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Schermata 2017-06-24 alle 20.56.41.pngThe issue of stroke is particularly noticeable in neurology due to the high prevalence rate and serious consequences. Accordingly, telenurology is also intensively concerned with this disease pattern and attempts to contribute to medical progress in the field of neurology, using knowledge of the use of modern technologies. In Thuringia, the stroke telemedicine network "SATELIT" has existed for almost 5 years and has shown during this time that telemedical developments and application can help to contribute to the improvement of care quality in neurological diseases by means of computer-supported communication and network technologies. In Umbria, Italy a stroke network was successfully deployed since 2016 using fix units in the west of the county and mobile units in the earthquake area to the east. In addition to acute stroke treatment, the German Society for Telemedicine, in cooperation with the Hans Berger Clinic for Neurology at the University Hospital of Jena, will also be discussing with the First German Telenurology Congress the health policy and socio-political significance of the Telemedicine in neurology. The conference is aimed at clinicians, doctors, nurses, therapists and costumers as well as companies interested in current medical developments in the field of neurology, rehabilitation and aftercare. The focus of the 2017 Congress will be telemedicine in stroke care as the most important field of application. Other neurological applications such as dizziness, Parkinson's disease, or epilepsy are also being investigated. In addition, telemedicine products and latest developments are presented in an accompanying industrial exhibition.
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The regional Neurology meeting re-opened the issue of local pathways to thrombectomy. The access to most advanced techniques seems slowed by ETS procedures and lack of full week coverage 7/7.

Rapido

An awarness campaign in Italy by ARS and ALICE. Just developed a leaflet to help recognizing warning signs

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data from the ministery of health for central italy

So far it was a secret given to word of mouth among health professionals. The new Guide to Health Focus, now in its third edition with the most current data, it also recognizes the right of patients to know which are the most reliable centers to turn to be taken care of in the best way.Of course, hard to choose when you have a heart attack or a stroke: it relies on the ETS and it is hoped that in their region and in their local health healthcare is efficient.

Background

The SOCRATES study compares ticagrelor versus aspirin for the prevention of major vascular events in patients with acute ischemic stroke or transient ischemic attack [1,2].

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SOCRATES (Acute Stroke Or Transient IsChaemic Attack TReated with Aspirin or Ticagrelor and Patient OutcomES) is a global clinical trial involving 9,600 patients who have experienced an acute ischemic stroke or transient ischemic attack (TIA). Annually, 15 million people worldwide suffer a stroke of this type. Ischemic strokes occur as a result of an obstruction of a vessel supplying blood to the brain. A TIA is secondary to a temporary insufficient blood supply to parts of the brain and is often considered a warning sign that a stroke may follow.

SOCRATES is a randomized, parallel group study evaluating the efficacy of ticagrelor compared to aspirin in reducing major vascular events (composite of all-cause mortality, myocardial infarction [MI], and stroke) in patients with acute ischemic stroke (NIHSS ≤ 5) and TIA.

Also announced today is the initiation of THEMIS (Effect of Ticagrelor on Health Outcomes in DiabEtes Mellitus Patients Intervention Study), a global clinical trial involving 17,000 patients with Type 2 diabetes at high risk of cardiovascular (CV) events. Of the 340 million people who suffer from the disease, 90 percent have type 2 diabetes and 50 percent of whom die from CV disease.

“A major goal of treating patients with diabetes is to reduce their cardiovascular risk,” said THEMIS study co-chair Deepak L. Bhatt, MD, MPH, Professor of Medicine at Harvard Medical School and Senior Physician at Brigham and Women’s Hospital.

“THEMIS will allow us to test a bold new strategy in the care of patients with diabetes who are at high risk of myocardial infarction, stroke, and cardiovascular death,” stated THEMIS study co-chair Ph. Gabriel Steg, MD, Professor of Medicine at Université Paris-Diderot and Director of the Coronary Care Unit at Hôpital Bichat.

THEMIS is an event-driven, randomized, parallel group study evaluating the efficacy of long-term treatment with ticagrelor versus placebo for the prevention of major CV events – the composite of CV death, MI or stroke – in patients with Type 2 diabetes without a history of previous MI or stroke but with documented coronary atherosclerosis.

SOCRATES and THEMIS will be monitored by Independent Data Monitoring Committees who will review the safety and efficacy of treatments in these trials. The trials will be conducted in accordance with Good Clinical Practice. Both studies will be posted on clinicaltrials.gov in the near future.

AstraZeneca is currently collaborating with over 4,000 clinical investigators in more than 30 countries as part of the PARTHENON program, and has established partnerships with a number of pre-eminent research institutions. Other studies in the PARTHENON program include PEGASUS, studying BRILINTA for secondary prevention in patients with previous myocardial infarction, and EUCLID studying patients with Peripheral Artery Disease.

PARTHENON will provide an unparalleled dataset to build scientific understanding of BRILINTA in a broad a range of atherothrombotic conditions. AstraZeneca has approved more than 100 investigator sponsored studies, which will be starting during the coming year.

BRILINTA is currently not approved for the treatment of patients with ischemic stroke, TIA, peripheral artery disease, or for secondary prevention in patients with a history of previous myocardial infarction.

BRILINTA Indications

BRILINTA is indicated to reduce the rate of thrombotic cardiovascular (CV) events in patients with ACS (unstable angina [UA], non–ST-elevation myocardial infarction [NSTEMI], or ST-elevation myocardial infarction [STEMI]). In PLATO, BRILINTA has been shown to reduce the rate of a combined end point of CV death, myocardial infarction (MI), or stroke compared to clopidogrel. In PLATO, the difference between treatments was driven by CV death and MI with no difference in stroke. In patients treated with an artery-opening procedure known as percutaneous coronary intervention (PCI), BRILINTA reduces the rate of stent thrombosis.

BRILINTA has been studied in ACS in combination with aspirin. Maintenance doses of aspirin above 100 mg decreased the effectiveness of BRILINTA. Avoid maintenance doses of aspirin above 100 mg daily.

References

1.Giacalone G, Abbas MA, Corea F. Prevention strategies for cardioembolic stroke: present and future perspectives. Open Neurol J. 2010; 4:56-63. doi: 10.2174/1874205X01004020056.

2.Silvestrelli G, Corea F, Micheli S, Lanari A. Clinical pharmacology and vascular risk.Open Neurol J. 2010;4:64-72. doi: 10.2174/1874205X01004020064.

Neurology meeting in Perugia under the patronage of the Società Italiana di Neurologia. Hosted by the Neurolgy Department University of Perugia, Paolo Calabresi, Aroldo Rossi, Lucilla Parnetti, Nicola Tambasco.
First ever as far as i know. I can remember in 1996 a joint tosco-umbro meeting at palazzo Murena.

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Video Salute – Corriere TV.

 

A survey by the Corriere della Sera on the so-called “Zamboni method” for the treatment of multiple sclerosis has evoked many reactions. Professor Giancarlo Comi, President of the Italian Society of Neurology clarifies his point of view on the matters in controversy, noting that the data currently available suggest that the assumptions underlying the method (which is the unblocking of the jugular veins intravascularly) not have sufficient basis

Consiglio Superiore della Sanità Officiers

The largest ever Italian survey on 10-mortality rates for stroke was released this july by the large diffusion media Focus.

The survey was published after a governamental commision made available to journalist raw epidemiological data.

The list of smallest and high mortality Stroke centres is available on line as well. It is up to the political level the decision to keep this state of things or force resources to the best stroke-care provider.

 

 

 

 

 

The PREvention of VENous Thromboembolism In Hemorrhagic Stroke patients (PREVENTIHS) study started in june.

An Italian national  randomized open label trial, with blind follow on LMWH vs standard care in primary prevention of DVT or PE in hemorrhagic stroke. Coordinated by the Stroke Unit of Perugia University. Enrollement time 2 years planned size for 240 patients.

Participating centres:

Dipartimento di Medicina interna, Varese,

Stroke Unit, Reggio Emilia,

Medicina Interna,Ferrara,

Medicina Interna, Cecina,

Stroke Unit, Mantova,

Medicina Interna Vimercate,

Stroke Unit, Bologna

Unità Ictus San Giovanni Battista, Foligno.

 

 

 

 

According to non official sources the national health care authorities in the last week abolished the formal need of triple form transcription in order to prescribe Clopidogrel for secondary prevention in non cardioembolic stroke. The need of a specialist to prescribe the drug with a so called “piano terapeutico” forced patients and stroke doctors to extra useless work.