Fluctuating position-related cognitive disturbances and recurrent cerebral ischemic attacks as presenting symptoms in a patient with platypnea-orthodeoxya syndrome

Platypnea-orthodeoxia syndrome is a condition of dyspnea and hypoxia whilst in the upright position, which improves in the recumbent position. We present a case of platypnea-orthodeoxia due to a fenestrated atrial septal aneurysm that induced recurrent strokes and a recent condition of fluctuating confusion and cognitive impairment, modified by position, associated with rapid variations of O2 saturation position related. The suspect of platypnea-orthodeoxia syndrome may be hypothesized in case of patients with recurrent cerebral ischemia and fluctuating cognitive disturbances induced by change of position. In those cases a careful echocardiographic evaluation and O2 saturation determination in up and downright position are required

Covid-19 and health care leaders: How could emotional intelligence be a helpful resource during a pandemic?

The COVID-19 pandemic is not over, and the long-term psychological and physical consequences for HCWs are unknown. Health care organizations and leaders should act immediately to promote EI to protect their team in the current pandemic and prepare HCWs for future emergencies

Role of Interfacial Energy and Crystallographic Orientation on the Mechanism of the ZnO + Al2O3 -> ZnAl2O4 Solid-State Reaction: I. Reactivity of Films Deposited onto the Sapphire (110) and (012) Faces

The initial steps of the reaction between ZnO and Al2O3 have been investigated with X-ray diffraction, atomic force microscopy, and X-ray absorption spectroscopy at the Zn-K edge starting from 45 nm thick zincite films deposited onto (110)- and (102)-oriented sapphire single crystals. The formation of nonequilibrium phase(s) has been detected for both orientations. For the (001)(zincite) parallel to (110)(sapphire) interface, the rate-determining step is the motion of the interface(s); the growth of the spinel layer is linear with time, with a rate constant k = 1.1(2) x 10(-9) cms(-1) at 1000 degrees C. At the (110)(zincite) parallel to (012)(sapphire) interface, the reaction shows dumped oscillations. The results are discussed along with a comparison with previous results on thinner films to clarify the role of interfacial free energy and crystallographic orientation

Role of Interfacial Energy and Crystallographic Orientation on the Mechanism of the ZnO + Al2O3 -> ZnAl2O4 Solid-State Reaction: II. Reactivity of Films Deposited onto the Sapphire (001) Face

The initial steps of the reaction between ZnO and (001)-oriented Al2O3 single crystals have been investigated with X-ray diffraction, atomic force microscopy, and X-ray absorption spectroscopy at the Zn-K edge starting from 45 nm thick zincite films. The reaction eventually yields the ZnAl2O4 spinel on this interface but via a complex mechanism involving side and intermediate nonequilibrium compounds, the spinel initially forming with a distribution of lattice parameters. Evidence is given of the fact that one of the side compounds has a crystal structure close to that of the Zn3In2O6 compound. The results are discussed in the general context of the same reaction on different single-crystal substrates and different film thicknesses

Acute and interictal allodynia in patients with different headache forms : an Italian pilot study

Objective.-To investigate allodynia in patients with different primary headaches. Background.-Many migraineurs have allodynia during headache attacks; some may have allodynia outside attacks; allodynia may also be associated with other primary headaches. Methods.-A total of 260 consecutive primary headache patients presenting for the first time at a headache center, and 23 nonheadache controls answered written questions (subsequently repeated verbally) to determine the presence of acute and interictal allodynia. Results.-We divided the patients into: episodic migraine (N = 177), subdivided into only migraine without aura (N = 114) and those sometimes or always reporting migraine with aura (N = 63); episodic tension-type headache (N = 28); chronic headaches (headache 2:15 days/month, N = 52), including chronic migraine, chronic tension-type headache, and medication-overuse headache; and other headache forms (N = 3). Acute allodynia was present in 132 (50.7%), significantly more often in patients sometimes or always suffering migraine with aura, and those with chronic headache forms, compared to patients with migraine without aura and episodic tension-type headache. Interictal allodynia was present in 63 (24.2%) patients, with significantly higher frequency in those having migraine with aura attacks than controls and common migraine patients. Conclusions.-Allodynia is not specific to migraine but is frequent in all headache patients: acute allodynia was reported in half those interviewed and in over a third of patients in each headache category; interictal allodynia was reported by nearly 25%

Allodynia in different forms of migraine

About 60% of patients complain of cutaneous allodynia during migraine episodes, often in the periorbitary region of the pain side. Pre-clinical studies have shown that the underlying mechanism is sensitisation of primary nociceptors and central trigeminovascular neurons and that patients have a lower pain threshold for mechanical stimulation compared to controls. The objective of this study was to determine the prevalence of allodynia during headache attacks in different forms of migraine. The subjects were 221 outpatients consecutively evaluated in the Headache Center of the L. Sacco Hospital in Milan: 114 had only attacks of migraine without aura (MO), 63 had also attacks with aura (MA) and 44 patients with chronic migraine with and without drug overuse (CM). Presence of head allodynia was investigated by a semistructured interview. Statistical analysis was performed by chi square test with Bonferroni correction for multiple comparisons. Forty-seven out of 114 MO patients (41.2%) complained of allodynia during headache episodes, 41 out of 63 MA patients (65.0%), and 29 out of 44 CM patients (65.9%). A higher frequency of allodynia in MA and CM with respect to MO patients was observed (p <0.01 at chi square test). Allodynia was a common complaint in migraineurs, being present in more than 40% patients of each group. A higher frequency was observed in MA and in CM patients. This observation may suggest that both frequency of attacks and presence of aura episodes may contribute to induce changes in neuronal activation threshold thought to sustain allodynia