34 research outputs found

    Secondary Cerebrovascular Prevention in Light of the COVID-19 Pandemic.

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    Background The COVID-19 pandemic has affected healthcare systems, professionals and patients around the world. At the same time, the burden of cerebrovascular events is considerable. Worldwide, more than one million deaths per year are due to cerebrovascular events, which are the second most frequent cause of death and the main cause of long-term disability in Europe. To approach the challenges of the COVID-19 pandemic and secondary cerebrovascular prevention. Conclusion We recommend:(1) As in normal times, during the COVID-19 pandemic wave, patients need to seek urgent medical attention in case of any acute cerebrovascular event. This will assure they receive needed rapid cerebrovascular secondary prevention in addition to acute intravenous and endovascular reperfusion strategies.(2) As in normal times, during the COVID-19 pandemic wave, it is of utmost importance that patients adhere to their individual recommendations for secondary prevention.(3) Optimal secondary but also primary cerebrovascular prevention might reduce the burden of COVID-19 now and during potential subsequent waves.(4) Patients with cerebrovascular disease should strictly adhere to advice concerning the pandemic provided by their governments and to pandemic-related recommendations for them as individuals expressed by their treating physicians

    Subcortical vascular lesions predict functional recovery after rehabilitation in patients with L-dopa refractory parkinsonism

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    OBJECTIVES: To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism. DESIGN: Observational study. SETTING: A hospital geriatric rehabilitation department ("Ancelle della Carita" hospital of Cremona). PARTICIPANTS: Thirty-eight subjects (mean age+/-standard deviation of 78.9+/-6.5; 66% women) with gait disturbances and L-dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training. MEASUREMENTS: The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta-UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini-Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors. RESULTS: Patients were divided into two groups of equal size based on the delta-UPDRS (high and low functional recovery: delta-UPDRS >8 and less than or equal to8, respectively). Of all variables, only subcortical cerebrovascular load predicted functional recovery at discharge (odds ratio adjusted for age, MMSE, and UPDRS on admission=2.3, 95% confidence interval=1.0-5.1). The adjusted proportion of patients with high functional recovery decreased with increasing subcortical cerebrovascular load: 83%, 61%, 44%, and 27% (adjusted P for trend=0.047). CONCLUSION: Subcortical cerebrovascular load is a predicting factor of successful rehabilitation in patients with L-dopa refractory parkinsonism

    Glacial seismic geomorphology and Plio-Pleistocene ice sheet history offshore of northwest Europe

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    Plio-Pleistocene records of ice-rafted detritus suggest northwest European ice sheets regularly reached coastlines. However, these records provide limited insight on the frequency, extent, and dynamics of ice sheets delivering the detritus. Three-dimensional reflection seismic data of the northwest European glaciated margin have previously documented buried landforms that inform us on these uncertainties. This paper reviews and combines these existing records with new seismic geomorphological observations to catalogue landform occurrence along the European glaciated margin and considers how they relate to ice sheet history. The compilation shows Early Pleistocene ice sheets regularly advanced across the continental shelves. Early Pleistocene sea level reconstructions demonstrate lower magnitude fluctuations compared to the Middle-Late Pleistocene, and more extensive/frequent Early Pleistocene glaciation provides a possible mismatch with sea level reconstructions. This evidence is discussed with global records of glaciation to consider possible impacts on our wider understanding of Plio-Pleistocene climate changes, in particular how well Early Pleistocene sea level records capture ice sheet volume changes. Resolving such issues relies on how well landforms are dated, whether they can be correlated with other proxy datasets, and how accurately these proxies reconstruct the magnitudes of past climatic changes. Many questions about Pleistocene glaciation in Europe and elsewhere remain

    Glacial seismic geomorphology and Plio-Pleistocene ice sheet history offshore NW Europe

    No full text
    Plio-Pleistocene records of ice-rafted detritus suggest northwest European ice sheets regularly reached coastlines. However, these records provide limited insight on the frequency, extent, and dynamics of ice sheets delivering the detritus. Three-dimensional reflection seismic data of the northwest European glaciated margin have previously documented buried landforms that inform us on these uncertainties. This paper reviews and combines these existing records with new seismic geomorphological observations to catalogue landform occurrence along the European glaciated margin and considers how they relate to ice sheet history. The compilation shows Early Pleistocene ice sheets regularly advanced across the continental shelves. Early Pleistocene sea level reconstructions demonstrate lower magnitude fluctuations compared to the Middle-Late Pleistocene, and more extensive/frequent Early Pleistocene glaciation provides a possible mismatch with sea level reconstructions. This evidence is discussed with global records of glaciation to consider possible impacts on our wider understanding of Plio-Pleistocene climate changes, in particular how well Early Pleistocene sea level records capture ice sheet volume changes. Resolving such issues relies on how well landforms are dated, whether they can be correlated with other proxy datasets, and how accurately these proxies reconstruct the magnitudes of past climatic changes. Many questions about Pleistocene glaciation in Europe and elsewhere remain.<br/
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