ObjectivesThe pandemic caused by the new coronavirus (COVID-19) has changed care activities of health professionals. We analysed the possible association between the appearance of ‘de novo’ headache according to the type of mask used, the related factors and the impact of the cephalalgia on health professionals.MethodsCross-sectional study in a tertiary hospital in Extremadura, Spain. We provided an online questionnaire to healthcare workers during the period of maximum incidence of COVID-19 in our setting.ResultsThe subjects are n=306, 244 women (79.7%), with an average age of 43 years (range 23–65). Of the total, 129 (42.2%) were physicians, 112 (36.6%) nurses and 65 (21.2%) other health workers. 208 (79.7%) used surgical masks and 53 (20.3%) used filter masks. Of all those surveyed, 158 (51.6%) presented ‘de novo’ headache. The occurrence of a headache was independently associated with the use of a filter mask, OR 2.14 (95% CI 1.07 to 4.32); being a nurse, OR 2.09 (95% CI 1.18 to 3.72) or another health worker, OR 6.94 (95% CI 3.01 to 16.04); or having a history of asthma, OR 0.29 (95% CI 0.09 to 0.89). According to the type of mask used, there were differences in headache intensity, and the impact of a headache in the subjects who used a filter mask was worse in all the aspects evaluated.ConclusionThe appearance of ‘de novo’ headache is associated with the use of filter masks and is more frequent in certain healthcare workers, causing a greater occupational, family, personal and social impact.
BACKGROUND AND PURPOSE:The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis. MATERIALS AND METHODS:We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-fourmonth clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared. RESULTS:One hundred forty-one patients were included. Forty-four carotid artery stent placement and 23 carotid endarterectomy procedures were performed within 6 months after the event. Complete revascularization was achieved in 83.6%, 81.8% in the carotid artery stent placement group and 87% with carotid endarterectomy (P ¼ .360). Periprocedural stroke or death occurred in 6% (carotid artery stent placement ¼ 2.3%; carotid endarterectomy ¼ 13%; P ¼ .077) and was not related to revascularization failure. The carotid restenosis or occlusion rate was 8.3% (5% restenosis, 3.3% occlusion); with carotid artery stent placement it was 10.5%; and with carotid endarterectomy it was 4.5% (P ¼ .419). The 24-month cumulative rate of ipsilateral stroke was 4.8% in the carotid artery stent placement group, 17.4% for carotid endarterectomy, and 13.1% for medical treatment (P ¼ .223). Mortality was 12%, 4.5%, and 5.6%, respectively (P ¼ .422). Revascularization failure and restenosis occurred more frequently in patients with full collapse compared with patients without full collapse (33.3% versus 5.6%, P ¼ .009; 21.4% versus 2.9%, P ¼ .032, respectively).CONCLUSIONS: Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment. ABBREVIATIONS: CAS ¼ carotid artery stent placement; CEA ¼ carotid endarterectomy; CHS ¼ cerebral hyperperfusion syndrome; CNO ¼ carotid nearocclusion; IQR ¼ interquartile range T he treatment of symptomatic carotid near-occlusion (CNO) is controversial. Post hoc analyses of the NASCET and the European Carotid Surgery Trial (ECST) conducted in the 1990s revealed that the risk of recurrent stroke could be lower in
SARS-CoV-2 is one more virus that can affect the brain in one way or another. Now, we are only beginning to understand some mechanisms and the degree to which it can impact the nervous system. Considering the rapid accumulation of knowledge about multiple neurological and cognitive symptoms in COVID-19 patients, it seems useful to encourage the development of systematic approaches for the diagnosis, management and treatment of the cognitive aspects of COVID-19. From what is known at this time about the impact of COVID-19 on the brain, the presentation of long-term cognitive sequelae can be expected to be heterogeneous in nature and will depend at least in part on the severity of the disease at the stage acute COVID-19. The long-term essential characteristics of these sequelae will probably be related to a combination of causes and different neuropathological processes in the acute phase. The scope and severity of the current COVID-19 pandemic are unparalleled in modern society. The later implications for neurological function can be just as serious. Although the current focus is on the management of acute diseases, in the near future the focus should be on the long-term consequences of COVID-19 infection and its mitigation, hence the need for the development of systematic approaches for the management of the cognitive and neuropsychiatric aspects of COVID-19.
Background: In-stent thrombosis after mechanical thrombectomy (MT) worsen outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Although an optimal antiplatelet therapy is needed, the best approach to avoid in-stent thrombosis is yet to be elucidated. Hypothesis: Low-dose intravenous tirofiban is superior to intravenous aspirin in avoiding in-stent thrombosis in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. Methods: The ATILA-trial is a multicenter, prospective, phase IV, randomized, controlled (aspirin group as control), assessor-blinded clinical trial. Patients fulfilling inclusion criteria (AIS due to TL, ASPECTS ⩾ 6, pre-stroke modified Rankin Scale ⩽2 and onset <24 h) will be randomized (1:1) at MT onset to experimental (intravenous tirofiban) or control group (intravenous aspirin). Intravenous aspirin will be administered at a 500 mg single dose and tirofiban at a 500 µg bolus followed by a 200 µg/h infusion during first 22 h. All patients will be followed up to 3 months. Sample size estimated is 240 patients. Outcomes: The primary efficacy outcome is the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. The primary safety outcome is the rate of symptomatic intracranial hemorrhage. Secondary outcomes include functional independence defined as modified Rankin Scale 0–2, proportion of patients undergoing rescue therapy due to in-stent aggregation during MT and carotid reocclusion at 30 days. Discussion: ATILA-trial will be the first clinical trial regarding the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. Trial registration: NCT0522596.
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