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

The Reconstructed Cohort Design: A Method to Study Rare Neurodegenerative Diseases in Population-Based Settings

Rare neurodegenerative diseases are characterized by high heterogeneity and high clinical complexity, as well as low incidence and prevalence, thus making tracking small numbers of incident cases in the general population very challenging. Since it is not possible to use classical cohort studies to estimate the incidence of these rare diseases, we can "reconstruct" a theoretical cohort using case information from a well-defined geographic region collected through a surveillance system. The incidence rate is estimated as the ratio between the number of individuals at risk who were diagnosed with the disease of interest during the study period and the estimated overall amount of time individuals in the reference population spent at risk during the study period. If a series of assumptions are met, the approximate incidence proportion of a closed theoretical cohort without competing events and with the same follow-up duration can be calculated by multiplying the incidence rate with the length of the study time. This rationale relies on the presence of an effective referral system, which links all levels of the healthcare system together in the region, from general practitioners to specialized clinical centers. The reconstructed cohort design is a valid and cost-effective method to collect data on the incidence of rare neurodegenerative diseases and represents the theoretical framework for building up population-based registries

Le ordinanze sui conflitti contro le consultazioni elettoral-referendarie del 2020: una risposta a mosaico con tessere diverse?

The Constitutional Court has declared inadmissible all the actions for separation of powers proposed to block the carrying out of the constitutional referendum and to dispute the requirements to participate in the regional elections, then held last September. Here the four ordersare analysed from the judicial technique point of view. There emerges a significant lack of uniformity. More precisely, two of these ruling shave defects to the fundamental standardof the so-called dual consistency of constitutional justice,systemized by Antonio Ruggeri. The undoubted need for speed in adopting the decision does not appear to constitute sufficient justification.La Corte ha dichiarato inammissibili tutti i ricorsi per conflitto di attribuzione proposti per bloccare lo svolgimento del referendum costituzionale e contestare i requisiti per la partecipazione alle elezioni regionali poi celebrati lo scorso settembre. Sono qui analizzate le quattro relative ordinanze per il profilo della tecnica processuale. Emergono significative disomogeneità. Più precisamente, due di esse presentano difetti quanto al fondamentale canone della c.d. doppia coerenza della giurisprudenza costituzionale, sistematizzato da Antonio Ruggeri. L'indubbia esigenza di celerità nell'assunzione della decisione non pare poter costituire sufficiente giustificazione

A Cidadania Européia entre Categorias Tradicionais e a Pós-Modernidade

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LATE LIFE DEPRESSION AND LATE ONSET DEPRESSION: ARE THE SAME CLINICAL AND PATHOPSYSIOLOGICAL PICTURE?

Phenomenological differences between older patients with late- and early-onset depression may reflect differences in aetiology and neuropathological processes involved in these two types of depression. Early- onset depression has been mainly correlated to a family history of depression while late-onset depression has been principally correlated to vascular dysfunction. The same cortical and sub-cortical areas are involved in both types of depression. However, lesions in these brain areas and cognitive impairment are most pronounced in late-onset depression. Based on these observations we propose a common neuroanatomical substrate but different pathophysiological processes implicated in these two types of depression

COMPLESSITÀ DEL GOVERNARE, QUALITÀ DEI POLITICI E RUOLO DEI PARTITI. NOTE IN TEMPO DI PANDEMIA

The complexity of the art government is made more evident than ever by the pandemic. Even in politics, technique is indispensable. The responsibility for selecting high quality politicians lies with the parties, but experience shows that they don't do it. Wrong choices – not measured in terms of skills and competences in government – are among the main causes of the political system’s delegitimization. A law on parties could be one of the right ways to respond

Blockchain-Based Innovations for Population-Based Registries for Rare Neurodegenerative Diseases

Rare diseases are difficult if not impossible to study outside of population-based registries. Particularly in the context of rare neurodegenerative diseases characterized by case heterogeneity, difficult differential diagnosis by specialists, and small numbers of patients, registries make otherwise unfeasible incidence studies cost-effective and manageable. Building up and maintaining such registries is challenging and requires strong, active, and collaborative networks. Centralization around a leading institution provides structure and consistency, but this single-site storage leads to inefficiency and bottlenecks and is prone to failures, attacks, and manipulation. Furthermore, a substantial amount of trust is required between parties sharing data in a traditional registry. Patients are increasingly reluctant to share data in light of regular news reports about healthcare data breaches. Underfunded rare disease specialized centers are also hesitant to exchange with the leading institution out of fear that the low numbers of patients may seek treatment elsewhere. A lack of electronic health records and information system interoperability in certain settings leads to information silos and only further exacerbate the other issues. Blockchain technology may provide unique, innovative solutions to many of these challenges. Specifically, through digital trust and the use of an immutable distributed ledger, automated data transaction processing, guaranteed integrity, and enhanced security, blockchain technology seems to be perfectly suitable to optimize current population-based rare neurodegenerative disease registry construction and maintenance

LATE LIFE DEPRESSION AND LATE ONSET DEPRESSION: ARE THE SAME CLINICAL AND PATHOPSYSIOLOGICAL PICTURE?

Phenomenological differences between older patients with late- and early-onset depression may reflect differences in aetiology and neuropathological processes involved in these two types of depression. Early- onset depression has been mainly correlated to a family history of depression while late-onset depression has been principally correlated to vascular dysfunction. The same cortical and sub-cortical areas are involved in both types of depression. However, lesions in these brain areas and cognitive impairment are most pronounced in late-onset depression. Based on these observations we propose a common neuroanatomical substrate but different pathophysiological processes implicated in these two types of depression