Risultati per: Springer: Nuove riviste open access di Medicina Generale

Circulation, Volume 150, Issue Suppl_1, Page A4146716-A4146716, November 12, 2024. Background:Femoral access is predominantly used for mechanical thrombectomy in stroke patients with large vessel occlusions. Following interventional cardiology guidelines, routine radial access has been proposed as an alternative, though its safety and efficacy remain controversial. We aimed to evaluate the efficacy and safety of radial versus femoral access for mechanical thrombectomy in patients with stroke.Hypothesis:In mechanical thrombectomy for stroke patients with large vessel occlusions, could the transradial access (TRA) result in comparable efficacy but fewer access site complications compared to transfemoral access (TFA)?Methods:A systematic search was performed in PubMed, Scopus, Cochrane, Embase, and Web of Science databases from inception to May 2024, to identify studies measuring the efficacy and safety of radial versus femoral access for mechanical thrombectomy in patients with stroke. The meta-analysis was performed using the Review Manager and Open Meta Analyst.Results:Ten studies (2,277 participants) were included in the review. There were no significant differences between radial and femoral access in terms of successful recanalization (0R: 1.01; 95% CI, 0.59,1.73; p=0.98), complete recanalization (OR: 1.08; 95% CI, 0.60,1.94; p=0.81), favorable functional outcomes (0R: 0.86; 95% CI, 0.53,1.41; p=0.56), first-pass reperfusion (OR: 0.89; 95% CI, 0.67,1.19; p=0.44), number of passes (MD: 0.10; 95% CI, -0.13,0.33; p=0.4), access-to-reperfusion time (MD: -3.92; 95% CI, -9.49,1.65; p=0.17), or symptomatic intracranial hemorrhage (OR: 0.95; 95% CI, 0.55,1.65; p=0.86). However, access site complications were significantly less frequent in the TRA group as compared with the TFA group (OR: 0.21; 95% CI, 0.08,0.60; p=0.004). Meta-regression showed no significant associations for publication year, mean age, gender, or baseline NIHSS scores with clinical outcomes.Conclusion:This meta-analysis indicates that TRA and TFA provide comparable outcomes in mechanical thrombectomy for acute ischemic stroke, with TRA resulting in fewer access site complications. Further large-scale randomized trials are recommended to confirm these findings and potentially support a shift towards TRA in neurovascular procedures.

Circulation, Volume 150, Issue Suppl_1, Page A4118076-A4118076, November 12, 2024. Introduction:The occurrence of innominate artery stenosis is less prevalent compared to subclavian artery disease. Small studies suggest up to 8% of individuals initially diagnosed with suspected subclavian steal syndrome may present with innominate artery lesions. Deployment of an embolic protection filter within the internal carotid artery during percutaneous intervention of the innominate artery presents a solution to mitigate embolism.Case:A 70-year-old female with a history of peripheral vascular disease presented with claudication in both arms, manifested as pain in both arms. Her left subclavian was stented months prior to presentation. An aortogram revealed severe stenosis of the innominate artery (Figure 1). Since multiple attempts to cross the lesion antegrade from the femoral access site were unsuccessful, we proceeded with the successful deployment of an embolic protection filter in the right internal carotid artery via our right radial artery access site (Figure 2). Using the right radial artery, we passed a long run-through guidewire into the distal abdominal aorta. Due to severe aortic tortuosity, we were unable to snare the wire from the aorta. Therefore, we upsized the radial sheath to 7 French over both wires (runthrough and bare). Using a support catheter, we exchanged the runthrough wire for a Glidewire Advantage. We advanced an 8 x 29mm balloon expandable stent to the area of innominate stenosis and deployed it (Figure 3). We postdilated the stent with a 14mm balloon. Angiography demonstrated adequate expansion. On follow up, the patient was without claudication and had triphasic flow in the innominate and left subclavian arteries.Discussion:Treating innominate artery stenosis via radial access employing a sole entry point for both embolic protection and treatment administration offers a substitute where additional access is infeasible. Modern embolic protection techniques are superior due to their flexibility and ease of use. In this case, placing the embolic protection device in the carotid artery was mandatory through the sole radial access to prevent trapping the filter behind the innominate artery stent. We were able to perform both the embolic device placement and the stenting with the same radial access.Conclusion:Endovascular intervention of innominate artery stenosis via radial access, utilizing a single radial access for both embolic protection and treatment delivery, presents an alternative when femoral access is not feasible.

New England Journal of Medicine, Ahead of Print.

Introduction
Post-COVID-19 condition, or syndrome, also known as long COVID, is an infection-associated chronic condition that can develop after a SARS-CoV-2 infection and last at least 3 months to years. Despite representing a high burden for the Unified Health System (SUS), which has affected millions of Brazilians, it has received limited attention in Brazil. Prevalence studies to date have failed to include a broad representation of the population, and there has been insufficient exploration of the impact on people’s lives and the burden of and barriers to accessing health services. This article presents the research protocol for the quantitative component of a mixed methods project to produce evidence to inform SUS’s provision of care for long COVID. The protocol was designed to study long COVID in SUS patients hospitalised for COVID-19 in a large city in Southeast Brazil to capture symptoms and factors associated with the syndrome, effects on quality of life and employment, health needs, use of health services and barriers to accessing necessary healthcare.

Methods and analysis
An ambidirectional cohort study to capture data retrospectively and prospectively from adults previously discharged from SUS hospitals for COVID-19. The study involves up to two telephone surveys with the patients or proxies selected from a sampling plan for population estimates. Survey questions include baseline and follow-up data on demographic, socioeconomic, comorbidities, work status, health-related quality of life, vaccination status, long COVID symptoms, healthcare needs, use and barriers to access. Descriptive and appropriate multivariable analyses will be employed.

Ethics and dissemination
The project was approved by the Research Ethics Committees of participant institutions and by the Brazilian National Research Ethics Commission. All participants provided verbal consent. We plan to publish articles in scientific journals and multimedia resources for SUS professionals and the general population.

Objective
The study aims to evaluate anxiety and depression levels and access to mental health services among internally displaced persons (IDPs) in Mogadishu, Somalia.

Design
A community-based, cross-sectional survey was carried out in IDP camps. Face-to-face interviews were conducted using a modified Hospital Anxiety and Depression Scale. Data were analysed using SPSS V.25.0, incorporating univariate and logistic regression analyses.

Setting
The study was conducted in 10 IDP camps located in the districts of Daynile and Kahda in the Banadir region of Somalia between November and December 2023.

Participants
The study included 522 randomly sampled individuals aged 18–70 years living in the selected IDP camps.

Results
The study revealed high prevalence rates of anxiety (43.7%) and depression (35.8%) among IDPs in the selected districts. Of those with anxiety, 54% were categorised as borderline cases and 46% as severe cases. Similarly for depression, 72.7% were classified as borderline cases and 27.3% as severe cases. Significant associations were found between anxiety symptoms and variables such as camp residence (OR: 3.872, 95% CI 2.333 to 6.424), female gender (OR: 2.387, 95% CI 1.604 to 3.552), young age (OR: 6.319, 95% CI 4.309 to 9.267), marriage contract (OR: 4.569, 95% CI 2.850 to 7.325), lack of education (OR: 1.92, 95% CI 1.349 to 2.737) and past experiences of trauma (OR: 5.207, 95% CI 3.274 to 8.281). Depressive symptoms were significantly associated with younger age (OR: 1.536, 95% CI 1.069 to 2.208), lack of formal education (OR: 1.661, 95% CI 1.153 to 2.395) and history of trauma (OR: 3.695, 95% CI 2.529 to 5.400). Additionally, the study highlighted a grave shortage of mental health and psychosocial support (MHPSS) services. User evaluations of MHPSS services varied, indicating room for improvement.

Conclusion
The study revealed elevated levels of anxiety and depression among IDPs in the districts of Kahda and Daynile in the Banadir region of Somalia, underscored by a critical shortage of MHPSS services, emphasising the need for tailored mental health interventions.

Da Pma a celiachia, il decreto alle Regioni. Fermo da 8 anni

Objectives
This study aimed to understand the current state of continuing professional development (CPD) for rehabilitation professionals globally and identify perceived requirements to enhance education to guide efforts to develop internationally relevant, interprofessional, rehabilitation coursework adaptable to the various professions and contexts to support workforce development.

Design
This was a mixed methods, exploratory study. A convenience sample of rehabilitation professionals received surveys regarding current access to CPD and the perceived needs for additional resources to support professional development. Semistructured interviews were performed with select participants.

Setting
Surveys were distributed online, while interviews were conducted via Microsoft Teams or telephone, depending on the participants’ access.

Participants
A total of 445 professionals completed the survey. Additionally, interviews were performed with 104 participants from Myanmar, Pakistan, Uganda and Ukraine to clarify and expand on survey responses.

Results
The CPD requirements for practising clinicians and regulation of CPD activities varied widely across countries and professions. Participants expressed a need for additional resources and educational opportunities, particularly for multidisciplinary rehabilitation focusing on neurological conditions. However, there were multiple barriers to accessing technological resources and professional development in low and middle-income countries that must be navigated alongside low engagement and motivation for lifelong learning.

Conclusion
There is an opportunity to enhance global rehabilitation workforce development by fostering partnerships focused on the efficient delivery of training. This includes developing CPD programmes that consider cultural contexts, patient populations, and practice settings. Support for CPD can be improved through both internal and external motivators and by regulating CPD activities to ensure effective, evidence-based practice.

Introduction
Successful reperfusion does not always lead to good neurological outcomes and impaired microcirculation can be one of the underlying causes. Intra-arterial alteplase after mechanical thrombectomy (MT) may improve microcirculation contributing to neurological recovery, but prospective randomised studies are still needed to validate its efficacy and safety. We aim to assess the efficacy and safety of intra-arterial alteplase after MT for acute ischaemic stroke (AIS) with large-vessel occlusion (LVO).

Methods and analysis
The Intra-arterial Alteplase for Acute Ischaemic Stroke After Mechanical Thrombectomy (PEARL) study is a multicentre, prospective, open-label, blinded-endpoint, randomised controlled trial. We consecutively screen AIS patients with anterior circulation LVO and National Institute of Health Stroke Scale of 6–25, who reach stable expanded Thrombolysis in Cerebral Infarction scores of 2b50-3 on angiography after MT. Eligible participants are 1:1 randomly assigned to the experimental group and the control group. Participants in the experimental group will receive intra-arterial alteplase (0.225 mg/kg and a maximum dose of 20 mg) after MT and standard medical treatment, while those in the control group will receive standard medical treatment alone after the procedure. The primary outcome is the proportion of patients with a 90-day modified Rankin scale of 0–1. A total of 324 participants are required to test the superiority hypothesis with 80% power at a two-tailed significance level of 0.05.

Ethics and dissemination
This study has been approved by the Ethics Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University (SYSKY-2023-390-02) and will be conducted following the Declaration of Helsinki. Ethical approvals have been obtained separately for all centres participating in the study. Study results will be published in peer-reviewed academic journals.

Trial registration number
NCT05856851.

This Viewpoint examines the implementation of the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act, known as the PACT Act, which expanded health care for millions of veterans from any era exposed to toxic hazards.

Introduction
Microwave imaging presents several potential advantages including its non-ionising and harmless nature. This open, multicentric, interventional, prospective, non-randomised trial aims to validate MammoWave’s artificial intelligence (AI)-based classification algorithm, leveraging microwave imaging, to achieve a sensitivity exceeding 75% and a specificity exceeding 90% in breast screening.

Methods and analysis
10 000 volunteers undergoing regular mammographic breast cancer screening will be recruited across 9 European centres and invited to participate in the clinical study, involving MammoWave testing on both breasts. MammoWave results will be checked against the reference standard, to be intended as the output of conventional breast examination path (with histological confirmation of cancer cases) with 2 years follow-up. Anonymised clinical and MammoWave’s results, including microwave images, associated features and a label provided by the AI-based classification algorithm, will be collected and stored in a dedicated electronic case report form. The prospective study will involve a comparative analysis between the output of the conventional breast examination path (control intervention) and the labels provided by MammoWave’s AI system (experimental intervention). These labels will categorise breasts into two groups: breast With Suspicious Finding, indicating the presence of a suspicious lesion or No Suspicious Finding, indicating the absence of a lesion or the presence of a low-suspicion lesion. This trial aims to provide evidence regarding the novel MammoWave’s AI system for detecting breast cancer in asymptomatic populations during screening.

Ethics and dissemination
This study was approved by the Research Ethics Committee of the Liguria Region (CET), Italy (CET-Liguria: 524/2023—DB id 13399), the Research Ethics Committee of Complejo Hospitalario de Toledo (CEIC), Spain (CEIC-1094), the National Ethics Committee for Clinical Research (CEIC), Portugal (CEIC-2311KC814), the Bioethical Committee of Pomeranian Medical University in Szczecin, Poland (KB-006/23/2024) and the Zurich Cantonal Ethics Commission, Switzerland (BASEC 2023-D0101). The findings of this study will be disseminated through academic and scientific conferences as well as peer-reviewed journals.

Trial registration number
NCT06291896.

Objective
The aim of the research was to explore the barriers to healthcare access for persons with various disabilities in rural Luuka district of Uganda. The findings will assist in appreciating the challenges persons with disabilities face in accessing Healthcare in a rural setting. These insights will contribute to the development of an intervention to improve healthcare access that is affordable, timely and acceptable.

Design and participants
This qualitative study formed the exploratory formative phase of the ‘Missing Billion’ project. A total of 27 participants with disabilities—visual impairment (n=5), physical impairment (n=5), multiple impairments (n=6) and intellectual/ cognitive impairment (n=5) were purposively selected to participate in in-depth interviews conducted by two experienced researchers. Participants were identified through contact lists provided by the district disability focal person and local disability associations, with additional participants identified through snowball sampling. Interviews with persons with hearing impairment (n=6) were conducted by a researcher with hearing impairment. The interviews were audio/video recorded and transcribed to facilitate thematic data analysis. We used the disability-inclusive health ‘Missing Billion’ framework to map and inform the barriers.

Setting
The study was conducted between September and November 2022 in rural communities in Luuka district, Eastern Uganda.

Findings
On the demand side, challenges revolved around autonomy and awareness, limited access to health information, lack of financial capacity and dependence on caregivers for healthcare choices left persons with disabilities feeling disempowered. On the supply side, discrimination and negative attitudes from healthcare workers were reported as prevalent. Absence of healthcare workers and service delivery delays impacted on healthcare access, resulting in poor care. Inaccessible healthcare facilities compounded issues, as they had limited accessibility features.

Conclusions
Complex and interconnected barriers underscore the pressing need for systemic changes to ensure equitable healthcare access for persons with disabilities in rural Uganda.

This Viewpoint contraceptive justice after the Dobbs v Jackson Women’s Health Organization US Supreme Court decision, which led to a decline in contraceptive access, especially in states with abortion bans.

New England Journal of Medicine, Ahead of Print.