Middle cerebral artery ischemic stroke and COVID-19: a case report

Journal of NeuroVirology - We present a clinical case of a patient with SARS-CoV-2 infection and respiratory symptoms, complicated with a pro-thrombotic state involving multiple vascular...     

The Outpatient Cost of Diabetes Care in Italian Diabetes Centers

Objective: To provide resource utilization patterns and cost estimates of outpatient care for types I and II diabetes mellitus in Italy, based on retrospectively collected data.
Design: Multicenter, retrospective observational study analyzing individual costs in a sample of patients with diabetes mellitus.
Study population: A total of 2260 patients were stratified into eight groups by type of diabetes, glycemic control, and age.
Setting: Thirty-five centers for diabetes care in Italy.
Results: The per-patient cost of treatment was €136.8 in two months for type I diabetes ( N = 592) and €123.3 for type II diabetes ( N = 1668). Pharmaceutical therapy consisting of antidiabetic drugs only accounted for only 32% to 36% of treatments cost in type I patients and between 13% and 24% in type II. Diagnostic tests accounted for 27% to 42% of treatment costs in patients with both type I and type II diabetes, day-hospital days accounted for 15% to 22% in type I, 25% to 27% in type II, and consultations accounted for 16% to 20% in type I patients and between 17% and 21% in type II diabetes.
Conclusion: Despite limitations caused by the short period considered, and considering that in Italy the cost of diabetes has received limited attention, we believe this study presents some interesting information on the burden of diabetes in this country.     

Digital literacy as a potential barrier to implementation of cardiology tele-visits after COVID-19 pandemic: the INFO-COVID survey

BACKGROUNDDuring the COVID-19 pandemic, the implementation of telemedicine has represented a new potential option for outpatient care. The aim of our study was to evaluate digital literacy among cardiology outpatients.METHODSFrom March to June 2020, a survey on telehealth among cardiology outpatients was performed. Digital literacy was investigated through six main domains: age; sex; educational level; internet access; availability of internet sources; knowledge and use of teleconference software programs.RESULTSThe study included 1067 patients, median age 70 years, 41.3% females. The majority of the patients (58.0%) had a secondary school degree, but among patients aged ≥ 75 years old the most represented educational level was primary school or none. Overall, for internet access, there was a splitting between “never” (42.1%) and “every day” (41.0%), while only 2.7% answered “at least 1/month” and 14.2% “at least 1/week”. In the total population, the most used devices for internet access were smartphones (59.0%), and WhatsApp represented the most used app (57.3%). Internet users were younger compared to non-internet users (63 vs. 78 years old, respectively) and with a higher educational level. Age and educational level were associated with non-use of internet (age-per 10-year increase odds ratio (OR) = 3.07, 95% CI: 2.54−3.71, secondary school OR = 0.18, 95% CI: 0.12−0.26, university OR = 0.05, 95% CI: 0.02−0.10). CONCLUSIONSTelemedicine represents an appealing option to implement medical practice, and for its development it is important to address the gaps in patients’ digital skills, with age and educational level being key factors in this setting.

Since the beginning of 2020, COVID-19 has been declared a pandemic by World Health Organization (WHO) and it has rapidly spread across the whole world, affecting all of the society layers, and in particular Health Care Systems.^[1] Worldwide, policymakers have promoted a series of measures to limit the diffusion of SARS-Covid 19 with the adoption of lockdown periods including isolation, social distancing, and quarantine. This has had a profound impact on people’s lives and the Health Care Systems organization.^[2-6]The follow-up of patients affected by chronic cardiac diseases is traditionally based on periodic ambulatory visits, done in coordination with general practitioners, in order to verify the implementation of guidelines-adherent preventive measures and treatments, to intercept any major change in patient’s clinical status, as well as to support a good patient-doctor relationship, which is fundamental for reaching therapeutic goals.^[7,8]The lockdown period had a profound impact on the management of cardiovascular conditions, with a decrease in the number of hospital admissions for acute coronary syndromes, and a parallel increase in the rate of out-of-hospital cardiac arrests, possibly related to the fact that people were more likely to stay home and delay their access to the hospital.^[9-11]A reduced referral to the hospital for medical care was also reported for arrhythmias, atrial fibrillation, and heart failure with potentially negative implications on patients’ outcomes.^[5,12,13] As people were asked to stay home, national health agencies and health care providers have searched for new strategies to best provide for their patients’ needs and tried at the same time to limit contagions and redirect resources to the treatment of patients with COVID-19 disease. In this perspective, while reducing ambulatory visits and planned procedures, the implementation of telehealth systems has represented a new potential option for outpatient care.^[14-19]Thus, the degree of digital literacy, in terms of the ability of individual patients to access various digital platforms through computers, laptops or mobile devices, has become a topic of great interest for a fast implementation of the “telemedicine opportunity” in our daily practice.The aim of our study was to take a picture of digital literacy among cardiology patients attending our outpatient clinic, through a survey performed during COVID-19 pandemic, in order to assess the possibilities to extend telemedicine, by using currently available technology, as a way to reach patients and their families at home.     

SMN mutants of spinal muscular atrophy patients are defective in binding to snRNP proteins

Spinal muscular atrophy (SMA) is a common motor neuron degenerative disease and the leading genetic cause of death of young children. The survival of motor neurons (SMN) gene, the SMA disease gene, is homozygously deleted or mutated in more than 98% of SMA patients. The SMN protein interacts with itself, with SMN-interacting protein 1, and with several spliceosomal small nuclear ribonucleoprotein (snRNP) Sm proteins. A complex containing SMN plays a critical role in spliceosomal snRNP assembly and in pre-mRNA splicing. SMN mutants found in SMA patients show reduced self-association and lack the capacity to regenerate the splicing machinery. Here we demonstrate that SMN mutants found in SMA patients are defective in binding to Sm proteins. Moreover, we show that SMN, but not mutants found in SMA patients, can form large oligomers and that SMN oligomerization is required for high-affinity binding to spliceosomal snRNP Sm proteins. These findings directly link the impaired interaction between SMN and Sm proteins to a defect in snRNP metabolism and to SMA.     

Ozonized autohemotransfusion improves hemorheological parameters and oxygen delivery to tissues in patients with peripheral occlusive arterial disease

Twenty-seven subjects suffering from peripheral occlusive arterial disease (POAD, clinical stage II-III according to Fontaine) were enrolled in this study to evaluate the effect of oxygen-ozone therapy upon hemorheological parameters and hemoglobin-oxygen affinity in patients with POAD. All patients underwent a major ozonized autohemotransfusion consisting of the slow reinfusion of 100 ml of autologous blood, previously exposed to a O(2)-O(3) mixture in a glass box for 10 min. Whole blood viscosity, erythrocyte filterability, hematocrit, and fibrinogen levels were assessed at the basal time and 30 min after the reinfusion of ozonized blood. At the same time p50 standard (p50std) values (an indicator of hemoglobin-oxygen affinity) and plasma values of malonyl dialdehyde (MDA, an indicator of lipid peroxidation) were evaluated. At the baseline, patients had significantly higher ( p<0.05- p<0.001) whole blood viscosity, MDA, and p50std values and significantly lower blood filterability ( p<0.01) as compared with 20 matched healthy volunteers (controls). Thirty minutes after the end of a major autohemotransfusion, whole blood viscosity significantly decreased ( p<0.01). This was accompanied by a significant fall in plasma fibrinogen level ( p<0.01) with no change in hematocrit. Blood filterability, MDA plasma level, and p50std values increased significantly at the same time ( p<0.01- p<0.005). The 2,3-DPG value did not change significantly. No significant changes occurred when the same patients received a non-ozonized autohemotransfusion (control test). In conclusion, ozonized autohemotransfusion may be useful to improve both the poor rheological properties of the blood and the oxygen delivery to tissues in patients suffering from POAD.     

Intracranial hypertension in severe head injuries

Summary Long-term ICP monitoring was carried out in a series of 124 patients with severe head injuries admitted to the Intensive Care Unit. Forty-nine percent of patients were admitted within six hours of injury. Most of them were referred by Community Hospitals. Only patients with diffuse brain lesions or patients operated on for mass lesions and remaining in a coma state after operation are taken into account. Altogether, 46 patients survived, but 15 of them remained severely disabled or in a vegetative state, and 78 died. Twenty-four percent of the whole series succumbed to fulminationg intracranial hypertension. The average survival in this group was 5.1 days. Twenty-nine percent died after exhibiting different levels of intracranial hypertension ranging from 20 to 50 mm Hg. In this group the role of extracerebral complications as a cause of death should not be underestimated. Death caused by cerebral lesions with ICP not exceeding 15 mm Hg was exceedingly rare in the first 72 hours. Normal or fairly raised ICP does not rule out the risk of devastating intracranial hypertension: reliable and harmless P/V tests are needed. All patients who survived after showing sustained intracranial hypertension exceeding 50 mm Hg were under 20 years of age. In the present series the results of treatment of intracranial hypertension were, on the whole, rather disappointing.     

201Tl for the differential diagnosis of cold thyroid nodules

Summary We used²⁰¹Tl-chloride for studying and differentiating thyroid areas shown to be ‘cold’ in previous¹³¹I or^99mTc scanning. We investigated sixteen thyroid neoplasms that were removed surgically shortly afterwards. We found an intense intranodular accumulation of²⁰¹Tl in five scintigraphs shown to be of histologically malignant neoplasms, and an intense accumulation also in one of those shown to be histologically benign. We did not detect any²⁰¹Tl-chloride accumulation in two cases of thyroiditis; one of these had shown an intense accumulation in a previous¹³¹Cs scintigram.