Risultati per: GPG: Versione 5.0 (25 Novembre 2019)

Objectives
To explore the potential use of body mass index (BMI), proteinuria and total lymphocyte count changes in predicting immunological and virological response in individuals with HIV initiated on antiretroviral treatment (ART).

Design
Prospective cohort study.

Setting
Three urban HIV care and treatment centres in Dar es Salaam.

Participants
Individuals with HIV initiating ART.

Outcome measures
HIV viral load ≥1000 copies/mL (viral non-suppression) at 6 months after ART initiation.

Results
Of 215 (out of 220 enrolled) participants who returned for evaluation at 6 months, 147 (66.8%) were women. At 6 months of follow-up, 89.4% (76/85) of participants with sustained weight gain were virally suppressed compared with 31.8% (7/22) with sustained loss, p

Introduction
Health systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6 months of the COVID-19 pandemic compared with prior to the pandemic.

Methods
We conducted a mixed study design in eight health facilities that are part of the Birhan field site in Amhara, Ethiopia and compared the trend of service utilisation in the first 6 months of COVID-19 with the corresponding time and data points of the preceding year.

Result
New family planning visits (43.2 to 28.5/month, p=0.014) and sick under 5 child visits (225.0 to 139.8/month, p=0.007) declined over the first 6 months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7/month, p=0.433) and postnatal care (26.6 to 19.8/month, p=0.155) visits, facility delivery rates (90.7 to 84.2/month, p=0.776), and family planning visits (313.3 to 273.4/month, p=0.415) declined, although this did not reach statistical significance. Routine immunisation visits (37.0 to 36.8/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities’ decreased fear of COVID-19 and awareness-raising activities.

Conclusion
We observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients’ evolving concerns during public health emergencies.

Objective
The study aimed to evaluate trends in the prevalence and correlates of sedentary behaviour (SB) in people aged 15–64 years from 2009 to 2019 in Mongolia.

Design
Repeat population-based cross-sectional study.

Setting
Nationally representative sample of persons living in the general community aged 15–64 years in Mongolia.

Participants
The sample included 17 780 people (15–64 years) who participated in Mongolia STEPS surveys 2009, 2013 or 2019.

Primary and secondary outcome measures: self-reported
SB, along with physical measurements, health status and health behaviour, and sociodemographic covariates. Multinomial logistic regression calculated OR with 95% CI for moderate and high SB, with low SB as reference category.

Results
Across study years, the proportion of low (

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Stroke, Ahead of Print. Background:To determine whether extremely mild small vessel disease (SVD) phenotypes can occur inNOTCH3variant carriers from Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) pedigrees using clinical, genetic, neuroimaging, and skin biopsy findings.Methods:Individuals from CADASIL pedigrees fulfilling criteria for extremely mildNOTCH3-associated SVD (mSVDNOTCH3) were selected from the cross-sectional Dutch CADASIL cohort (n=200), enrolled between 2017 and 2020. Brain magnetic resonance imaging were quantitatively assessed for SVD imaging markers. Immunohistochemistry and electron microscopy was used to quantitatively assess and compare NOTCH3 ectodomain (NOTCH3ECD) aggregation and granular osmiophilic material deposits in the skin vasculature of mSVDNOTCH3cases and symptomatic CADASIL patients.Results:Seven cases were identified that fulfilled the mSVDNOTCH3criteria, with a mean age of 56.6 years (range, 50–72). All of these individuals harbored aNOTCH3variant located in one of EGFr domains 7-34 and had a normal brain magnetic resonance imaging, except the oldest individual, aged 72, who had beginning confluence of WMH (Fazekas score 2) and 1 cerebral microbleed. mSVDNOTCH3cases had very low levels of NOTCH3ECDaggregation in skin vasculature, which was significantly less than in symptomatic EGFr 7-34 CADASIL patients (P=0.01). Six mSVDNOTCH3cases had absence of granular osmiophilic material deposits.Conclusions:Our findings demonstrate that extremely mild SVD phenotypes can occur in individuals from CADASIL pedigrees harboringNOTCH3EGFr 7-34 variants with normal brain magnetic resonance imaging up to age 58 years. Our study has important implications for CADASIL diagnosis, disease prediction, and the counseling of individuals from EGFr 7-34 CADASIL pedigrees.

Stroke, Ahead of Print. Background:Cavernous cerebral malformations can arise because of mutations in theCCM1,CCM2, orCCM3genes, and lack ofCdc42has also been reported to induce these malformations in mice. However, the role of the CCM3 (cerebral cavernous malformation 3)-associated kinases in cavernoma development is not known, and we, therefore, have investigated their role in the process.Methods:We used a combination of an in vivo approach, using mice genetically modified to be deficient in the CCM3-associated kinases STK24 and STK25 (serine/threonine kinases 24 and 25), and the in vitro model of human endothelial cells in which expression ofSTK24andSTK25was inhibited by RNA interference.Results:Mice deficient for bothStk24andStk25, but not for either of them individually, developed aggressive vascular lesions with the characteristics of cavernomas at an early age.Stk25deficiency also gave rise to vascular anomalies in the context ofStk24heterozygosity. Human endothelial cells deficient for both kinases phenocopied several of the consequences ofCCM3loss, and singleSTK25deficiency also inducedKLF2expression, Golgi dispersion, altered distribution of β-catenin, and appearance of stress fibers.Conclusions:The CCM3-associated kinases STK24 and STK25 play a major role in the inhibition of cavernoma development.

Stroke, Volume 53, Issue Suppl_1, Page A50-A50, February 1, 2022. Testing Procedures Influence Allocentric and Egocentric Neglect AssociationsHemispatial visual neglect is common after right hemisphere (RH) stroke and can impact attention to the left side of view (egocentric) or the left side of objects irrespective of location (allocentric). Allocentric and egocentric neglect correlations have been reported as high as 0.80; however, others report low correlations and dissociations between them using the same task but with different administration procedures.To determine if divergent results are due to distinct procedures, we compared allocentric and egocentric neglect presence and severity between the two.Thirty-eight adults (21 female, age 65±15 years, 14±2 years education, 21 black/16 white) completed neglect testing within 10 days of RH stroke. Neglect testing comprised circling 10 complete circles (egocentric task) and crossing out 20 circles with gaps (10 left gaps, 10 right gaps; allocentric task). All participants completed testing once with allocentric and egocentric tasks on separate pages and once with both tasks on the same page. We used pairedt-tests, Pearson correlations, and Fisher’s Exact test for analyses.Neglect severity did not differ across single- and separate-page conditions (allocentric:t(32)=0.68,p=0.50;egocentric:t(36)=-1.27,p=0.21). Single- and separate-page severity scores were strongly associated (allocentric:r=0.65,p

Stroke, Volume 53, Issue Suppl_1, Page ATMP18-ATMP18, February 1, 2022. Background:We evaluated the frequency and outcomes of Coronavirus Disease 2019 (COVID-19) associated stroke (ischemic and hemorrhagic) and myocardial infarction (MI) in a global research network.Methods:All adult (≥ 18 years) patients with ICD-10 diagnoses of COVID-19 were included and those with a stroke (ischemic stroke, intracerebral hemorrhage [ICH], transient ischemic attach [TIA] or subarachnoid hemorrhage [SAH]) or myocardial infarction (MI) ± 28 days from COVID-19 diagnosis were flagged. Individuals with a prior history of stroke / MI were excluded. COVID-19 associated stroke (CAS) and MI (CAM) frequencies were compared to prior AHA-reported population-based incidences. Severe COVID-19 disease (use of ventilator, intubation, or life support) and 90-day mortality were evaluated among no-stroke/MI and stroke/MI subgroups utilizing general linear models adjusted for age, sex, race/ethnicity, and Charlson Comorbidity Index scores. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported.Results:Between Jan 2020 and Jul 2021, we identified 637,820 COVID-19 patients of whom 4,559 (0.71%) had a CAS and 6,972 (1.09%) had a CAM. COVID-19 was associated with significantly higher stroke/MI rates compared to population based reported incidence (ORs, CI for CAS 1.99, 1.93 – 2.05 and CAM 3.09, 3.01 – 3.16). Severe COVID disease was observed among 1.07% of COVID-19 only patients, 11.25% of CAS patients (aOR, CI: 4.82, 4.35 – 5.34), and 14.81% of CAM patients (aOR, CI: 5.77, 5.34 – 5.22). 90-Day mortality was 1.92% for COVID-19 only patients, 14.35% for CAS patients (aOR, CI: 3.16, 2.87 – 3.46), and 20.52% for CAM patients (aOR, CI: 4.12, 3.85 – 4.41). Group specific demographic and outcome proportions are reported (Figure).Conclusion:The COVID-19 pandemic has tremendously exacerbated the burden of cerebrovascular and cardiovascular disease globally. Continued work is needed to understand drivers of poor outcomes among COVID-19 patients.

Stroke, Volume 53, Issue Suppl_1, Page ATMP97-ATMP97, February 1, 2022. Background:The global burden of diseases (GBD) of neurological disorders is increasing worldwide. The purpose of this study is to determine the burden of neurological disorders, including incidence, prevalence, death, disability-adjusted life-years (DALY), years lived with disability, and years of life lost between 1990 and 2019 in Asia regions.Methods:The GBD study is updated every year, and the most recent version provides the burden of diseases according to age, gender, and region from 1990 to 2019. Our study included 13 neurological diseases including stroke, Alzheimer’s disease and other dementias, Parkinson’s disease, brain and central nervous system cancer, idiopathic epilepsy, motor neuron disease, multiple sclerosis, migraine, tension-type headache, meningitis, encephalitis, tetanus, other neurological disorders. All rates were described as age-standardized using the GBD standard. Data were described using 95% uncertainty intervals (UIs) and changes from 1990 to 2019 as percent (95% UIs) provided by the GBD website.Results:In 2019, DALYs of neurological diseases were 64.4 million in South-East Asia (95% UI 45.2-94.2) and 85.0 million in Western pacific regions (95% UI 63.0-118.5). The three neurological diseases with the highest DALYs in WHO South-East Asia and WHO Western pacific regions in 2019 were stroke, migraine, Alzheimer’s disease and other dementias. DALYs of stroke and Alzheimer’s disease and other dementia, Parkinson’s disease, brain and central nervous system cancer, multiple sclerosis, migraine, and tension type headache increased in both regions in 2019 compared to 1990. Infectious diseases such as tetanus, meningitis, encephalitis decreased in both regions. The age-standardized rate of stroke incidence (-10%, 157 to 141 in South-East Asia, -12%, 211 to 186 in Western Pacific) and mortality (-30%, 135 to 95 in South-East Asia, -42%, 180 to 104 in Western Pacific) decreased markedly in both regions.Conclusion:This study demonstrated the burden of neurological diseases in Asia. To reduce the burden of neurological disease, a strategy suited to the reality of each country will be needed, and this study can serve as the cornerstone of the strategy.

Stroke, Volume 53, Issue Suppl_1, Page AWP224-AWP224, February 1, 2022. Background:Stroke and myocardial infarction (MI) prevalence varies by race/ethnicity, as do the risk factors.Methods:We included biyearly data from the 2011-2019 Behavioral Risk Factor Surveillance System (BRFSS) surveys of adults (age ≥18) in the United States. We describe survey-weighted prevalence of self-reported stroke and MI by race and ethnicity. We also describe the prevalence of modifiable vascular risk factors in patients with stroke and MI.Results:The weighted number of U.S. participants represented in BRFSS surveys increased from 237,404,549 in 2011 to 251,703,709 in 2019. Stroke prevalence increased from 2.9% in 2011 to 3.4% in 2019 (

Stroke, Volume 53, Issue Suppl_1, Page A103-A103, February 1, 2022. Introduction:We sought to present burden estimates of ischemic and hemorrhagic stroke in the US in 2019 and to describe trends from 1990 to 2019 by age, sex, and geographic location.Methods:We performed an analysis of the Global Burden of Disease (GBD) 2019 study. Data on stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2019 were obtained from the GBD results tool. We measured crude and age-standardized incidence, prevalence, mortality, and DALYs per 100,000 (with 95% uncertainty intervals) for all stroke, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage from 1990 to 2019.Results:In the US in 2019, there were 0.46 million (0.40-0.52) incident strokes, of which 67.5% were ischemic (0.31 million [0.26-0.38]), 0.19 million (0.17-0.21) stroke-related deaths and 3.83 million (3.47-4.16) stroke-attributable DALYs. The crude number of incident strokes, prevalent strokes, mortality, and DALYs increased from 1990 to 2019 but age-standardized stroke burden measures declined or remained flat (Figure 1). Trends in stroke incidence, prevalence, mortality, and DALYs varied by age group and geographic location, with stroke incidence decreasing in older adults nationwide and increasing in younger adults (15-49 years) in the South and Midwest US (Figure 2).Conclusions:While age-standardized measures of stroke burden are decreasing, there is a large and increasing number of people affected by stroke in the US, especially among younger populations in the South and Midwest.Public health efforts to reduce stroke burden across the lifespan should incorporate location-specific stroke trends.

Stroke, Volume 53, Issue Suppl_1, Page AWMP104-AWMP104, February 1, 2022. Introduction:High burden of Metabolic Syndrome (MS) results in incident stroke and poor outcomes. We report contemporary national estimates of stroke prevalence and quantify MS burden and its socio-demographic associates among stroke individuals.Methods:We analyzed 2019 Behavioral Risk Factor Surveillance System data; a nationally representative survey of health-related conditions and behaviors among community dwelling adults. We identified individuals with self-reported stroke and flagged 4 MS indicators (diabetes, hypertension, BMI ≥ 25 kg/m2, hypercholesterolemia). Individuals with ≥ 2 features were categorized as High MS (HMS). We compared socio-demographic characteristics (age, sex, race, education, income, marital and employment status, stroke belt residence) and healthcare utilization (insurance status and frequency of healthcare visits) among HMS and no-HMS groups. We fit survey design logistic regression models with appropriate sampling weights and report national estimates of stroke prevalence and HMS associates.Results:In 2019, there were 8,570,876 adults (≥ 18 years) with stroke in the US; translating into a nationwide prevalence of 3.4% (7.9% among ≥ 65 years). Overall, 94.4% had at least one MS feature; 77.4% had HMS. Advanced age, male sex, non-Hispanic Black (NHB) race and residence in stroke belt region were associated with HMS. Participants with high income (≥ $75,000) and health insurance coverage were less likely to have HMS. In the fully adjusted model, advanced age; Asian American / Pacific Islander race and Hispanic ethnicity (vs. Non-Hispanic White) and residence in the US stroke belt had higher likelihood of HMS (Figure). Healthcare utilization patterns and sex were not significantly associated with HMS. Updated 2020 BRFSS data will be presented.Conclusion:Racial and regional disparities exist in HMS burden among stroke individuals. Targeted MS prevention and management measures are needed for high-risk populations.

Stroke, Volume 53, Issue Suppl_1, Page A25-A25, February 1, 2022. Introduction:Tenecteplase has been demonstrated to be an effective option for thrombolysis in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Thrombolysis decision making is an important component of telestroke consultations. Data is scarce concerning tenecteplase usage in telestroke patients. We aimed to evaluate if tenecteplase was safe and feasible for patients with confirmed LVO in a large telestroke network.Methods:We conducted a retrospective analysis of AIS patients with LVO and treated with thrombolysis from May 2018 to April 2021. We compared outcomes in telestroke patients treated with IV alteplase (May 2018 – April 2020) to patients treated with IV tenecteplase (May 2020 – April 2021). We evaluated our primary efficacy and safety outcomes: 90 day functional outcome as measured by modified Rankin Scale (mRS) and complications related to thrombolysis. Secondary outcomes included door to needle time (DTN) and door in door out time (DIO). Ordinal regression assessed 90 day mRS and binomial logistic regression analysis evaluated complications between the groups. Quantile regression models assessed the median to compared groups for DTN and DIO.Results:There were 3747 telestroke consults during the study period and 537 (14.3%) were found to have an LVO, of which 109 (39 IV tenecteplase; 70 IV alteplase) were eligible, received thrombolysis and were included in this study. Patients treated with IV tenecteplase had significantly less disability at 90 days compared to patients treated with IV alteplase [1 (0 – 4.5) vs. 3 (1 – 6)], adjusted odds ratio (aOR) = 0.31 [95%CI, 0.14 – 0.72], p = 0.006, based on mRS ordinal shift analysis. Similar complication rates were reported between the thrombolysis groups, aOR = 3.73 [95%CI, 0.23 – 59.95], p = 0.35. An adjusted quantile regression model found IV tenecteplase was administered 9.40 minutes quicker, standard error (SE) = 3.67, [95%CI, 2.11 – 16.69] than IV alteplase, p = 0.01. There were no differences reported between thrombolysis groups and DIO, p = 0.63.Conclusion:Telestroke patients presenting with confirmed LVO and treated with IV tenecteplase were found to have better 90 day outcomes compared to patients treated with IV alteplase, without increased complication rates.

Comunicato del 05/12/2021 n°76