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2. COVID‐19 and Mental Health: A 'Pandemic Within a Pandemic'

Author

Fisicaro, Francesco, Lanza, Giuseppe, Concerto, Carmen, Rodolico, Alessandro, Di Napoli, Mario, Mansueto, Gelsomina, Cortese, Klizia, Mogavero, Maria P., Ferri, Raffaele, Bella, Rita, Pennisi, Manuela, Crusio, Wim E., Series Editor, Dong, Haidong, Series Editor, Radeke, Heinfried H., Series Editor, Rezaei, Nima, Series Editor, Steinlein, Ortrud, Series Editor, Xiao, Junjie, Series Editor, and Rosenhouse-Dantsker, Avia, Editorial Board Member

Published
2024
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3. Vagus Nerve Stimulation in Ischemic Stroke

Author

Andalib, Sasan, Divani, Afshin A., Ayata, Cenk, Baig, Sheharyar, Arsava, Ethem Murat, Topcuoglu, Mehmet Akif, Cáceres, Eder Leonardo, Parikh, Vinay, Desai, Masoom J., Majid, Arshad, Girolami, Sara, and Di Napoli, Mario

Published
2023
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6. Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative

Author

Sasanejad, Payam, Afshar Hezarkhani, Leila, Arsang-Jang, Shahram, Tsivgoulis, Georgios, Ghoreishi, Abdoreza, Barlinn, Kristian, Rahmig, Jan, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Borhani-Haghighi, Afshin, Sariaslani, Payam, Sharifi-Razavi, Athena, Ghandehari, Kavian, Khosravi, Alireza, Smith, Craig, Nilanont, Yongchai, Akbari, Yama, Nguyen, Thanh N, Bersano, Anna, Yassi, Nawaf, Yoshimoto, Takeshi, Lattanzi, Simona, Gupta, Animesh, Zand, Ramin, Rafie, Shahram, Pourandokht Mousavian, Seyede, Reza Shahsavaripour, Mohammad, Amini, Shahram, Kamenova, Saltanat U, Kondybayeva, Aida, Zhanuzakov, Murat, Macri, Elizabeth M, Nobleza, Christa O'Hana S, Ruland, Sean, Cervantes-Arslanian, Anna M, Desai, Masoom J, Ranta, Annemarei, Moghadam Ahmadi, Amir, Rostamihosseinkhani, Mahtab, Foroughi, Razieh, Hooshmandi, Etrat, Akhoundi, Fahimeh H, Shuaib, Ashfaq, Liebeskind, David S, Siegler, James, Romano, Jose G, Mayer, Stephan A, Bavarsad Shahripour, Reza, Zamani, Babak, Woolsey, Amadene, Fazli, Yasaman, Mojtaba, Khazaei, Isaac, Christian F, Biller, Jose, Di Napoli, Mario, and Azarpazhooh, M Reza

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Stroke, Brain Disorders, Clinical Research, Good Health and Well Being, Aged, Aged, 80 and over, COVID-19, Disability Evaluation, Europe, Female, Fibrinolytic Agents, Hospital Mortality, Humans, Infusions, Intravenous, Intracranial Hemorrhages, Iran, Ischemic Stroke, Male, Middle Aged, Risk Assessment, Risk Factors, Thrombolytic Therapy, Time Factors, Treatment Outcome, COVID 19, Thrombolytic therapy, Longitudinal study, Safety, Outcomes, Disability, Stroke severity, death, Neurology & Neurosurgery, Clinical sciences
Abstract

BackgroundThere is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.MethodsThis multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes.ResultsA total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054).ConclusionIV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

Published
2021

9. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results

Author

Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, PN, Akbari, Yama, Divani, Afshin A, Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Bin Basri, Hamidon, Iqbal, Omer M, Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N, Abootalebi, Shahram, Gupta, Animesh, Alet, Matias, Lattanzi, Simona, Desai, Masoom, Gagliardi, Rubens J, Girotra, Tarun, Inoue, Manabu, Yoshimoto, Takeshi, Isaac, Cristian Flavo, Mayer, Stephan A, Morovatdar, Negar, Nilanont, Yongchai, Nobleza, Christa O'Hana S, Saber, Hamidreza, Kamenova, Saltanat, Kondybayeva, Aida, Krupinski, Jerzy, Siegler, James E, Stranges, Saverio, Torbey, Michel T, Yorio, Diana, Zurrú, María Cristina, Rubinos, Clio Aracelli, Shahripour, Reza Bavarsad, Borhani-Haghighi, Afshin, Di Napoli, Mario, and Azarpazhooh, M Reza

Subjects
Stroke, Brain Disorders, Neurosciences, Patient Safety, Health and social care services research, 8.1 Organisation and delivery of services, Good Health and Well Being, Aged, Aged, 80 and over, Bayes Theorem, Brain Ischemia, COVID-19, Female, Hospital Mortality, Hospitalization, Humans, Interrupted Time Series Analysis, Intracranial Hemorrhages, Iran, Length of Stay, Male, Middle Aged, Outcome and Process Assessment, Health Care, Recovery of Function, Thrombolytic Therapy, Time Factors, Time-to-Treatment, Treatment Outcome, Epidemiology, Outcome, Mortality, Disability, Stroke care, Clinical Sciences, Neurology & Neurosurgery, Clinical sciences
Abstract

BackgroundThe emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran.MethodsThis study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model.ResultsDuring the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p

Published
2020

10. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE).

Author

Abootalebi, Shahram, Aertker, Benjamin M, Andalibi, Mohammad Sobhan, Asdaghi, Negar, Aykac, Ozlem, Azarpazhooh, M Reza, Bahit, M Cecilia, Barlinn, Kristian, Basri, Hamidon, Shahripour, Reza Bavarsad, Bersano, Anna, Biller, Jose, Borhani-Haghighi, Afshin, Brown, Robert D, Campbell, Bruce Cv, Cruz-Flores, Salvador, De Silva, Deidre Anne, Di Napoli, Mario, Divani, Afshin A, Edgell, Randall C, Fifi, Johanna T, Ghoreishi, Abdoreza, Hirano, Teruyuki, Hong, Keun-Sik, Hsu, Chung Y, Huang, Josephine F, Inoue, Manabu, Jagolino, Amanda L, Kapral, Moira, Kee, Hoo Fan, Keser, Zafer, Khatri, Rakesh, Koga, Masatoshi, Krupinski, Jerzy, Liebeskind, David S, Liu, Liping, Ma, Henry, Maud, Alberto, McCullough, Louise D, Meyer, Dawn Matherne, Mifsud, Victoria, Morovatdar, Negar, Nilanont, Yongchai, Oxley, Thomas J, Özdemir, Atilla Özcan, Pandian, Jeyaraj, Pantoni, Leonardo, Papamitsakis, Nikolaos IH, Parry-Jones, Adrian, Phan, Thanh, Rodriguez, Gustavo, Romano, Jose G, Sabaa-Ayoun, Ziad, Saber, Hamidreza, Sasannezhad, Payam, Saver, Jeffrey L, Scharf, Eugene, Shuaib, Ashfaq, Silver, Brian, Singhal, Shaloo, Smith, Craig J, Stranges, Saverio, Sylaja, PN, Torbey, Michel, Toyoda, Kazunori, Tsivgoulis, Georgios, Wasay, Mohammad, Yassi, Nawaf, Yoshimoto, Takeshi, Zamani, Babak, and Zand, Ramin

Subjects
Humans, Pneumonia, Viral, Coronavirus Infections, Treatment Outcome, Hospitalization, Registries, Incidence, Hospital Mortality, Risk Factors, Retrospective Studies, Prospective Studies, Comorbidity, Time Factors, Stroke, Healthcare Disparities, Host-Pathogen Interactions, Pandemics, Interrupted Time Series Analysis, Practice Patterns, Physicians', Betacoronavirus, COVID-19, SARS-CoV-2, Health policy, Mortality, National crisis, Pandemic, Pneumonia, Viral, Practice Patterns, Physicians', Physicians, Neurology & Neurosurgery, Clinical Sciences, Neurosciences
Abstract

Background and purposeThe novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.MethodsThis is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center.ConclusionThe proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Published
2020

15. Brain Vascular Expression of Monomeric C-Reactive Protein Is Blocked by C10M Following Intraperitoneal Injection in an ApoE-/- Murine Model of Dyslipidemia: An Immunohistochemical Analysis

Author

Pastorello, Ylenia, Russo, Aurelio Pio, Bănescu, Claudia, Caprio, Vittorio, Gáll, Zsolt, Potempa, Lawrence, Cordoș, Bogdan, Di Napoli, Mario, Slevin, Mark, Pastorello, Ylenia, Russo, Aurelio Pio, Bănescu, Claudia, Caprio, Vittorio, Gáll, Zsolt, Potempa, Lawrence, Cordoș, Bogdan, Di Napoli, Mario, and Slevin, Mark

Abstract

Introduction The neurovascular unit (NVU), comprising vascular and glial cells along with neurons, is vital for maintaining the blood-brain barrier (BBB) and cerebral homeostasis. Dysfunction of the NVU is implicated in key neurodegenerative disorders such as Alzheimer's disease (AD). Monomeric C-reactive protein (mCRP), the dissociated form of native, pentameric C-reactive protein (pCRP), is associated with enhanced pro-inflammatory responses in the vascular system, leading to increased permeability and potential NVU disruption. Methods This study utilized ApoE-/- mice receiving a high-fat diet which were injected intraperitoneally with either mCRP or mCRP together with a small molecule inhibitor (C10M) and investigated the deposition of mCRP and CD105 expression in the brain parenchyma and its localization within the microvasculature. Results Histological analysis revealed significant mCRP deposition in brain microvessels and neurons, indicating potential disruption of the BBB and neuronal damage. Moreover, co-administration of C10M effectively blocked mCRP accumulation in the brain parenchyma, suggesting its potential as a therapeutic agent for effectively inhibiting inflammation-associated degenerative changes. Immunohistochemical staining demonstrated co-localization of mCRP with CD105, indicating potential angiogenic activation and increased susceptibility to inflammatory insult. Discussion These findings provide evidence supporting the potential role of mCRP as a contributor to neuroinflammation in individuals with chronic systemic inflammation. Conclusion Further studies in human subjects should help validate the efficacy of C10M in preventing or halting neurodegeneration in conditions such as AD and stroke-associated dementia.

Published
2024

21. 12 versus 24 h bed rest after acute ischemic stroke thrombolysis: a preliminary experience

Author

Silver, Brian, Hamid, Tariq, Khan, Muhib, Di Napoli, Mario, Behrouz, Reza, Saposnik, Gustavo, Sarafin, Jo-Ann, Martin, Susan, Moonis, Majaz, Henninger, Nils, Goddeau, Richard, Jun-O'Connell, Adalia, Cutting, Shawna M., Saad, Ali, Yaghi, Shadi, Hall, Wiley, Muehlschlegel, Susanne, Carandang, Raphael, Osgood, Marcey, Thompson, Bradford B., Fehnel, Corey R., Wendell, Linda C., Potter, N. Stevenson, Gilchrist, James M., and Barton, Bruce

Published
2020
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