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25 results on '"Di Napoli, Mario"'

7. Statin Therapy and Outcome After Ischemic Stroke: Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials

Author

Ní Chróinín, Danielle, Asplund, Kjell, Åsberg, Signild, Callaly, Elizabeth, Cuadrado-Godia, Elisa, Díez-Tejedor, Exuperio, Di Napoli, Mario, Engelter, Stefan T., Furie, Karen L., Giannopoulos, Sotirios, Gotto, Antonio M., Jr, Hannon, Niamh, Jonsson, Fredrik, Kapral, Moira K., Martí-Fàbregas, Joan, Martínez-Sánchez, Patricia, Milionis, Haralampos J., Montaner, Joan, Muscari, Antonio, Pikija, Slaven, Probstfield, Jeffrey, Rost, Natalia S., Thrift, Amanda G., Vemmos, Konstantinos, and Kelly, Peter J.

Published
2013
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11. Evaluation of C-Reactive Protein Measurement for Assessing the Risk and Prognosis in Ischemic Stroke: A Statement for Health Care Professionals From the CRP Pooling Project Members

Author

Di Napoli, Mario, Schwaninger, Markus, Cappelli, Roberto, Ceccarelli, Elena, Di Gianfilippo, Giacinto, Donati, Cristina, Emsley, Hedley C.A., Forconi, Sandro, Hopkins, Stephen J., Masotti, Luca, Muir, Keith W., Paciucci, Anna, Papa, Francesca, Roncacci, Sabina, Sander, Dirk, Sander, Kerstin, Smith, Craig J., Stefanini, Alessandro, and Weber, Daniela

Published
2005
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12. Microbiological Etiologies of Pneumonia Complicating Stroke: A Systematic Review

Author

Kishore, Amit K, Vail, Andy, Jeans, Adam R, Chamorro, Angel, Di Napoli, Mario, Kalra, Lalit, Langhorne, Peter, Roffe, Christine, Westendorp, Willeke, Nederkoorn, Paul J, Garau, Javier, van de Beek, Diederik, Montaner, Joan, Woodhead, Mark, Meisel, Andreas, Smith, Craig J, Pneumonia in Stroke Consensus (PISCES) Group, ACS - Atherosclerosis & ischemic syndromes, Amsterdam Neuroscience - Neuroinfection & -inflammation, Amsterdam Neuroscience - Neurovascular Disorders, and Neurology

Subjects
medicine.medical_specialty, medicine.drug_class, Antibiotics, Brain Ischemia, 03 medical and health sciences, Broad spectrum, 0302 clinical medicine, medicine, pneumonia, Humans, 030212 general & internal medicine, Intensive care medicine, bacteria, Stroke, Advanced and Specialized Nursing, business.industry, Pneumonia, medicine.disease, infection, Systematic review, Etiology, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery
Abstract

Background and Purpose— Identifying the causal pathogens of pneumonia complicating stroke is challenging, and antibiotics used are often broad spectrum, without recourse to the microbiological cause. We aimed to review existing literature to identify organisms responsible for pneumonia complicating stroke, before developing a consensus-based approach to antibiotic treatment. Methods— A systematic literature review of multiple electronic databases using predefined search criteria was undertaken, in accordance with Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Published studies of hospitalized adults with ischemic stroke, intracerebral hemorrhage, or both, which identified microbiological etiologies for pneumonia complicating stroke up to January 1, 2017, were considered. Analysis included summary statistics and random-effects meta-analysis where appropriate. Results— Fifteen studies (40% ischemic stroke, 60% ischemic stroke and intracerebral hemorrhage) involving 7968 patients were included. Reported occurrence of pneumonia varied considerably between studies (2%–63%) with a pooled frequency of 23% (95% confidence interval, 14%–34%; I 2 =99%). Where reported (60%), the majority of pneumonia occurred within 1 week of stroke (78%). Reported frequency of positive culture data (15%–88%) varied widely. When isolated, aerobic Gram-negative bacilli (38%) and Gram-positive cocci (16%) were most frequently cultured; commonly isolated organisms included Enterobacteriaceae (21.8%: Klebsiella pneumoniae , 12.8% and Escherichia coli , 9%), Staphylococcus aureus (10.1%), Pseudomonas aeruginosa (6%), Acinetobacter baumanii (4.6%), and Streptococcus pneumoniae (3.5%). Sputum was most commonly used to identify pathogens, in isolation (40%) or in conjunction with tracheal aspirate (15%) or blood culture (20%). Conclusions— Although the analysis was limited by small and heterogeneous study populations, limiting determination of microbiological causality, this review suggests aerobic Gram-negative bacilli and Gram-positive cocci are frequently associated with pneumonia complicating stroke. This supports the need for appropriately designed studies to determine microbial cause and a consensus-based approach in antibiotic usage and further targeted antibiotic treatment trials for enhanced antibiotic stewardship.

Published
2017
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25. Angiotensin-converting enzyme inhibitor use is associated with reduced plasma concentration of C-reactive protein in patients with first-ever ischemic stroke.

Author

Di Napoli M and Papa F

Subjects
Aged, Anticoagulants therapeutic use, Blood Pressure drug effects, Brain Ischemia complications, Female, Follow-Up Studies, Humans, Male, Multivariate Analysis, Prospective Studies, Risk Assessment, Risk Factors, Stroke complications, Survival Analysis, Treatment Outcome, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Brain Ischemia blood, Brain Ischemia drug therapy, C-Reactive Protein analysis, Stroke blood, Stroke drug therapy
Abstract

Background and Purpose: High levels of C-reactive protein (CRP) are associated with an increased risk of future cardiovascular events in ischemic stroke. It has been hypothesized that the benefit of angiotensin-converting enzyme (ACE) inhibitors in patients at high vascular risk may also result from their anti-inflammatory action. Data evaluating this hypothesis are limited in ischemic stroke., Methods: We conducted a prospective observational study in 507 patients with first-ever ischemic stroke to analyze the effect of ACE inhibitor treatment at the time of stroke onset on CRP levels within the first 24 hours and the relationship to outcome. Risk estimates were calculated according to Cox regression analysis controlled for blood pressure (BP) levels, clinical and neuroradiological confounding variables, and log-normalized CRP levels at entry., Results: ACE inhibitor treatment was associated with lower (2.6-fold; P<0.0001) median CRP levels and with a reduced 2-year cardiovascular risk (hazard ratio, 0.39; 95% CI, 0.29 to 0.53; P<0.0001) compared with a different BP-lowering regimen. The relationship between ACE inhibitor status and log-normalized CRP levels remained significant (P<0.0001) after we controlled for important confounding variables and concomitant treatments. The reduced risk was also evident in multivariable analysis when ACE inhibitor treatment was controlled for BP, associated risk factors, neuroradiological findings, and concomitant treatments (hazard ratio, 0.43; 95% CI, 0.30 to 0.62; P<0.0001). This risk reduction was greatly attenuated and not more significant when log-normalized CRP levels were included (hazard ratio, 0.67; 95% CI, 0.43 to 1.04; P=0.0721) in the model., Conclusions: Concomitant treatment with ACE inhibitor at the time of an acute stroke is associated with lower inflammatory response and better long-term outcomes, apparently apart from the effects on BP.

Published
2003
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