Dissecting the Spectrum of Stroke Risk Factors in an Apparently Healthy Population: Paving the Roadmap to Primary Stroke Prevention.

We aimed to investigate, for the first time, the spectrum of stroke risk factors specific to the population of the Republic of Moldova. The subjects were examined according to a pre-established protocol of risk factor estimation. The study involved 300 subjects, including 60% women and 40% men, with a mean age of 49.9 ± 14.5 years. The most common risk factor was abdominal obesity, identified in 75% of subjects; general obesity was detected in 48%, while 32% of subjects were overweight and 20% were normally weighted. Hypertension was observed in 44%; 8% of those examined had atrial fibrillation, and 9% had diabetes mellitus. Left myocardial hypertrophy on ECG was present in 53% of subjects, and acute ischemic changes in 2%. Laboratory observations detected that glycosylated hemoglobin increased by 7%, and >50% had dyslipidemia. Total cholesterol was significantly elevated by 58%, LDL-cholesterol was increased by 32%, and HDL-cholesterol was decreased by 9%. Homocysteine was increased in 55% and high-sensitivity C-reactive protein in 28% of subjects. These results indicate the presence of modifiable risk factors and the necessity to elaborate on the primary prevention strategies aimed at minimizing the burden of stroke in the population of the Republic of Moldova.

Multinational perspectives on changes to psychiatric care during the COVID-19 pandemic: a survey of practicing psychiatrists.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant upheaval in psychiatric care. Despite survey data collected from psychiatric patients and broad samples of individuals in single countries, there is little quantitative or qualitative data on changes to psychiatric care from the perspective of mental health providers themselves across developing countries. METHODS: To address this gap, we surveyed 27 practicing psychiatrists from Central and Eastern Europe, as well as Africa, the Middle East, and Latin America. RESULTS: Respondents observed a marked increase in anxiety in their patients, with increased (though less prominent) symptoms of depression, somatization, and addiction. They reported largescale changes in the structure of psychiatric treatment, chiefly a decline in psychiatric admissions and closing/repurposing of psychiatric beds. Results supported strong "buy in" from clinicians regarding the use of telehealth, though some clinicians perceived a reduction in the ability to connect with, and build alliances with, their patients. Finally, clinicians described an improvement in the image and meaning of psychiatry in society, increased awareness of mental illness, and greater value placed on mental health in the general population. CONCLUSIONS: These changes warrant further empirical study as to their potential long-term ramifications, particularly as the COVID-19 pandemic persists and new waves of infection occur periodically throughout the world. The increased psychiatric burden on the population coupled with the apparent salience of mental health and well-being in the public consciousness represents a global opportunity for psychiatry to advocate for further treatment, research, and education.

Head-to-head comparison of PI-RADS v2 and PI-RADS v1.

PURPOSE: To compare the reproducibility and diagnostic performance of PI-RADS version 2 (v2) and version 1 (v1) for the diagnosis of prostate cancer (PCa) on multiparametric MRI. METHODS: This IRB-approved retrospective study included 65 consecutive biopsy-naïve or biopsy-negative patients suspicious for PCa (mean age: 65 years, mean PSA: 10.8ng/ml) who were undergoing MR-guided biopsy after multiparametric 3T prostate MRI (T2w, DWI, DCE). Two independent readers (R1; R2) scored the prostate lesions according to the v2 score and the v1 sum score. Diagnostic measures (sensitivity, specificity, and area under the ROC-curve) were compared for all cases and stratified by location (transitional zone, TZ, peripheral zone, PZ). Inter-reader agreement was assessed by kappa statistics. RESULTS: Inter reader agreement for v2 and v1 was substantial to almost perfect (kappa v2: 0.71, v1: 0.81). Overall, sensitivity between both readers and methods did not differ (p>0.05). Overall specificity was higher using v1 compared to v2 (R1: p=0.0078, R2: p=0.0313) In the TZ, v2 showed a higher AUC (0.81-0.84) compared to v1 (AUC 0.77-0.78). Here, the sensitivity of v2 (87.5-100%) was higher than that of v1 (75%) while v2 specificity (50%-56.3%) was lower than that of v1 (68.8-75%). In the PZ, AUCs were higher using v1 (AUC 0.82-0.83) compared to v2 (AUC 0.61-0.63). The specificity for v1 was higher (43.8-62.3%) than that for v2 (12.5-18.8%) while both v2 and v1 achieved 100% sensitivity. CONCLUSION: PI-RADS v2 and v1 inter-reader agreement is excellent, but their diagnostic performance differs. While v2 appears to be the preferable method for the evaluation of TZ lesions, v1 performs better in the PZ.