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Background: The predictors of intracranial haemorrhagic transformation (HT) in acute ischaemic stroke (AIS) patients undergoing dual antiplatelet therapy (DAPT) are not well known. Objectives: The aim of this study is to identify the possible clinical and radiological predictors of HT in patients, irrespective of clinical indication for this treatment. Design: This study is a monocentric cohort retrospective study. Methods: We enrolled consecutive AIS patients, from our prospective register, admitted to Stroke Unit between June 2021 and June 2023 undergoing DAPT with Acetylsalicylic Acid and Clopidogrel within 72 h from symptoms onset. According to current guidelines, DAPT indication was for patients with a minor stroke, symptomatic intracranial artery stenosis and carotid angioplasty stenting. We collected clinical, demographical and radiological data. We used ABC/2 method to measure stroke volume in magnetic resonance imaging (MRI)/Diffusion-weighted imaging (DWI) sequences performed within 48 h. The primary outcome was the presence of HT at non-contrast brain computed tomography, performed 7 days after commencing DAPT. Results: One hundred ninety-four patients were included. Twenty-eight (14.4%) presented HT. Higher NIH Stroke Scale (NIHSS) and MRI/DWI lesion volume related to increased risk of HT (p < 0.001). Reperfusion therapy and mechanical thrombectomy (MT), stent placement and a loading dose (LD) of dual antiplatelet or Clopidogrel were associated with a higher occurrence of HT (p < 0.05). Furthermore, we individuated an NIHSS cut-off value >4 (area under the curve (AUC) 0.80, sensitivity 0.82, specificity 0.65) and a volume cut-off value >8.2 ml (AUC 0.82, sensitivity 0.79, specificity 0.80) associated with an increased risk of HT (respectively, adjusted odds ratio (adj. OR) 6.5, confidence interval (CI) 1.3–32.7, p = 0.024 and adj. OR 11.0, CI 3.1–39.2, p < 0.001). Conclusion: In clinical practice, MT treatment, antiplatelet LD administration, stent placement and clinical severity may relate to a higher risk of HT in patients with AIS and DAPT in the acute phase. In particular, we found that lesion volume cut-off could help to identify patients at greater risk of HT, regardless of the indication for DAPT. Plain language summary: Possible clinical and radiological features able to predict the risk of haemorrhagic transformation in patients affected by acute cerebral ischemic stroke undergoing treatment with dual antiplatelet, Acid Acetylsalicylic and Clopidogrel This monocentric cohort retrospective study aims to identify predictive factors for haemorrhagic transformation (HT) in patients with acute ischaemic stroke (AIS) and dual antiplatelet therapy (DAPT). DAPT is indicated for minor strokes, symptomatic intracranial artery stenosis and carotid stent placement. Although there are guidelines on this subject, there are some grey areas due to the emergence of new possible uses of DAPT and to a lack of studies addressing some issues (e.g. patients with moderate to severe AIS undergoing DAPT). We selected patients >18 years old from our prospective registry, who were admitted for AIS and started DAPT within 72 hours from the event. We collected clinical and radiological data. All patients underwent brain magnetic resonance imaging (MRI). We calculated the volume of the AIS using an easily reproducible methodology (ABC/2). We then identified which patients developed HT after one week of therapy and examined the factors potentially associated with an increased risk of HT. Our study provided useful insights for clinical practice. We observed an increased risk of HT in patients with higher scores on the stroke clinical severity scale (NIHSS), larger infarcts, treatment with mechanical thrombectomy, administration of antiplatelet loading doses and stent placement. Furthermore, we identified a 11-fold increased risk of HT in patients with acute ischaemic lesion volumes on MRI >8.2 ml, and a 6-fold increased risk for patients with NIHSS >4. This study is easily reproducible in clinical practice, as it utilizes readily available clinical and radiological parameters. It highlights how the integration of clinical and radiological data can assist neurologists in navigating grey areas of treatment. In this way, it might be possible to identify patients at risk of haemorrhage, who should be monitored more closely to prevent adverse effects that could lead to the interruption of DAPT, thereby reducing the risk of a new ischemic stroke. [ABSTRACT FROM AUTHOR]

This paper defines the first internationally comparable measure of the risk of economic violence to acknowledge its prevalence in different countries and its geographical and gender heterogeneity. Thanks to the availability of micro-data from the OECD/International Network on Financial Education survey, currently used to track financial literacy in different countries, we define a measure of the risk of economic violence (REV) that takes into consideration three macro-areas: (a) the risk of being prevented from acquiring and accumulating financial resources; (b) the risk of being unaware and not having access to personal and/or household financial resources; and (c) the risk of financial dependency. The definition of the new economic violence risk measure (REV) then allows us to verify with real data the presence of women's greater exposure to the risk of economic violence and the presence of gender differences in the determinants of economic violence risk. Finally, we verify that financial literacy protects individuals from the risk of economic violence, without gender differences. [ABSTRACT FROM AUTHOR]

Purpose: Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. Methods: A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. Results: Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. Conclusion: Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome. [ABSTRACT FROM AUTHOR]

This study concerns the behaviour of steel frames protected by different anti-seismic devices (dampers). Typical hysteretic and viscous dampers are arranged in three steel moment-resisting frames (MRFs) having different dynamical features but are designed to accomplish determined performance objectives. The proposed devices are selected following an iterative procedure based on the use of a suitable damage functional, which has been applied to control the behaviour of the protected structures under a specific seismic record. The outcomes obtained by implementing incremental dynamic analyses, carried out on the basis of seven historical records characterized by different features, allow to analyse the improvement of the structural performance due to the considered dampers and, therefore, to provide design information about their employment. The comparison of results is carried out taking into account the dampers capacity to protect the structures from damage, the inter-storey drifts, the residual deformations and the possible amplification effects. In conclusion, the equivalent behaviour factors for each damper type are given, with the aim of providing useful design parameters for the implementation of simplified conventional linear analyses. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Clostridioides difficile (CD) is a major nosocomial pathogen and the leading cause of antibiotic-associated diarrhoea. In light of the strong association between antimicrobial use and CD infections (CDI), it may be hypothesised that areas at higher prevalence of antimicrobial resistance, like the region of Campania in southern Italy, could also have a higher rate of CDI. In this multicentre, region-based, prospective study, we analysed such issues, exploiting CDI incidence data collected from local hospitals. In 2016, the Italian National Centre for Disease Control supported a project involving three Italian regions: Friuli Venezia Giulia, Lazio and Campania. In Campania, a network of 49 hospitals willing to participate in the project was created. The project consisted of two phases: a survey on practice patterns concerning CDI and an epidemiological surveillance study. We identified a stringent need to improve awareness about CDI among the regional health-care community, as a widespread lack of surveillance programmes for CDI control was observed (existing in only 40% of participating facilities). Moreover, almost half of the participating hospitals (n=16, 43%) had no standardised procedures or protocols to control and prevent CDI. In the second phase of the study, we collected data of CDI cases during a six-month surveillance programme. In all, 87 CDI cases were observed, for a total of 903,334 patient bed-days and 122,988 admissions. According to the above data, CDI incidence was 0.96 cases/10000 patient bed-days, much lower than expected based on prior studies conducted elsewhere. The results of our study suggest CDI remains a rather neglected clinical issue in Campania. Despite a high burden of antimicrobial resistance and antimicrobial use in our geographic setting, we observed a very low incidence of CDI. Such a low incidence could be explained by underdiagnosis, but could also be related to actual diet, the lower patient age or the specific genetic background. However, further studies are warranted to either confirm or rebut the above hypotheses.

Tracheobronchial foreign body aspiration occurs rarely in adults and may go unrecognized for a long time, but early detection and immediate retrieval of the foreign body are essential to prevent major morbidity. We describe the case of an adult who unusually aspirated part of his dental prosthesis during an attempted strangulation, which was unacknowledged until 6 months later when he was hospitalized with acute respiratory failure and required an emergency surgical tracheotomy. The foreign body was successfully removed via flexible bronchoscopy.

Delivering prescription drugs directly to patients at the moment of discharge from the hospital is a useful tool for ensuring continuity in patient drug use, improving prescriptive appropriateness, limiting pharmaceutical expenditure and analyzing pharmacoepidemiological data. A project was therefore conducted from April 2005 to January 2007, at the G. Rumino hospital in Benevento (Italy), to encourage the direct delivery of drugs to patients upon discharge. The project consisted of various phases. Firstly, the medical records of all patients discharged from the hospital during April 2005 were analysed, mainly to collect information regarding discharge prescriptions, verify whether copies of the discharge form and prescription records were present in the chart, the type of drugs prescribed and whether these were available in the hospital pharmacy list of available drugs and had been dispensed to the patient. The percentage of drugs not available and of patients who did not pick up the prescribed drugs was calculated, critical aspects of the prescription process were analysed, and corrective measures implemented. A second evaluation of medical records was then performed for patients discharged in January 2007, to evaluate the effectiveness of the corrective measures applied. Results show that most discharged patients continue not to take advantage of the direct distribution of drugs in hospital and more information and communication to physicians and patients regarding this opportunity is required.

Sexually Transmitted Diseases (STDs) are a main problem in the public health policy. The importance of these diseases is not only limited to their high incidence but also to the complications they may cause and to their role in the HIV transmission. Control of STDs represents one of the main aims of the World Health Organization. For many years STDs were thought to have been almost completely eliminated; instead, recently the rates of STDs are increasing. This has prompted the search for control strategies, that, however, have shown to be difficult to implement. For this reason, prevention programs based on promotion of responsible sexual behaviour, early diagnosis and treatment, and reduction of infectiousness, have been implemented in many countries.

Case sheets are very important instruments for improving health care quality in hospitals. Despite their importance, they are very seldom used and filled in the right way. The study is based on an attempt to optimise case sheets editing; it implies multiple steps: 1. Project development; implementation of a pattern for assessing markers (thoroughness, clearness, reliability and record tracking); 2. Delivery of personal research protocols; 3. Early analysis, assessment of results; detection of severity; 4. Correctional interventions; 5. Secondary analysis; assessment of interventions. Although most indicators have shown an improvement, outcomes remain unsatisfactory, given the extent of shortfalls before intervention.