CI: 1.51 to 3.32)). After adjustment for pre-specified covariates, there appeared to be a lower hazard of CRAO in patients with AF (aHR 0.61 (95% CI: 0.45 to 0.98)). Further analyses including cerebral ischemic stroke (aHR 1.16 (95% CI: 1.14 to 1.18)) and specifically embolic stroke (aHR 4.29 (95% CI 4.10-4.48)) as positive controls argued against overadjustment bias. We present sensitivity analyses including CRAO identified in any position of the discharge ICD list, using different ascertainment windows for AF and using broader categories of retinal ischemia.Conclusion:The incidence of CRAO was higher in patients with AF than those without AF, but the hazard of CRAO was not higher for patients with AF after adjustment for measured covariates. Endpoint and exposure ascertainment may have been limited by inclusion only of inpatient and emergency department encounters.

Objectives
To examine the capacity and quality of maternal and child health (MCH) services at the subnational primary healthcare (PHC) level in 12 low-income and middle-income countries (LMICs) and its association with intermediate health outputs such as coverage and access to care.

Design
Observational cross-sectional study using matched subnational data from service provision assessment surveys and demographic health surveys from 2007 to 2019.

Settings
138 subnational areas with available survey data in 12 LMICs (Afghanistan, Bangladesh, Democratic Republic of Congo, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania and Uganda).

Outcomes
Eight intermediate MCH outcomes/outputs were explored: (1) met need for family planning by modern methods; (2) attendance of four or more antenatal care visits; (3) perceived financial barriers to care; (4) perceived geographical barriers to care; (5) diphtheria-pertussis-tetanus (DPT) third dose coverage; (6) DPT dropout-rate; (7) care-seeking for pneumonia; and (8) oral rehydration solutions coverage.

Results
Overall, moderate-to-poor PHC performance was observed across the 12 countries, with substantial heterogeneity between the different subnational areas in the same country as well as within the same subnational area across both capacity and quality subdomains. The analysis of the relationship between PHC service delivery and child health outcomes revealed that recent supervision (b=0.34, p

Comunicato del 30/01/2023 n°7

Introduction
Exercise is vital to staying well and preventing secondary complications in people with chronic neurological impairments (CNI). Appropriate exercise is often inaccessible to this population. The purpose of the study is to investigate the effects of a seated, virtual exercise programme on heart rate, recovery, fatigue, pain, motivation, enjoyment and quality of life in people with CNI.

Methods and analysis
Individuals with CNI will be screened for eligibility, and 60 participants will be randomised 1:1 into either a live or prerecorded group. There is no geographical limitation to where participants reside, since participation is virtual. The study will be coordinated by one site in White Plains, New York, USA. The live group will exercise with an instructor via Zoom while the prerecorded group will exercise at their chosen time using prerecorded videos, 3x/week for 12 weeks. Primary outcome measures: change in heart rate during exercise/recovery. Secondary outcome measures: fatigue, motivation, level of pain and exertion, physical well-being, enjoyment of physical activity, motivation and quality of life. Outcomes will be assessed at baseline, midpoint, end of study and 1-month poststudy. Adverse events, medication changes and physical activity will be tracked throughout. Within-group and between-group comparisons will be performed by using analysis of covariance and regression.

Ethics and dissemination
BRANY IRB approval: 22 September 2020, protocol #20-08-388-512. All participants will provide written informed consent. Results will be disseminated through presentations, publications and ClinicalTrials.gov.

Trial registration number
NCT04564495.

Scende incidenza Covid a 88 ed Rt da 0,91 a 0,89. Monitoraggio settimanale, nessuna regione a rischio alto, è moderato per 4

Il grido di allarme nasce anche dal fatto che la prima legge di bilancio dopo lo tsunami del Covid lascia la Sanità quasi a bocca asciutta

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Monitoraggio Covid Iss-ministero Salute, in crescita anche Rt da 1,04 a 1,14

Contro il definanziamento ulteriore della sanità pubblica