Risultati per: Approfondimenti sulla terapia domiciliare del COVID‑19

Indicata per la rara sindrome di Wiskott-Aldrich

Background
The COVID-19 pandemic has widened inequities, affecting migrant and refugee populations in vulnerable situations, who may face elevated risks of infection, constrained healthcare access and discrimination. Inclusive vaccination campaigns are recommended, but barriers persist. This study aimed to identify barriers and facilitators and estimate vaccination coverage among refugees and migrants in low- and middle-income countries, emphasising inclusive policies for effective rollout.

Methods
A mixed-method study was conducted in two phases in Ecuador, Nepal, Pakistan, the Philippines and Rwanda. Phase 1 (March–May 2022) included policy analysis, in-depth interviews and focus-group discussions with 52 key informants analysed with thematic and grounded theory approaches using hybrid coding. Phase 2 (June–August 2022) included a cross-sectional study among refugees and migrants in regular (MIRS) and irregular situations (MIIS) and used descriptive analysis and a COVID-19 Vaccine Equity Index (CVEI).

Results
A total of 1378 individuals responded to the survey (43.8% MIRS, 31.2% MIIS and 25% refugees). 87% reported receiving at least one dose of the COVID-19 vaccine. The CVEI at the global level (0.824) suggested differences in complete vaccination between migrants and other residents in most of the study countries (refugees reported more access to vaccines than MIRS and MIIS). However, the qualitative phase reported delays and inequities in the early stage of the vaccination process in all countries. Overall, 64.2% of respondents perceived that government’ campaigns were successful. Both the qualitative and quantitative phases identified several barriers and facilitators. The main barriers included a lack of trust in authorities, extended waiting times and distance to vaccination centres, discrimination and xenophobia, lack of identity documentation, and adverse reaction concerns. On the other hand, the primary facilitators were the widespread distribution of vaccination centres, sources and provision of information, specific campaigns for refugees and migrants, free vaccination and the motivation to protect others’ health.

Conclusions
Despite the high coverage of COVID-19 vaccines among refugees and migrants in the study countries, the process had significant barriers. Simple vaccination registration procedures, targeted campaigns, mobile vaccination teams for hard-to-reach and vulnerable groups, and building trust in the host country authorities are pivotal for future and inclusive vaccine deployments.

Studio longitudinale della Cattolica sui cittadini nel Lodigiano

Il lockdown ha frenato la diffusione del Covid. In risposta in Commissione al senatore Borghi

Stroke, Volume 56, Issue Suppl_1, Page ATP323-ATP323, February 1, 2025. Introduction:Hypertension is one of the leading causes of mortality. The direction and strength of the association between death from hypertensive and hypertensive renal disease and stroke mortality during the COVID-19 pandemic among different U.S. ethnic groups is unclear.Hypothesis:Hypertensive and hypertensive renal disease mortality is positively correlated with increased stroke death overtime during the COVID-19 pandemic. We aim to examine the correlation between mortality from Hypertensive and hypertensive renal disease and stroke before and after the COVID-19 pandemic among U.S. Hispanic and non-Hispanic populations.Methods:A database query from the U.S. Centers Disease for Control and Prevention (CDC) Wonder was retrieved. A yearly age-adjusted mortality from hypertension or hypertensive renal disease from 2017 to 2022 was correlated with the mortality from stroke by Pearson’s correlation coefficient. Further analyses were performed by stratified data before and after 2019 as well as among Hispanic and non-Hispanic subgroups.Results:Age-adjusted mortality from hypertension and hypertensive renal disease trended down before the COVID-19 pandemic (from 9 to 8.91 deaths per 100,000 populations) but trended up after the pandemic (from 10.08 to 10.29 deaths per 100,000 populations). A similar trend occurred in age-adjusted mortality from stroke (from 37.59 to 36.59 deaths per 100,000 populations during pre-pandemic and from 38.84 to 39.53 deaths per 100,000 populations during post-pandemic). Those overall cause-specific mortalities are highly correlated with the correlation coefficient of 0.9697 (Figure 1). The correlation remained but slightly attenuated among Hispanics, while more pronounced among non-Hispanics (0.9649 and 0.9680, respectively; Figures 2 and 3). Stratified by time-related to the COVID-19 pandemic, age-adjusted mortality from hypertension and hypertensive renal disease and stroke trended down before the COVID-19 pandemic but trended up after the pandemic. The correlation was 0.9866 before the pandemic and up to 0.9988 during the pandemic (Figures 1, 2, and 3).Conclusions:Hypertensive and hypertensive renal disease mortality as well as stroke mortality have trended up and increased during the COVID-19 pandemic, particularly among the non-Hispanic population. Further investigations are required to mitigate health and ethnic disparities, especially during high demand for limited resources.

Stroke, Volume 56, Issue Suppl_1, Page ATMP27-ATMP27, February 1, 2025. Background:In 2022, stroke shifted from the fourth to the fifth leading cause of death in the U.S. as COVID-19 temporarily took its place. Despite this change, stroke remains a significant cause of mortality and long-term disability in the U.S. This study analyzes trends in in-hospital mortality among stroke-related hospitalizations in California from 2016 to 2022, with a particular focus on the pandemic years.Methods:This retrospective analysis utilized patient discharge data from the California Department of Health Care Access and Information, screening nearly 25 million inpatient events for stroke-related ICD-10-CM diagnosis codes (I60-I63) among individuals 20 and older. Multivariate logistic regression (MLR) analysis assessed the impact of the pre- and post-COVID-19 periods on in-hospital mortality, adjusting for confounders such as age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).Results:The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). Initially, the age-and-sex-adjusted in-hospital mortality rate decreased from 28.88 per 100,000 in 2016 to 27.38 in 2019. However, with the onset of COVID-19 in 2020, the rate increased to 27.94, peaking in 2021 at 30.78 during the pandemic’s height. In 2022, the rate slightly declined to 28.30 but remained above pre-pandemic levels.Similar trends from 2016 to 2022 were observed in age-adjusted rates for males, which increased from 27.77 to 29.73, and for females, which decreased from 29.91 to 26.98. The gap between male and female mortality rates widened significantly during the pandemic, with male mortality peaking in 2021 with a difference of 3.75.MLR analysis revealed a 22.6% increase in in-hospital mortality during the post-COVID period compared to the pre-COVID period (AOR=1.23, p

Stroke, Volume 56, Issue Suppl_1, Page A19-A19, February 1, 2025. Introduction:Prior studies have shown the association between oral infection, incident stroke and atrial fibrillation (AF) a cause of cardioembolic stroke. However, the impact of preventative oral behavior such as dental flossing on stroke, cardioembolic stroke and AF are unknown. The relationship between flossing incident stroke, stroke subtypes and AF was tested in the Atherosclerosis Risk in Communities (ARIC) cohort study.Methods:In the ARIC study, home use of flossing was assessed through a structured questionnaire in visit 4 along with assessment of covariates including age, gender, race-center, hypertension, diabetes, hyperlipidemia, smoking, body mass index, education-level, regular brushing and regular dental care utilization . Outcomes were compared across index subtypes (infarction: thrombotic, cardioembolic, and lacunar strokes) using Kaplan-Meier analysis and Cox proportional hazards regression, adjusting hazards ratio (HR) for all the above covariates along with 95% confidence interval (CI).Results:In the ARIC study, 6278 dentate participants, without a prior history of stroke and 6108 without prior AF were followed for incident ischemic stroke, stroke subtypes and AF over a 25-year period. Of them 65% (N=4092 in stroke-free cohort and 4050 in AF-free cohort) reported flossing. During the follow-up period,434 were identified as having strokes, of whom 147 thrombotic, 97 cardioembolic and 95 lacunar subtypes. A total of 1291 (20%) participants were noted to have incident AF. The individuals reporting dental flossing had a lower rate of incident ischemic stroke, cardioembolic stroke and AF (Kaplan-Meier curves below). Dental flossing was significantly associated with a lower risk of ischemic stroke (adjusted HR, 0.78; 95% CI, 0.63-0.96), cardioembolic stroke subtype (adjusted HR, 0.56; 95 CI, 0.36-0.87) and AF ( adjusted HR, 0.88; 95% CI, 0.78-1.00), but not thrombotic (adjusted HR, 0.91; 95% CI, 0.63-1.32) or lacunar stroke (adjusted HR 1.09; 95% CI 0.68-1.76).Conclusion:Those reporting dental flossing have a lower risk for incident ischemic stroke, driven by cardioembolic stroke subtype and AF. The associated lower risks are independent of oral care/behavior measures such as regular brushing and regular dental care utilization, suggesting it may be a key behavior modification to emphasize in stroke risk reduction.

Stroke, Volume 56, Issue Suppl_1, Page A162-A162, February 1, 2025. Background:Preceding respiratory tract infections (RTIs) caused by bacteria or viruses are associated with worse stroke outcomes, likely due to an exaggerated inflammatory immune response, endothelial dysfunction, platelet activation, and coagulopathy. Recent studies have revealed increased plasma von Willebrand factor (VWF) levels and reduced ADAMTS13 activity (the risk factors for stroke) in patients with RTIs, including COVID-19. However, it remains unclear whether an imbalance in the VWF–ADAMTS13 axis plays a causative role in the pathophysiology ofS. aureus- or COVID-19-associated stroke severity or is merely an associative marker of disease status.Objective:To examine whether an imbalance in the VWF–ADAMTS13 axis is a causal link between RTIs and stroke severity.Methods:Wild-type (WT) mice (3–4 months old) were infected intranasally with sublethal doses ofS. aureus(on days 0, 2, and 5) or mouse-adapted SARS-CoV-2 (on day 0). On day 6 (S. aureus) or day 3 (SARS-CoV-2), the infection was confirmed to be localized in the lungs (but not in the brain) and the plasma VWF levels and ADTMTS13 activity were quantified. In another set of experiments, WT,Vwf−/−, andAdamts13−/−mice (3–4 months old) with respective littermate controls were subjected to transient (30 or 45 min) cerebral ischemia (filament stroke model) followed by reperfusion. For theS. aureusexperiments, brain infarcts were assessed on day 2 post-reperfusion and functional outcomes (corner test, wire hanging test, modified neurological severity score, and rotarod test) on week 1 and 4 post-reperfusion. For the SARS-CoV-2 experiments, brain infarcts and functional outcomes (the Bederson score) were assessed on day 1 post-reperfusion.Result:We demonstrated thatS. aureusor SARS-CoV-2 infection localized to the lungs in the WT mice resulted in increased (2–3 fold) plasma VWF levels and reduced ADAMTS13 activity, concomitant with larger infarcts and worse functional outcomes (P

Stroke, Volume 56, Issue Suppl_1, Page AWMP76-AWMP76, February 1, 2025. Importance:The COVID-19 pandemic significantly disrupted healthcare systems worldwide, impacting the management of acute ischemic stroke (AIS). Understanding changes in AIS admissions, treatment patterns&outcomes during the pandemic is essential for optimizing stroke care in future public health crises.Objective:To evaluate the impact of the COVID-19 pandemic on AIS admissions, treatment utilization, complications&outcomes in the U.S. from 2016 to 2021, focusing on the pre-pandemic (2016-2019)&peri-pandemic (2020-2021) periods.Methods:A retrospective observational cohort study utilizing the National Inpatient Sample (NIS) nationwide database, analyzing weighted hospital discharge records over 6 years, encompassing urban, rural, teaching &non-teaching hospitals.Participants were AIS patients aged 18 years&older (n=3,154,154), identified using ICD-10 codes. Sociodemographic characteristics such as age, sex, race&comorbidities were evaluated. The mean patient age was 70.0 ± 0.03 years, with an average length of stay of 5.1 ± 0.01 days&an adjusted mean cost of $16,765 ± 71. Men accounted for 50.5% of the cohort. AIS hospitalizations from 2016 to 2021 were collected, comparing pre-&peri-pandemic periods. Primary outcomes included AIS admission trends, while secondary outcomes included reperfusion therapy utilization, intubation&ventilation rates, discharge disposition&complications.Results:AIS admissions increased from 507,920 in 2016 to 535,694 in 2021. A demographic shift was observed, with the proportion of male patients rising from 49.8% to 51.4%&the mean age decreasing from 70.3 to 69.7 years (p < 0.0001). Most patients were White (69.5% in 2016), but their proportion decreased over time, while Black, Hispanic&Asian/Pacific Islander cases increased (p 0.5734). Reperfusion therapy usage increased, with mechanical thrombectomy (MT) rising from 2.2% to 5.6% in 6 years. Intubation/ventilation rates grew from 4.8% pre-COVID to 5.5% peri-COVID (p < 0.0001). Subarachnoid&intracerebral hemorrhage rates had increased throughout the 6 years in the group with MT-only intervention (p .011&.002, respectively).Conclusions:The COVID-19 pandemic led to significant shifts in AIS hospitalization patterns, including changes in age distribution, increased reperfusion therapy use&rising complications. These findings highlight the need for adaptive public health strategies&resource allocation to maintain stroke care during future crises.

Stroke, Volume 56, Issue Suppl_1, Page A137-A137, February 1, 2025. Introduction:Stroke is the fifth leading cause of death and long-term disability in the United States with an estimated prevalence of 7 million individuals affected as of 2019. Protocols for stroke management established by the American Heart Association (AHA) and American Stroke Association (ASA) include a 25-minute timeframe from door to CT time (DTCT). Adapting to challenges during the COVID-19 pandemic likely increased the DTCT in acute stroke patients from various sociodemographic backgrounds.Methods:We aimed to identify factors affecting the DTCT time for a cohort of over 23,000 patients between January 2018 and August 2022. The primary endpoint was DTCT ≤25 minutes upon arrival to hospital for all patients suspected of acute ischemic stroke. Race and ethnicity were self-reported.Results:We have identified patient race and post-COVID timing of care as two factors with statistically significant effects on DTCT time. 4,468 patients (19.1%) had DTCT times less than or equals to 25 minutes, and 16,464 patients (70.5%) had DTCT times more than 25 minutes. Patients in the pre-COVID, COVID, and post-COVID phases were 6,852 (29.3%), 13,593 (58.2%) and 2,919 (12.5%), respectively. In our cohort, Black (OR 1.35; 95% CI 1.23-1.49) and Asian patients (OR 1.33; 95% CI 1.01-1.74) were more likely to have DTCT >25 minutes compared to White patients. Hispanic patients (OR 1.20; 95% C1 1.07-1.34) were more likely to have DTCT >25 minutes compared to non-Hispanics. Patients presenting during COVID (OR 1.45; 95% CI 1.34-1.57) and post-COVID period (OR 1.46; 95% CI 1.30-1.65) were more likely to have DTCT >25 minutes compared to the pre-COVID period.Conclusion:Therefore, we demonstrated a discrepancy in DTCT time for acute ischemic stroke patients based on their race and ethnic population. We also observed an increase in DTCT time after the start of COVID-19 which has persisted after the pandemic. These diverse factors highlight the complex interplay of logistical, organizational, and healthcare challenges that have influenced DTCT time. Identifying disparities can help address inequities and ensure that all patients, regardless of background, receive timely care.

Stroke, Volume 56, Issue Suppl_1, Page ATP291-ATP291, February 1, 2025. Introduction:In patients with severe COVID-19 infection there is an increased risk of cerebrovascular events, including acute ischemic stroke (AIS). In patients who present with COVID-19 infection and AIS, certain stroke subtypes have been reported with greater frequency. The objective of this study was to determine differences in patient demographics and stroke sub-type by COVID status at a US comprehensive stroke center.Methods:We retrospectively evaluated adults (≥18) with AIS admitted during the first year of the COVID pandemic (3/1/2020 – 3/1/2021). Demographics (age, sex, race, comorbidities with ≥5% incidence), stroke subtype (TOAST classification), severity (NIHSS), management (intravenous and intraarterial therapy [IVT and IAT]), and outcomes (in-hospital mortality and discharge modified Rankin scale [mRS]) were compared for patients who were COVID+ vs COVID– using Pearson chi-square tests.Results:Among 1,086 AIS patients, 475 (44%) were evaluated for COVID-19 infection during their inpatient stay. Most patients (94%) had PCR testing. Thirty-five (7%) patients were COVID+ and 441 (93%) were COVID–. There were significant differences in study covariates by COVID status, table 1. COVID+ patients had a greater proportion of cryptogenic strokes (62% vs. 32%, p

Stroke, Volume 56, Issue Suppl_1, Page AWP209-AWP209, February 1, 2025. Background:COVID-19, primarily a respiratory illness caused by SARS-CoV-2, is associated with vascular complications like ischemia due to endothelial injury, hypercoagulability, and inflammation. This study examines how COVID-19 affects functional outcomes of ischemic stroke patients.Methods:Ischemic stroke patients admitted to our Joint Commission-certified primary stroke center were retrospectively analyzed from March 1, 2020, to March 1, 2022. A subgroup analysis was conducted for patients during the vaccination period (April 14, 2021, to March 1, 2022). Patients were included if they were ≥18 years old and had a stroke on admission or during hospitalization. Univariate and multivariable analyses were used, with a significance threshold of p

Stroke, Volume 56, Issue Suppl_1, Page AWP268-AWP268, February 1, 2025. Introduction:The overall composition of stroke subtype is typically stable within biogeographical groups. Whether the COVID-19 pandemic impacted stroke etiology is still being investigated, but most studies have been performed outside the United States. This study sought to determine the composition of acute ischemic strokes (AIS) before and during the pandemic.Methods:This retrospective cohort study was conducted at a comprehensive stroke center in Colorado (USA). Adults (≥18) with AIS were compared based on admission date: Pre-COVID period (1/1/2019 – 12/31/2019) vs. COVID period (3/1/2020 – 3/1/2021). Stroke subtype was examined using TOAST classification: 1) large artery atherosclerosis; 2) cardioembolic; 3) small vessel occlusion; 4) other known etiology (e.g., hematologic disorders or arterial dissection); 5) cryptogenic stroke. Comparisons were made with Pearson chi-square tests.Results:There were 2,130 patients with AIS during the study period: Pre-COVID (n=1,034) and COVID (n=1,096). There were significant differences in stroke subtype by time period (Table 1). Compared to the pre-COVID period, the COVID period had a lower proportion of strokes from large artery atherosclerosis (17.6% vs. 12.1%, p

Stroke, Volume 56, Issue Suppl_1, Page AWP288-AWP288, February 1, 2025. Background:The COVID-19 pandemic disrupted healthcare systems and altered patient behaviors, potentially affecting stroke prevalence and outcomes. This study examines trends in stroke-related hospitalizations by age and sex in California from 2016 to 2022, focusing on the pandemic years (2020-2022).Methods:A retrospective analysis of patient discharge data from the California Department of Health Care Access and Information was conducted, screening nearly 25 million inpatient events for stroke-related ICD-10-CM codes (I60-I63) among individuals aged 20 and older. Age-and-sex-standardized hospitalization rates per 100,000 population were calculated. Multivariate logistic regression (MLR) assessed the impact of pre- and post-COVID-19 periods on stroke-related admissions, adjusting for age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).Results:The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). From 2016 to 2019, stroke-related hospitalization rates were stable (257.7 to 259.2 per 100,000). A significant decrease to 242.6 occurred in 2020, followed by an increase to 253.7 in 2021, coinciding with peak COVID-19 cases. By 2022, the rate slightly declined to 251.0, indicating stabilization but not a return to pre-pandemic levels. While the overall trend from 2016 to 2022 was not statistically significant (p=0.400), fluctuations reflect the pandemic’s impact, particularly in 2021.Age and gender analyses showed distinct trends. The age-adjusted rate for males remained stable (p=0.774), while females faced a notable decrease (p=0.018). Among those aged 20-44, stroke-related hospitalizations increased by 19% (RR=1.19, p

Background
This qualitative evaluation was embedded in the Rehabilitation Exercise and psycholoGical support After COVID-19 InfectioN (REGAIN) study, a randomised controlled trial (RCT) for those with post-COVID-19 condition (‘long COVID’) after hospital admission for COVID-19, comparing weekly home-based, live online supervised group exercise and psychological support sessions with ‘best practice usual care’ (a single session of advice).

Objective
To increase our understanding of how and why the REGAIN programme might have worked and what helped or hindered this intervention.

Design
A qualitative evaluation which utilised interviews with participants and practitioners delivering the intervention. Framework and thematic analysis were used to analyse the findings.

Setting
England and Wales, UK.

Participants
Adults discharged from National Health Service (NHS) hospitals at least 3 months previously after COVID-19, with ongoing physical and/or mental health sequelae.

Results
Twenty intervention participants, 20 control participants and five practitioners were interviewed.
The themes from the group support sessions were: (1) you are not alone; (2) sharing experiences and addressing worries; (3) gaining new perspectives; (4) hope for progression; (5) peer support and bonding; (6) integration of facilitation skills; (7) modified activity pacing and goal setting, and (8) giving participants structure. The themes from group exercise were: (1) monitoring and modification of the online exercise; (2) catering for differing abilities; (3) feeling safe and confident to exercise; (4) progression of fitness; (5) optimal timing in the recovery trajectory; (6) group effect; (7) initial apprehension about exercise group; (8) gauging exercise capabilities; (9) translating exercises into life; and (10) on-demand supplementary videos. The 1:1 consultation sessions revealed patients needed to tell their stories.

Conclusion
Being listened to and being understood by someone ‘who got it’ was very important to people with post-COVID-19 condition. The group sessions of both exercise and psychological support were valued by participants, working together, and learning from each other in the face of a new disease within a global pandemic.

Objectives
During the COVID-19 pandemic, designated rehabilitation centres were established in the province of Québec, where strict sociosanitary measures such as isolation and mandatory personal protection equipment requirements were followed. This study aimed to describe the impact of the pandemic on rehabilitation care indicators for poststroke users with (COV+) and without (COV–) COVID-19 infection in designated rehabilitation centres compared with those admitted in the previous year (pre-COV).

Method
A retrospective analysis of 292 medical files was performed in 3 rehabilitation centres. Demographic characteristics were collected, as well as indicators routinely collected in acute care and rehabilitation such as length of stay (LOS), the Functional Independence Measure and a number of physical/occupational therapy (PT/OT) sessions. Non-parametric statistical tests were used to compare variables among the three groups.

Results
COV+ users were older than COV– and pre-COV ones (p