Search

Background and purpose The European Federation of Neurological Associations (EFNA), in partnership with the NeuroCOVID‐19 taskforce of the European Academy of Neurology (EAN), has investigated the impact of the first wave of the COVID‐19 pandemic on individuals with neurological diseases, as well as the hopes and fears of these patients about the post‐pandemic phase. Methods An EFNA‐EAN survey was available online to any person living with a neurological disorder in Europe. It consisted of 18 items concerning the impact of the first wave of the COVID‐19 pandemic on the medical care of people with neurological disorders, and the hopes and fears of these individuals regarding the post‐pandemic phase. Results For 44.4% of the 443 survey participants, the overall care of their neurological disease during the pandemic was inappropriate. This perception was mainly due to significant delays in accessing medical care (25.7%), insufficiently reliable information received about the potential impact of COVID‐19 on their neurological disease (49.6%), and a substantial lack of involvement in their disease management decisions (54.3%). Participants indicated that their major concerns for the post‐pandemic phase were experiencing longer waiting times to see a specialist (24.1%), suffering from social isolation and deteriorating mental well‐being (23.1%), and facing delays in clinical trials with disinvestment in neuroscience research (13.1%). Conclusions Despite the great efforts of health services to cope with the first wave of the COVID‐19 pandemic, individuals with neurological conditions feel they have been left behind. These findings provide invaluable insights for improving the care of patients with neurological disorders in the further course of the COVID‐19 pandemic., For 44.4% of individuals with neurological disorders participating in the survey, the overall care of their neurological disease during the pandemic was inappropriate due to significant delays in accessing medical care, insufficient information about the potential impact of COVID‐19 on their neurological disease, and a lack of involvement in their disease management decisions. Survey participants indicated that their major concerns for the post‐pandemic phase were experiencing longer waiting times to see a specialist, suffering from social isolation and deteriorating mental well‐being, and facing delays in clinical trials. Overall, despite the great efforts of health services to cope with the first wave of the COVID‐19 pandemic, people with neurological disorders feel they have been left behind.

Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.

Background and purpose: The recent SARSCoV2 pandemic has posed multiple challenges to the practice of clinical neurology including recognition of emerging neurological complications and management of coexistent neurological diseases. In a fastevolving pandemic, evidencebased studies are lacking in many areas. This paper presents European Academy of Neurology (EAN) expert consensus statements to guide neurologists caring for patients with COVID19. Methods: A refined Delphi methodology was applied. In round 1, statements were provided by EAN scientific panels (SPs). In round 2, these statements were circulated to SP members not involved in writing them, asking for agreement/disagreement. Items with agreement >70% were retained for round 3, in which SP cochairs rated importance on a fivepoint Likert scale. Results were graded by importance and reported as consensus statements. Results: In round one, 70 statements were provided by 23 SPs. In round two, 259/1061 SP member responses were received. Fiftynine statements obtained >70% agreement and were retained. In round three, responses were received from 55 cochairs of 29 SPs. Whilst general recommendations related to prevention of COVID19 transmission had high levels of agreement and importance, opinion was more varied concerning statements related to therapy. Conclusion: This is the first structured consensus statement on good clinical practice in patients with neurological disease during the COVID19 pandemic that provides immediate guidance for neurologists. In this fastevolving pandemic, a rapid response using refined Delphi methodology is possible, but guidance may be subject to change as further evidence emerges. (VLID)5891876 Version of record

In questo studio abbiamo voluto verificare l'eventuale neso fra diversi parametri caratterizzanti l'abitudine al fumo e la comparsa di particolari istotipi di carcinoma polmonare. L'analisi è stata corretta per le variabili relative all'esposizione ambientale ed occupazionale da noi già studiate sui soggetti che compongono la nostra casistica

La relazione tra inquinamento atmosferico e tumori polmonari è stata valutata mediante uno studio di tipo caso-controllo. I rischi relativo (RR) di tumore polmonare sono stati stimati calcolando gli odds ratio con metodi di regressione logistica multivariata. I residenti nella zona rurale hanno presentato un rischio relativo significativamente inferiore alla periferia urbana presa come riferimento.

Nel presente studio sono stati studiati 756 soggetti deceduti per neoplasia polmonare ed altrettanti controlli tutti selezionati dalla casistica autoptica dell'Istituto di Anatomia patologica dell'Università di Trieste. Obiettiov dello studi è stato quello di quantificare il rischio relativo attribuibile all'esposizione professionael ad agenti oncogeni noti o sospetti e di qullo derivante dall'esposzione ambientale a sostanze inquinanti. Per lo studio, del tipo cas-controllo , sono stati selezinoati esclusivamente i soggetti che risiedevano nella provincia di gTrieste, area particolarmente idonea per motivi geografici e storici a studi di tipo epidemiologico , dove più del 50% dei decessi viene sottoposto a verifca autoptica. I risultati di tale sutdio opportunamente corretti per i fattore legatio al fumo di sigaretta, hanno confermato un elevato rischio relativo derivante dall'esposizione all'amianto (R.R. = 1,99) e dall'esposizone professionael a sostanze cancerogene certe o fortemente sospette per la loro capacità oncogena, così come elencato rispettivametne nella lista A (R.R.=2.28) ed in quella B ((R.R.= 1.33) dallo stesso I.A.R.C. Lo studio così condotto ha permesso inoltre di calcolare il rischio relativo imputabiel alla sola esposizone ambientale a sostanze carcinogene nelle aree industriali (R.R.=1.7) ed in quelle urbane (R.R. = 1.6) rispetto a quello delle aree rurali e della periferia cittadina.

La letteratura scientifica riporta una più elevata incidenza di neoplasie polmonari nelle aree urbane rispetto a quelle rurali e rischi particolarmetne alti verrebbero riscontrati nelle zone contigue agli insediametni industriali. E' stato anche dimostrato , per i carcinogeni respiratori fino ad ora più estesamente investigati (il fumo di sigaretta e l'asbesto), che l'effetto oncogenetico sul parenchim polmonare si esplica con l'espressione preferenziale di alcuni tipi istologici. Per quantificare l'effetto dell'esposizinoe all'inquinamento atmosferico sul rischio di neolasai polmonare e valutare la sua eventuale selettività di azione su alcuni istotipi, abbiamo esteso l'analisi del nostro studio caso-controllo. Sono stati esaminati in totale 1512 soggetti, tutti maschi residenti a Trieste, euamente divisi tra casi e controlli, appaiati per età ed anno di morte e tutti sottoposti ad autopsia. I preparati istologici relativi alle neoplasie dei 756 casi sono stati revisionati e riclassificati in base ai criteri OMS. Le informazioni pertinenti le abitudini di vita da analizzare sono state raccolten mediate interviste telefoniche dei parenti. Le esposizioni di natura occupazionale dei soggetti e quella associata al fumo di sigaretta sono state considerate in questo caso come fattori confondenti e le estensive informazion raccole a riguardo sono stae utilizzate per correggere gli odds ratiosper esposizione ambientale calcolati mediante regressione logistica non condizionata ed uliizzati come stimatori del rischio relativo (RR). .......

To investigate the relationship between air pollution and histologic type of lung cancer we conducted a case-control study among deceased men in Trieste, Italy. 755 cases of lung cancer and 755 controls were identified through the local autopsy registry. Information on smoking habits, occupation and place of residence was obtained from the subject's next-of-kin. Air pollution at the residence of each subject was estimated from the average value of total particulate at the nearest monitoring station. Spatial models and logistic regression were used to evaluate the effect of residence and air pollution on LC after adjustment for age, smoking habits, likelihood of exposure to occupational carcinogens and social group. The risk of lung cancer increased with increasing level of air pollution for all types of lung cancer combined (P = 0.022), for small cell carcinoma (P = 0.016) and for large cell carcinoma (P = 0.049). Compared with inhabitants of the residential area, residents of the rural area had a relative risk (RR) of 0.6 (95% confidence interval (CI): 0.4-1.0). The RR was 1.5 (1.0-2.2) for residents of the center of the city and 1.4 (1.0-2.1) for residents of the industrial area. In the center of the city the excess risk was almost completely restricted to small cell carcinoma (RR = 2.0) and to large cell carcinoma (RR = 2.6). In the industrial area the risk was increased especially for adenocarcinoma (RR = 2.1). These results provide evidence that air pollution is a moderate risk factor for certain histologic types of lung cancer.

We report herein, the first results of a record linkage between the Italian AIDS Registry and 13 population-based Cancer Registries (about 8-million population in 1991). An anonymous linkage process was carried out on about 339,000 cancer notifications and 6,067 AIDS ones reported between 1982 and 1994. Out of 243 Kaposi's sarcomas (KS) below age 50 years recorded at either type of registry, 90 (37%) were reported as such by both. Sixty-eight percent of individuals with KS at Cancer Registries could be identified at the AIDS Registry. Sixty-two percent of individuals with KS and 65% of individuals reported as having non-Hodgkin's lymphoma (NHL) at RAIDS could be also found at Cancer Registries. Among 6,067 persons with AIDS 15-69 years old, observed and expected numbers of cancer and age-standardised incidence ratios (SIR) on a total of 25,759 person-years were computed. Significantly increased SIR was found for Hodgkin's disease (8.9; 95% CI: 4.4-16.0), invasive carcinoma of the cervix uteri (15.5; 95% CI: 4.0-40.1), and non-melanomatous skin cancer (3.0, 95%, CI: 1.3-5.9). As in previous studies, KS and NHL were greatly increased (SIR = 1,300 and 59, respectively). The risk for all cancer types, after exclusion of KS and NHL, was approximately twice the risk of the general population. An increased SIR of Hodgkin's disease in persons with AIDS is thus confirmed, though many-fold smaller than for NHL. An association with invasive carcinoma of the cervix is also shown at a population level. These data indicate the potential of AIDS and Cancer Registries for improving cancer assessment in individuals with HIV/AIDS and elucidating the role of immune system on cancer onset.

BACKGROUND AND PURPOSE The recent SARS-CoV-2 pandemic has posed multiple challenges to the practice of clinical neurology including recognition of emerging neurological complications and management of coexistent neurological diseases. In a fast-evolving pandemic, evidence-based studies are lacking in many areas. This paper presents European Academy of Neurology (EAN) expert consensus statements to guide neurologists caring for patients with COVID-19. METHODS A refined Delphi methodology was applied. In round 1, statements were provided by EAN scientific panels (SPs). In round 2, these statements were circulated to SP members not involved in writing them, asking for agreement/disagreement. Items with agreement >70% were retained for round 3, in which SP co-chairs rated importance on a five-point Likert scale. Results were graded by importance and reported as consensus statements. RESULTS In round one, 70 statements were provided by 23 SPs. In round two, 259/1061 SP member responses were received. Fifty-nine statements obtained >70% agreement and were retained. In round three, responses were received from 55 co-chairs of 29 SPs. Whilst general recommendations related to prevention of COVID-19 transmission had high levels of agreement and importance, opinion was more varied concerning statements related to therapy. CONCLUSION This is the first structured consensus statement on good clinical practice in patients with neurological disease during the COVID-19 pandemic that provides immediate guidance for neurologists. In this fast-evolving pandemic, a rapid response using refined Delphi methodology is possible, but guidance may be subject to change as further evidence emerges.