Risultati per: Nota 79

Stroke, Volume 56, Issue Suppl_1, Page A79-A79, February 1, 2025. Introduction:During imaging follow-up of unruptured intracranial aneurysms (IA), changes in cerebrovascular (CV) anatomy are commonly found. While the focus is on the IA site, clinical images capture evidence of vascular remodeling and longitudinal change in the Circle of Willis. This study hypothesizes an association between IA and broader CV changes. This study developed a CV longitudinal atlas (CV shape vs. age) to determine a shared trajectory of CV morphological change in IA patients and identified clinical risk factors associated with IA which affected this trajectory.Methods:A total of 405 longitudinal standard clinical magnetic resonance angiography (MRA) image studies were included in the study. On the average there were 3.68 ± 1.34 MRA studies for each IA patient, with follow-up time ranging from 2.5 to 14 years. The Deformetrica was used to analyze the shape changes in the DICOM images. Specifically, a machine learning diffeomorphic analysis of arterial shape with age was performed. A hybrid geodesic regression/Bayesian atlas 4D longitudinal atlas model that inferred the average trajectory of arterial change from patients with overlapping ages of follow-up was created. Parameters mapping individual IA patients to the average trajectory were then analyzed based on patient characteristics.Results:The general longitudinal atlas trajectory consisted of longer cerebral arteries as patient age increased. The Kruskal-Wallis test associated several factors related to IA patient medical histories with this pattern of change. Specifically, diabetes mellitus (p=0.016) and no previous subarachnoid hemorrhage (p=0.023) were associated with a faster median rate of CV change (1.5-fold and 2.7-fold, respectively). Hypertension (p=0.0004), atherosclerosis (p=0.001), and ICA IA (p=0.013) were associated with CV morphology more advanced along the CV-age trajectory.Conclusion:We developed the first longitudinal atlas model of CV morphological change over time. We used this new technique to investigate the association of IA location and related risk factors with the trajectory of CV change. We identified characteristics that affected the speed and degree of CV change in individual patients. Risk factors like diabetes and hypertension impact a variety of vascular diseases, and our findings indicate IA patients with these factors may have broad CV change and may benefit from review of the Circle of Willis, in addition to the IA site during MRA follow-up.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Operazione contro il crimine farmaceutico, 5 arresti

Stroke, Volume 55, Issue Suppl_1, Page A79-A79, February 1, 2024. Background:Stroke outcomes may be changing over time with improved acute stroke therapy, secondary prevention, and post-acute care. At the same time, stroke mortality has declined suggesting more people are living with stroke disability. No US population-based data exists on trends in outcomes. The objective was to investigate trends and ethnic differences in 90-day stroke outcomes in a population-based study.Methods:First-ever ischemic strokes in the population-based Brain Attack Surveillance in Corpus Christi Project (2009-2020, n=1,449) were included. 90-day outcomes included function (activities of daily living (ADL)/instrumental ADL), cognition (modified mini-mental state exam), NIHSS, and quality of life (Stroke-Specific Quality of Life (SS-QoL)). Linear regression with multiple imputation and inverse probability weighting was used to model adjusted associations between time, ethnicity, the interaction of time and ethnicity and outcomes.Results:Median age was 66; 61% Mexican American (MA). Trends in 90-day function overtime were roughly quadratic (Figure) and the change in the ethnic difference was significant among reference groups (p-value&lt0.01). Trends in NIHSS were linear with no change in the ethnic difference (p-value=0.51). Trends in cognition were approximately cubic and the change in the ethnic difference was significant within reference groups (p-value=0.03). Trends in QOL were stable with no change in the ethnic difference.Conclusion:Recent improvements in 90-day post-stroke functional and cognitive outcomes in MAs have resulted in reduced disparities. Factors contributing to favorable trends in outcomes in this group should be further studied.

Stroke, Volume 55, Issue Suppl_1, Page ATP179-ATP179, February 1, 2024. Background:RCVS is characterized by severe thunderclap headaches often triggered by medications or sexual activity. Convexity subarachnoid hemorrhage, and less commonly, ischemic stroke and intracerebral hemorrhage can occur. There are few studies of the clinical-imaging features of RCVS (Singhal, 2011; Ducros, 2007). The pathogenesis is yet to be understood, and further studies looking into various triggers and outcomes, such as our present one, is essential to characterize the condition and develop targeted treatments.Methods:We performed an EMR search (2012-2023) for patients over 18Y of age with a diagnosis of RCVS in inpatient and outpatient settings. We retrospectively analyzed clinical (demographics, triggers, and discharge mRS)) and imaging features (CTA, MRA, DSA, and transcranial doppler (TCD)) to confirm RCVS diagnosis. RCVS score was calculated. Discharge mRS was inferred from EMR. Diagnosis adjudication was performed by RSM. Student t-test and Chi-square test were used to analyze outcomes.Results:Seventy-nine patients were identified (mean age 40±11.5Y, 91% women). The most common triggers were medications (39%), sexual activity (11.4%), and marijuana use (5%). One-third (35%) had chronic headache history (migraines 22%). Twenty-nine (37%) were postpartum (n=19) or pregnant (n=10). Fourteen had concurrent pre-eclampsia (17%). Twelve (15%) also had imaging features of posterior reversible encephalopathy syndrome (PRES). Vasoconstriction was seen on DSA (n=15), CTA (n=25), and MRA (n=23); In 14 patients, vasoconstriction was evident only on TCD. SAH occurred in 26 (33%), ischemic stroke in 8, and ICH in 9. Median RCVS score was 7 (IQR 6-9, range 4-10). CSF profile (n=19) was normal, aside from mildly elevated lymphocyte count (n=2, range 10-13 cells) or protein (n=5, range 50-80 mg/dL). Discharge mRS was 0-1 in 83%. Patients without RCVS trigger (n= 40) had higher ischemic stroke or hemorrhage occurrence (χ2= 3.8,P=0.05). RCVS scores in pregnant/postpartum patients were similar to others (t= 2.01,P= 0.06).Conclusion:In this case series, absence of an RCVS trigger was associated with occurrence of stroke or hemorrhage. Most patients had favorable prognosis. These findings need to be confirmed in prospective studies.

New England Journal of Medicine, Volume 389, Issue 15, Page 1416-1423, October 2023.

A partire dal 27 giugno 2023 è disponibile un aggiornamento dei documenti allegati alla Nota 100 (schede di prescrizione ed elenco dei farmaci)

L’Agenzia Italiana del Farmaco ha aggiornato la Nota 96 (determina AIFA n. 48/2023 pubblicata nella Gazzetta Ufficiale n. 43 del 20 febbraio 2023) sui criteri di appropriatezza prescrittiva della supplementazione con vitamina D e suoi analoghi (colecalciferolo, calcifediolo) per la prevenzione e il trattamento degli stati di carenza nell’adulto

Stroke, Volume 54, Issue Suppl_1, Page A79-A79, February 1, 2023. Background:Telestroke has been increasingly adopted by hospitals with limited access to neurological expertise and is often followed by transfer for a higher level of care. We sought to characterize factors independently associated with patient transfers after telestroke consultation in our regional telestroke network.Methods:We studied all telestroke consults from our urban comprehensive stroke center from 1/1/2005 to 06/30/2022 using the records in our telehealth portal. We examined the annual proportion of transfers among all consults overall and stratified by 6 levels of NIHSS severity and 4 levels of spoke hospital rurality. We used generalized linear mixed models to evaluate the association between transfer and patient demographics, hospital characteristics, use of video and care quality metrics (timeliness and tPA use), accounting for clustering by spoke hospital.Results:We identified 20,618 consecutive telestroke consults, of which 5,276 (25.6%) were transferred (602 cases excluded with unknown transfer status). The proportion of transfers decreased significantly over the study period (Figure). Decreases were observed for all rurality strata and all but the most severe strokes. After adjusting for temporal trends, factors independently associated with transfer included younger age, male gender, more severe stroke, and tPA use (Table).Conclusion:In our regional telestroke network, the proportion of transfers decreased substantially from 2005 to 2022 overall and across almost all patient and hospital groups. Telestroke may facilitate capacity management and retaining care in lower cost community settings, which may increase healthcare value.

L’introduzione della Nota 100 da parte dell’Agenzia italiana del farmaco ha riconfigurato le modalità di prescrizione di alcune classi di farmaci per il trattamento del diabete mellito di tipo 2, che possono essere prescritti anche dal medico di famiglia