PubMed Health⌕ Search

Biomedical subjects

E Duca

Publications and source records attributed to E Duca.

At least 19 recordsLinked to original sources
PubMed1993

Stroke care in the next decades: a projection derived from a community-based study in Umbria, Italy.

Recently published data show that stroke incidence is not longer declining, while case fatality rates has had a less pronounced fall in recent years than in the past. Projections of the increasing number of elderly people, combined with the greater risk of stroke in old age, suggest that in the forthcoming decades we will be faced with an increased request of health resources for patients with stroke. We have therefore used data from a community-based study on stroke incidence and outcome to project the number of first ever strokes, death from stroke and handicap from stroke in Italy, up to the year 2016. Results show that incidence will increase by 22.2%, and death at 6 months from first ever stroke by 29%. However, since patients already handicapped for other reasons are more likely to die from their stroke, the net number of newly handicapped persons will only increased by 5%. These results suggest that in the next decades the major increase in request of health care resources will result from the acute event and the immediate post-ictal phase, and not from the management of chronic handicap after a stroke.

Aged↗
PubMed1993

Silent brain infarctions in patients with first-ever stroke. A community-based study in Umbria, Italy.

BACKGROUND AND PURPOSE: The relative frequency of computed tomographic evidence of old cerebral infarctions without prior history of stroke, and their effect on short- and long-term outcome of patients with first-ever ischemic stroke, are currently unknown. Silent infarctions may relate to specific risk factors and may influence the rate of survival free of handicap. METHODS: We studied the prevalence of such lesions in patients registered with SEPIVAC, a community-based survey of stroke incidence and outcome in the Sixth Local Health Unit of Umbria, Italy. Of 375 first-ever strokes, 209 patients with cerebral infarction (computed tomogram done within 30 days after the stroke) were included in this study. Computed tomograms were reviewed blindly, and cases were classified as having a single lesion or multiple lesions; in the latter case, it was assumed that at least one silent brain infarction was present. The two groups were compared in terms of risk factors and outcome. To avoid a selection bias, these patients were also compared with 68 patients who were not submitted to computed tomography but were judged on clinical grounds to have a > 90% probability of having suffered a cerebral infarction. RESULTS: Risk factors and outcome did not differ between patients without and with a computed tomogram. In the latter group, 80 patients (38.3%; 95% confidence interval, 31.7%-44.9%) had silent brain infarction. Male sex (odds ratio, 1.84; 95% confidence interval, 1-3.4), ischemic changes on an electrocardiogram (odds ratio, 2.5; 95% confidence interval, 1.3-4.9), and--in the multivariate analysis--hypertension (odds ratio, 1.46; 95% confidence interval, 1.1-2) were significantly more frequent in these patients. Outcome at 1, 6, and 12 months was not influenced by the presence of silent infarctions. CONCLUSIONS: This community-based study shows that silent brain infarctions in patients with first-ever stroke are not significantly related to risk factors commonly described in hospital-based series (atrial fibrillation, transient ischemic attack, etc.); rather, silent infarctions seem to be a marker of widespread vascular disease.

Aged↗
PubMed1992

Diurnal and seasonal variations in the occurrence of stroke: a community-based study.

Several hospital-based studies suggest a circadian rhythm for stroke, with a peak of onset in the morning. To verify whether these results could be confirmed in a community-based study, we used data from the SEPIVAC, a community-based stroke register in Umbria, Italy. Cerebral infarctions (48%), primary intracerebral hemorrhages (54%), subarachnoid hemorrhages (53%) and 'not known' strokes (51%) were all more common between 6 a.m. and noon, and this peak was still present when strokes recognized on awakening were evenly redistributed over the sleep period. Looking at the subgroups of cerebral infarction, lacunar syndromes were more common during sleep. Cerebral infarctions were more frequent during winter, and primary intracerebral hemorrhages during autumn.

Cerebral Hemorrhage↗
PubMed1992

Was it infarction or haemorrhage? A clinical diagnosis by means of the Allen score.

Since the clinical distinction between haemorrhagic and ischaemic stroke cannot be achieved with a simple clinical evaluation, and it is virtually impossible to submit all stroke patients to CT, a weighted clinical score may offer some advantages to physicians who are involved in stroke management. The Allen score (also referred to as the Guy's Hospital score), a validated clinical score, has been tested in two different clinical settings, comprising 289 patients. When only the values under 4 and those over 24 are taken into account (i.e. greater than 90% probability of ischaemia and haemorrhage), the global accuracy of the score is 97%, and the diagnostic gain (given a pretest probability for haemorrhage of 11% and a likelihood ratio of 194) is 85%. Therefore, we conclude that this simple clinical method can be used for epidemiological studies of stroke incidence and outcome, as well as for a first bedside screening to decide which patients should have priority for CT.

Cerebral Hemorrhage↗
PubMed1991

A community-based study of incidence, risk factors and outcome of transient ischaemic attacks in Umbria, Italy: the SEPIVAC study.

The SEPIVAC study is a community-based epidemiological survey of incidence and outcome of transient ischaemic attacks (TIAs) and strokes in the territory of the 6th Local Health Unit, Umbria, Italy, where 49,218 people live, from 1 September 1986 to 31 August 1989. All cases were registered with the study either by notification from general practitioners (GPs) or by a check of hospital admission within the study area and in the two hospitals of Perugia. There were 94 incident cases of TIAs (45 males, 49 females), thus giving a crude rate of 0.64 per 1000 per year [95% conficence intervals (CI) 0.52/0.78]. The rate adjusted to the European population is 0.42 (CI 0.33/0.54). Mean age was 69.4 years, and females were significantly older than males. The weighted relative risk for males was 1.19 (CI 0.79/1.79). Thirty-one patients were treated at home by their GPs. Females had hypertension more frequently than males, whereas males smoked more frequently; we did not find any other statistically significant difference in the distribution of risk factors. Twelve patients out of 58 who had CT had an infarct, and 29 out of 54 submitted to Doppler ultrasonography had carotid stenosis. At 1 month, 4 patients had suffered an ischaemic stroke, 1 of whom died. At 6 months, 3 further strokes and 2 further deaths (1 due to myocardial infarction) had occurred.

Aged↗
PubMed1991

SEPIVAC: a community-based study of stroke incidence in Umbria, Italy.

The SEPIVAC study is a community-based epidemiological survey of incidence and outcome of acute cerebrovascular disease in the Sixth Local Health Unit, Umbria, Italy (population 49,218). The study was carried out from 1 September 1986 to 31 August 1989. There were 375 patients who were registered with a first ever stroke, with a crude rate of 2.54 (95% confidence limits 2.29-2.81) per 1000 per year; the rate adjusted to the European population is 1.55 (CL 1.36-1.77). The age adjusted relative risk for males is 1.35 (CL 1.10-1.66). Up to 15% of the patients were not admitted to hospital during the acute phase of their disease. At least 286 (76.3%, CL 72-80.6) of the cases were due to cerebral ischaemia; in 56 of these (19.6%, CL 15-24.2) a clinical diagnosis of lacunar ischaemia was made. The 30 day case fatality rate was 20.3% (CL 16.2-24.3); between one and six months 7.5% (CL 5-10.6) of patients died.

Aged↗
PubMed1989

First-year results of a community-based study of stroke incidence in Umbria, Italy.

The SEPIVAC study (Italian initials for "epidemiologic study of incidence of acute cerebrovascular disease") is a community-based epidemiologic survey of incidence and outcome of cerebrovascular disease in the territory of the 6th Local Health Unit, Umbria, Italy, where 49,101 people live. All cases were registered with the study either by notification from general practitioners or by check of hospital admission within the study area and in the two hospitals of Perugia. Death certificates were looked at as well. Patients were registered with the study when the clinical picture fulfilled the definition of stroke and transient ischemic attack (TIA) adopted for this study. Patients were followed up at approximately 30 days and 6 months. During the first year of the study (September 1, 1986 to August 31, 1987), 189 cases were registered: 108 suffered a "first ever in a lifetime" stroke, 30 a recurrent stroke, and 51 a "first ever in a lifetime" transient ischemic attack. Sixty-one percent of patients (71% of first strokes) had a computed tomography scan. For our study, the crude annual incidence rate of first stroke was 2.2 per 1,000 (confidence intervals 1.81-2.66); the standardized rate to the European population was 1.36 (confidence intervals 1.06-1.74). At least 83% of first strokes were due to cerebral ischemia; in 26 cases a clinical diagnosis of lacunar ischemia was made. The 30-day case fatality rate was 21%; 25% of our patients had recovered completely or almost completely after 1 month.

Cerebrovascular Disorders↗
PubMed1979

Single haemolysis for the assay of antibodies to some haemagglutinating arboviruses.

The single radial haemolysis reaction has been shown to be suitable for the quantitative assay of specific antibody to West Nile and Sindbis viruses. Only 5 mul of undiluted serum are needed for the test, which can be performed on crude preparations of antigen and without removal of nonspecific inhibitors. It is therefore a very simple procedure. Moreover, it appears to be more specific than the classical haemagglutination-inhibition tests.

Animals↗