RESUMEN
BACKGROUND: Intravenous thrombolysis is an effective treatment in acute stroke patients, but it increases the risk of intracerebral hemorrhages. Our aim is to establish if fibrinogen depletion increases the risk of intracerebral hemorrhage after intravenous thrombolysis for acute ischemic stroke. METHODS: In 104 ischemic stroke patients, treated with intravenous thrombolysis, we assessed the rate of intracerebral hemorrhages documented by computed tomographic scan at 24 hours and within 7 days post-treatment. Fibrinogen levels were determined at 2 hours after therapy: patients were classified as belonging to "low fibrinogen group" if levels decreased to less than 2 g/L and/or by 25% or more. Fibrinogen levels and other known hemorrhagic risk factors were studied using univariate and multivariate analyses. RESULTS: During the first 7 days, an intracerebral hemorrhage was detected in 24 patients (23.1%), and only 6 of these (5.8%) experienced symptomatic bleeding; 41 patients were included in the low fibrinogen group. Among the 24 hemorrhages, 18 occurred in the low fibrinogen group and 6 in the "normal fibrinogen group": the bleeding rate in the low fibrinogen group was significantly higher (43.9%) than that in the normal fibrinogen group (9.5%; odds ratio [OR] 7.43, P < .001). Univariate and multivariate analyses revealed that only clinical severity (OR 1.15, P < .001) and hypofibrinogenemia (OR 7.47, P < .001) were significantly associated with brain bleeding at 7 days and at 24 hours (P = .008). CONCLUSIONS: An early fibrinogen reduction seems to increase the risk of intracerebral hemorrhage after rtPA treatment in ischemic stroke. Fibrinogen assessment could be a rapid, inexpensive, and widely available tool to help the identification of patients at higher risk of bleeding.
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Isquemia Encefálica/tratamiento farmacológico , Hemorragia Cerebral/etiología , Fibrinógeno/análisis , Fibrinolíticos/efectos adversos , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/sangre , Hemorragia Cerebral/sangre , Femenino , Fibrinolíticos/administración & dosificación , Fibrinolíticos/sangre , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/sangre , Factores de Tiempo , Activador de Tejido Plasminógeno/administración & dosificación , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The prevalence of asthma, a common disorder in childhood, is often estimated by cross-sectional studies based on questionnaires, with the drawback that estimates are limited to certain age groups and areas. The use of electronic health data is increasingly allowing researchers to overcome these limitations. This study is aimed at assessing asthma occurrence of a school-aged population in Northeast Italy using two different data sources. METHODS: In 2004, a population-based survey using a standardized questionnaire was conducted to estimate asthma occurrence among a resident population of children aged 6-7 years and adolescents aged 13 years. A selection of dispensed asthma medications was extracted from electronic databases for a 4-year period prior to questionnaire completion (2000-03). Asthma prevalence was estimated by commonly used questionnaire classifications and compared with use of inhaled bronchodilators (alone or in combination) in various time periods. Correlations between the two approaches were calculated. RESULTS: A total of 10 252 subjects were eligible for analysis (85% of the resident population). A total of 4747 subjects (38% of the resident population) were registered in the drug database during 2000-03. Asthma prevalence was higher in males and in children. Congruence between the two enquiry methods varied according to criteria applied and improved with the protraction of the observation period. CONCLUSION: A longer period for the capture of medication data yielded higher congruence. A degree of mismatch was observed between the two methods most likely related to factors of drug use and questionnaire reliability. Nonetheless, the benefits of using easily accessible population data prevail, and further studies are warranted.
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Antiasmáticos/uso terapéutico , Asma/epidemiología , Sistema de Registros/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Adolescente , Factores de Edad , Asma/diagnóstico , Asma/tratamiento farmacológico , Niño , Estudios Transversales , Bases de Datos Factuales , Femenino , Humanos , Italia/epidemiología , Masculino , Pediatría , Prevalencia , Reproducibilidad de los Resultados , Factores SexualesRESUMEN
BACKGROUND: The ability to predict the future progression of MS represents a key issue for the neurologist. The aim of the study was to create a multifactorial prognostic index (MPI) providing the probability of a severe MS course at diagnosis based on clinical and immunological CSF parameters. METHODS: 64 clinically definite relapsing-remitting (RR)MS patients (38 benign, 26 severe MS) followed up for at least 10 years were included. Clinical and demographic details, EDSS after 5 and 10 years, progression index, relapse number and rate, time to a second relapse were assessed. CSF and serum samples collected at diagnosis were examined for CSF IgM and IgG oligoclonal bands (OB) and quantitative IgM and IgG determination. RESULTS: Kaplan-Meier analysis showed that the probability of reaching an EDSS score of 3 or 4 was significantly influenced by the presence of IgMOB (p<0.01 and p<0.01, log-rank test) and by the symptoms at onset (p=0.04 and p=0.03, log-rank test). These results were confirmed at multivariate analysis (Cox model). Univariate logistic analysis showed that IgMOB presence predicted a severe MS course (OR=9.33, CI=2.92- 29.88), whereas sensory symptoms at onset predicted a benign MS course (OR=0.12, CI=0.02-0.56). Using multivariate logistic regression the factors found to be significant were: presence/absence of IgMOB (p<0.01), onset with sensory (p<0.01) and pyramidal symptoms (p=0.01), and first inter-attack interval (p=0.03). The individual probability of a severe evolution was thus estimated by a simple formula comprising clinical and biological markers of prognosis available at diagnosis (pyramidal and sensory symptoms, months to the 2nd episode, and IgMOB presence/absence), giving the probability of developing a severe MS course. Applied to the same patient cohort this formula showed a global error of 6/64 (9.37%). We then used another independent series of 65 RRMS patients to validate this model. In this second patient cohort, 4/45 BMS and 4/20 SMS patients were found to have been incorrectly classified (based on the formula), with a global error of 8/65 (12.31%). CONCLUSION: For the first time we created a MPI, using clinical and biological markers to predict the clinical course of MS at diagnosis. This index can support the clinician in patient counselling, therapeutic choices, as well as in patient selection criteria for clinical trials.
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Inmunoglobulina M/líquido cefalorraquídeo , Bandas Oligoclonales/inmunología , Índice de Severidad de la Enfermedad , Adulto , Evaluación de la Discapacidad , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Esclerosis Múltiple/líquido cefalorraquídeo , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/inmunología , Valor Predictivo de las Pruebas , Probabilidad , Análisis de Regresión , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVE: To supply the local administrators with a tool for a preventive evaluation of the improvements in road safety brought about by specific interventions which are planned. It is one of the first Italian experiences in the area. STUDY DESIGN: The database consists of the accidents occurring in three municipalities of the province of Modena characterized by accidents of high severity. Models were used to simulate changes related to possible interventions. The goodness of the model-based estimates has been evaluated after the implementation of interventions. RESULTS: Scenario analyses indicate which actions are most effective. Preliminary estimates of efficacy suggest a good agreement with model-based forecasts. CONCLUSION: Results encourage the adoption of methods of preventive evaluation of the efficacy of preventive actions.
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Accidentes de Tránsito/prevención & control , Prevención Primaria/métodos , Accidentes de Tránsito/estadística & datos numéricos , Sistemas de Administración de Bases de Datos , Planificación Ambiental , Estudios de Evaluación como Asunto , Humanos , Incidencia , ItaliaRESUMEN
Respiratory health effects of short-term exposure to ambient air pollution have been examined in 120 'asthma-like' school-aged children in some areas of Emilia-Romagna (urban-industrial and rural area). They kept a daily diary, through 12 weeks, for respiratory symptoms, PEF measurements, drug consumption and daily activity. The average daily concentrations of air pollutants in the same period (TSP, NO2, CO, PM2.5) were higher in the industrial than the rural area. Asthma was diagnosed in 77% of cases, 85% of subjects took medical treatments for respiratory disease in the last year and 90% used medicine for respiratory diseases. Significantly lower variations in PEF, between morning and evening, were observed in the rural area, considering only the asthmatic or cough subsets of children. Symptom prevalence was higher in the urban-industrial area than the rural area; the most frequent symptoms were cough, phlegm and stuffed nose. The two area populations are homogeneous in individual features, family susceptibility, passive smoking exposure and atopy. The differences observed in the frequency of daily reported symptoms could be attributed to external situations like the different reported exposures to pollutants. Although most analyses revealed non-significant associations, panel analysis showed a significant statistical risk for the cough and phlegm group by an increase of 10 microg of TSP (RR 1.0017, 95% CI: 1.0002-1.0033) in the entire group. In the urban-industrial panel we observed a significant association between cough and phlegm together and PM2.5 (RR 1.0044, 95% CI: 1.0011-1.0077). The results of this investigation should be used in orienting local political decisions.