Stroke epidemiology and COVID-19 pandemic

PURPOSE OF REVIEW: The aim of this study was to describe the impact of the COVID-19 outbreak on the epidemiology, cause and clinical characteristics of incident stroke in different settings and populations. RECENT FINDINGS: Several studies have shown that there are three main themes in the epidemiology of stroke during the COVID-19 pandemic: COVID-19 seems to be associated with stroke in a significant number of patients. This association has been reported in several clinical series, mainly from China. There is a consistent trend towards a decreased number of hospital admissions of stroke patients during the pandemic. There are no population-based data available on incident stroke in individuals with COVID-19. SUMMARY: In this review, we report on increased rates and severe prognosis of ischemic stroke among individuals with COVID-19, probably explained by hypercoagulability and inflammation, documented since the early phase of disease.We confirm the presence of falling rates of new ischemic stroke admissions in hospitals, probably due to social consequences of the pandemic: fear to be infected or not adequately treated in the hospital. This phenomenon is restricted to mild stroke and transient ischemic attacks.Short and long-term consequences of this trend of new strokes in the pandemic need to be evaluated

Coefficient of thermal expansion of nanostructured tungsten based coatings assessed by thermally induced substrate curvature method

The in plane coefficient of thermal expansion (CTE) and the residual stress of nanostructured W based coatings are extensively investigated. The CTE and the residual stresses are derived by means of an optimized ad-hoc developed experimental setup based on the detection of the substrate curvature by a laser system. The nanostructured coatings are deposited by Pulsed Laser Deposition. Thanks to its versatility, nanocrystalline W metallic coatings, ultra-nano-crystalline pure W and W-Tantalum coatings and amorphous-like W coatings are obtained. The correlation between the nanostructure, the residual stress and the CTE of the coatings are thus elucidated. We find that all the samples show a compressive state of stress that decreases as the structure goes from columnar nanocrystalline to amorphous-like. The CTE of all the coatings is higher than the one of the corresponding bulk W form. In particular, as the grain size shrinks, the CTE increases from 5.1 10$^{-6}$ K$^{-1}$ for nanocrystalline W to 6.6 10$^{-6}$ K$^{-1}$ in the ultra-nano-crystalline region. When dealing with amorphous W, the further increase of the CTE is attributed to a higher porosity degree of the samples. The CTE trend is also investigated as function of materials stiffness. In this case, as W coatings become softer, the easier they thermally expand.Comment: The research leading to these results has also received funding from the European Research Council Consolidator Grant ENSURE (ERC-2014-CoG No. 647554

Thermomechanical properties of amorphous metallic tungsten-oxygen and tungsten-oxide coatings

In this work, we investigate the correlation between morphology, composition, and the mechanical properties of metallic amorphous tungsten-oxygen and amorphous tungsten-oxide films deposited by Pulsed Laser Deposition. This correlation is investigated by the combined use of Brillouin Spectroscopy and the substrate curvature method. The stiffness of the films is strongly affected by both the oxygen content and the mass density. The elastic moduli show a decreasing trend as the mass density decreases and the oxygen-tungsten ratio increases. A plateaux region is detected in correspondence of the transition between metallic and oxide films. The compressive residual stresses, moderate stiffness and high local ductility that characterize compact amorphous tungsten-oxide films make them promising for applications involving thermal or mechanical loads. The coefficient of thermal expansion is quite high (i.e. 8.9 $\cdot$ 10$^{-6}$ K$^{-1}$), being strictly correlated to the amorphous structure and stoichiometry of the films. Under thermal treatments they show a quite low relaxation temperature (i.e. 450 K). They crystallize into the $\gamma$ monoclinic phase of WO$_3$ starting from 670 K, inducing an increase by about 70\% of material stiffness.Comment: The research leading to these results has also received funding from the European Research Council Consolidator Grant ENSURE (ERC-2014-CoG No. 647554). The views and opinions expressed herein do not necessarily reflect those of the European Commissio

Prevalence, Characteristics, and Patterns of Health Care Use for Chronic Headache in Two Areas of Italy. Results of A Questionnaire Interview in General Practice

We set out to define the prevalence, clinical features and severity of chronic headache among the affiliates of two groups of general practitioners (GPs) and to illustrate the diagnostic and therapeutic modalities employed. A semistructured questionnaire was completed for 2291 children and adults, seen at office or home consultations over a 6-month period by 44 GPs in two areas of Northern Italy (Varese and Sondrio) and Southern Italy (San Giovanni Rotondo), to assess the presence and the clinical features of chronic headache, the severity of the disease (i.e. the degree of interference with work and daily living activities), the diagnostic work-up, and the main treatment modalities. GPs attempted the classification of headache according to the International Headache Society (IHS) criteria. The sample comprised 910 men and 1381 women aged 2-92 years; 39% of cases reported chronic headache (Varese/Sondrio 40%; San Giovanni Rotondo 38%; men 28%; women 47%). Headache was mostly present for >10 years, with one to three attacks/month lasting 4-24 h. Headache was mild in 18% of cases, moderate in 29%, severe in 24%, and very severe in 29%. Diagnostic assessment and treatment varied in the study areas. Diagnostic work-up, hospital admissions, referral to headache centres, and treatment modalities tended to be correlated with headache severity. The GPs could not classify headache using the IHS categories in 27% of cases (Varese/Sondrio 11%; San Giovanni Rotondo 78%). An inverse correlation was found between case classification and use of subsidiary diagnostic and therapeutic aids. Chronic headache is common among individuals seen in general practice. The patterns of health care use tend to be correlated to its severity. A better knowledge of the IHS criteria may be directly related to lower management costs

The ILAE classification of seizures and epilepsies: implications for the clinic

INTRODUCTION: The classification of epileptic seizures and the epilepsies has recently been revised by the International League Against Epilepsy (ILAE) and a new classification scheme issued. Areas covered: The new classification scheme has been critically appraised in the light of the previous classifications and subsequent revisions. The purposes of the classification and its potential use have been extensively discussed. Expert Commentary: This ILAE classification scheme, the latest of a series of proposals published in the last thirty years, has made progress as it has a multi-level structure (seizure types, epilepsy types, epilepsy syndromes) allowing for differing uses and combines the previously separate seizure types and epilepsies schemes into a single instrument. Seizures and epilepsies can also be classified based on the available diagnostic aids, which may differ substantially between counties with mature economies and resource-poor countries. An intrinsic limitation of the classification, however, is the attempt to box cases as seen in clinical practice into schematic categories, leaving no room for variants and atypical clinical presentations. Another limitation is the lack of flexibility which hampers the ability to link the instrument to the preceding classifications in order to preserve continuity and monitor disease trends in time and space

Risk of Guillain-Barré syndrome after 2010–2011 influenza vaccination

Influenza vaccination has been implicated in Guillain Barré Syndrome (GBS) although the evidence for this link is controversial. A case–control study was conducted between October 2010 and May 2011 in seven Italian Regions to explore the relation between influenza vaccination and GBS. The study included 176 GBS incident cases aged ≥18 years from 86 neurological centers. Controls were selected among patients admitted for acute conditions to the Emergency Department of the same hospital as cases. Each control was matched to a case by sex, age, Region and admission date. Two different analyses were conducted: a matched case–control analysis and a self-controlled case series analysis (SCCS). Case–control analysis included 140 cases matched to 308 controls. The adjusted matched odds ratio (OR) for GBS occurrence within 6 weeks after influenza vaccination was 3.8 (95 % CI: 1.3, 10.5). A much stronger association with gastrointestinal infections (OR = 23.8; 95 % CI 7.3, 77.6) and influenza-like illness or upper respiratory tract infections (OR = 11.5; 95 % CI 5.6, 23.5) was highlighted. The SCCS analysis included all 176 GBS cases. Influenza vaccination was associated with GBS, with a relative risk of 2.1 (95 % CI 1.1, 3.9). According to these results the attributable risk in adults ranges from two to five GBS cases per 1,000,000 vaccinations

Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from the AUSL Romagna, Italy

Objectives: An observation of the admissions to the emergency room (ER) requiring psychiatric evaluation during the lockdown and investigation of the demographic and clinical variables. Methods: Retrospective longitudinal observational study of ER accesses for psychiatric evaluation was performed, comparing two periods (9 March–3 May 2020 vs. 9 March–3 May 2019). Data (number of admissions, key baseline demographic and clinical variables) were extracted from the ER databases of referral centres in a well-defined geographic area of North-Eastern Italy (Cesena, Ravenna, Forlì, and Rimini). Results: A 15% reduction of psychiatric referrals was observed, together with a 17% reduction in the total number of patients referring to the ER. This reduction was most evident in the first month of the lockdown period (almost 25% reduction of both referrals and patients). Female gender (OR: 1.52: 95%, CI: 1.12–2.06) and being a local resident (OR: 1.54: 95%CI: 1.02–2.34) were factors associated with the decrease. Conclusions: Lockdown changed dramatically health priorities in the local population, including people with mental health. We speculate that our observations do not only refer to the confinement due to the lockdown regime but also to fear of contagion and adoption of different coping strategies, especially in women.Key-points During lockdown 15% reduction of psychiatric visits and >17% reduction in the number of psychiatric patients referring to the ER was observed. in the first four weeks of the lockdown almost 25% reduction of both visits and patients was observed Female gender and being a local resident were factors associated with the decrease

The impact of COVID-19 quarantine on mental health: an observational study from an outpatient service for non-psychotic patients in Russia (Moscow)

We aimed to compare psychiatric hospital visits during the COVID-19 quarantine period with the same period in 2019, to reveal the predictors of underutilization of mental health services. We then investigated the fluctuation of telemedicine service during the quarantine period. The retrospective study included patients with non-psychotic mental disorders who consecutively visited the Moscow clinic. The number of outpatient visits, inpatient admissions, sociodemographic factors were analyzed. We assessed the sample within two periods -the "quarantine period" (March 30 -June 9, 2020) and "control period" (March 30 -June 9, 2019). Psychiatric visits decreased in older, retired and disabled persons, and increased among the unemployed. In multivariate analysis, the reduction became significant for the number of inpatient admissions. Telemedicine calls gradually increased from the start of the service, but decreased towards the end of the quarantine. In conclusion, referrals to outpatient and inpatient psychiatric services decreased during the quarantine period, with newly established TMS potentially compensating for that decrease. The strongest factor associated with visits during the pandemic is employment status

Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study

BACKGROUND AND PURPOSE: Seizures in most people with epilepsy remit but prognostic markers are poorly understood. There is also little information on the long-term outcome of people who fail to achieve seizure control despite the use of two antiepileptic drugs (drug resistance). METHODS: People with a validated diagnosis of epilepsy in whom two antiepileptic drugs had failed were identified from primary care records. All were registered with one of 123 family physicians in an area of northern Italy. Remission (uninterrupted seizure freedom lasting 2 years or longer) and prognostic patterns (early remission, late remission, remission followed by relapse, no remission) were determined. RESULTS: In all, 747 individuals (381 men), aged 11 months to 94 years, were followed for 11 045.5 person-years. 428 (59%) were seizure-free. The probability of achieving 2-year remission was 18% at treatment start, 34% at 2 years, 45% at 5, 52% at 10 and 67% at 20 years (terminal remission, 60%). Epilepsy syndrome and drug resistance were the only independent predictors of 2- and 5-year remission. Early remission was seen in 101 people (19%), late remission in 175 (33%), remission followed by relapse in 85 (16%) and no remission in 166 (32%). Treatment response was the only variable associated with differing prognostic patterns. CONCLUSION: The long-term prognosis of epilepsy is favourable in most cases. Early seizure remission is not invariably followed by terminal remission and seizure outcome varies according to well-defined patterns. Prolonged seizure remission and prognostic patterns can be predicted by broad syndromic categories and the failure of two antiepileptic drugs