Cryptogenic Stroke: Cryptic Definition?

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Depression after minor stroke: prevalence and predictors

Background and purpose: Post-stroke depression (PSD) is one of the most frequent complications of stroke, with a prevalence ranging 2060%. As PSD seems to be related to stroke severity, we hypothesized that the prevalence of PSD would be lower in patients with minor stroke. Methods: We investigated the prevalence and predictors of PSD over a 30-month follow-up period in a cohort of patients with minor ischaemic stroke (NIHSS <= 5). Results: We enrolled 105 patients (mean age 64.38 +/- 11.2 years, M/ F 69/36). PSD was diagnosed in 43 (41%) patients, 40 (93%) of whom had dysthymia; 22% of patients were already depressed at 1 month. The most frequent depressive symptoms (DSs) were working inhibition, indecisiveness, and fatigability. Patients who developed PSD were less educated (P = 0.044) and diabetic (P = 0.006). After excluding patients that were already depressed at 1 month, we performed a logistic regression model to detect predictors of PSD. Crying (P = 0.012, OR 1.067, CI 0.269-4.553) and guilt (P = 0.007, OR 0.037, CI 0.02i` 03-0.401) at baseline were two DSs found to be significantly correlated with PSD. Higher educational level (P = 0.022, OR 0.084, CI 0.010-0.698) and diabetes (P = 0.007, OR 14.361, CI 2.040-101.108) were the risk factors significantly correlated with PSD. Conclusion: Post-stroke depression is frequent even in patients with minor stroke. Early detection of DSs might help to predict long-term development of PSD. No correlation was observed between lesion site or side and the development of PSD

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Processing energy and signals by molecular and supramolecular systems

Any kind of device or machine requires a substrate, energy, and information signals. If we wish to operate at the nanometer scale, we must use molecules as substrates. Energy- and signal-processing at a molecular level relies on cause/effect relationships between the input supplied and the kind of process obtained. We have classified energy- and signal-processing at the molecular level according to the nature of the input (electronic, photonic, or chemical) and the nature of the obtained effect (electronic, photonic, or chemical process that follows). By coupling the three kinds of inputs with the three types of resulting processes, nine types of molecular-based processes (electronic, photonic, chemionic, electrophotonic, electrochemionic, photoelectronic, photochemionic, chemiophotonic, and chemioelectronic) can be identified. In this concept article, looking at molecular transformations in an unconventional way, we have tried to give a flavor of some of the new features that project the old science of chemistry towards novel achievements