151
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Peng TJ, Jasne AS, Simonov M, Abdelhakim S, Kone G, Cheng YK, Rethana M, Tarasaria K, Herman AL, Baker AD, Yaghi S, Frontera JA, Sansing LH, Falcone GJ, Spudich S, Schindler J, Sheth KN, Sharma R. Prior Stroke and Age Predict Acute Ischemic Stroke Among Hospitalized COVID-19 Patients: A Derivation and Validation Study. Front Neurol 2021; 12:741044. [PMID: 34675873 PMCID: PMC8524436 DOI: 10.3389/fneur.2021.741044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: Our objective was to identify characteristics associated with having an acute ischemic stroke (AIS) among hospitalized COVID-19 patients and the subset of these patients with a neurologic symptom. Materials and Methods: Our derivation cohort consisted of COVID-19 patients admitted to Yale-New Haven Health between January 3, 2020 and August 28, 2020 with and without AIS. We also studied a sub-cohort of hospitalized COVID-19 patients demonstrating a neurologic symptom with and without an AIS. Demographic, clinical, and laboratory results were compared between AIS and non-AIS patients in the full COVID-19 cohort and in the sub-cohort of COVID-19 patients with a neurologic symptom. Multivariable logistic regression models were built to predict ischemic stroke risk in these two COVID-19 cohorts. These 2 models were externally validated in COVID-19 patients hospitalized at a major health system in New York. We then compared the distribution of the resulting predictors in a non-COVID ischemic stroke control cohort. Results: A total of 1,827 patients were included in the derivation cohort (AIS N = 44; no AIS N = 1,783). Among all hospitalized COVID-19 patients, history of prior stroke and platelet count ≥ 200 × 1,000/μL at hospital presentation were independent predictors of AIS (derivation AUC 0.89, validation AUC 0.82), irrespective of COVID-19 severity. Among hospitalized COVID-19 patients with a neurologic symptom (N = 827), the risk of AIS was significantly higher among patients with a history of prior stroke and age <60 (derivation AUC 0.83, validation AUC 0.81). Notably, in a non-COVID ischemic stroke control cohort (N = 168), AIS patients were significantly older and less likely to have had a prior stroke, demonstrating the uniqueness of AIS patients with COVID-19. Conclusions: Hospitalized COVID-19 patients who demonstrate a neurologic symptom and have either a history of prior stroke or are of younger age are at higher risk of ischemic stroke.
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Affiliation(s)
- Teng J Peng
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Adam S Jasne
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Michael Simonov
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Safa Abdelhakim
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Gbambele Kone
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Yee Kuang Cheng
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Melissa Rethana
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Karan Tarasaria
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Alison L Herman
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Anna D Baker
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Shadi Yaghi
- Department of Neurology, New York University Langone Health, New York, NY, United States.,Department of Neurology, Brown University School of Medicine, Providence, RI, United States
| | - Jennifer A Frontera
- Department of Neurology, New York University Langone Health, New York, NY, United States
| | - Lauren H Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Guido J Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Serena Spudich
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Joseph Schindler
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Richa Sharma
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
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152
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Reactive Exercises with Interactive Objects: Interim Analysis of a Randomized Trial on Task-Driven NMES Grasp Rehabilitation for Subacute and Early Chronic Stroke Patients. SENSORS 2021; 21:s21206739. [PMID: 34695957 PMCID: PMC8538703 DOI: 10.3390/s21206739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
Enriched environments and tools are believed to promote grasp rehabilitation after stroke. We designed S2, an interactive grasp rehabilitation system consisting of smart objects, custom orthoses for selective grasp constraining, and an electrode array system for forearm NMES. Motor improvements and perceived usability of a new enriched upper limb training system for sub-acute stroke patients was assessed in this interim analysis. Inclusion criteria: sub-acute stroke patients with MMSE>20, ipsilesional MI>80%, and contralesional MI<80%. Effects of 30-min therapy supplements, conventional vs. S2 prototype, are compared through a parallel two-arms dose-matched open-label trial, lasting 27 sessions. Clinical centres: Asklepios Neurologische Klinik Falkenstein, Königstein im Taunus, Germany, and Clinica Villa Beretta, Costa Masnaga, Italy. Assessment scales: ARAT, System Usability, and Technology Acceptance. Methodology: 26 participants were block randomized, allocated to the study (control N=12, experimental N=14) and underwent the training protocol. Among them, 11 participants with ARAT score at inclusion below 35, n = 6 in the experimental group, and n = 5 in the control group were analysed. Results: participants in the enriched treatment group displayed a larger improvement in the ARAT scale (+14.9 pts, pval=0.0494). Perceived usability differed between clinics. No adverse effect was observed in relation to the treatments. Trial status: closed. Conclusions: The S2 system, developed according to shared clinical directives, was tested in a clinical proof of concept. Variations of ARAT scores confirm the feasibility of clinical investigation for hand rehabilitation after stroke.
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153
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Regan J, Walshe M, Lavan S, Horan E, Murphy PG, Healy A, Langan C, Malherbe K, Murphy BF, Cremin M, Hilton D, Cavaliere J, Curley J, Moloney A, Flanagan G, Whyte A. Dysphagia, Dysphonia, and Dysarthria Outcomes Among Adults Hospitalized With COVID-19 Across Ireland. Laryngoscope 2021; 132:1251-1259. [PMID: 34622966 PMCID: PMC8662217 DOI: 10.1002/lary.29900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the presence, degree, predictors, and trajectory of dysphagia, dysphonia, and dysarthria among adults hospitalized with COVID-19 across the Republic of Ireland (ROI) during the first wave of the pandemic. STUDY DESIGN Prospective observational cohort study. METHODS Adults with confirmed COVID-19 who were admitted into 14 participating acute hospitals across ROI and referred to speech and language therapy between March 1st and June 30th, 2020 were recruited. Outcomes obtained at initial SLT evaluation and at discharge were oral intake status (Functional Oral Intake Scale), perceptual voice quality (GRBAS), and global dysarthria rating (Dysarthria Severity Scale). RESULTS Data from 315 adults were analyzed. At initial SLT assessment, 84% required modified oral diets, and 31% required tube feeding. There were high rates of dysphonia (42%) and dysarthria (23%). History of intubation (OR 19.959, 95% CI 6.272, 63.513; P = .000), COVID-19 neurological manifestations (OR 3.592, 95% CI 1.733, 7.445; P = .001), and age (OR 1.034; 95% CI 1.002, 1.066; P = .036) were predictive of oral intake status. History of intubation was predictive of voice quality (OR 4.250, 95% CI 1.838, 9.827; P = .001) and COVID-19 neurological manifestations were predictive of dysarthria (OR 2.275; 95% CI 1.162, 4.456; P = .017). At discharge, there were significant improvements in oral intake (Z = -7.971; P = .000), voice quality (Z = -5.971; P = .000), and dysarthria severity (Z = -2.619; P = .009), although need for modified oral intake (59%), dysphonia (23%), and dysarthria (14%) persisted. CONCLUSION Dysphagia, dysphonia, and dysarthria were widespread among adults hospitalized with COVID-19 and they persisted for many at discharge. Prompt SLT evaluation is required to minimize complications. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sarah Lavan
- Speech and Language Therapy Department, St. James' Hospital, Dublin, Ireland
| | - Eanna Horan
- Speech and Language Therapy Department, Tallaght University Hospital, Dublin, Ireland
| | - Patricia Gillivan Murphy
- Speech and Language Therapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anne Healy
- Speech and Language Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Caoimhe Langan
- Speech and Language Therapy Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Karen Malherbe
- Speech and Language Therapy Department, Galway University Hospital, Galway, Ireland
| | - Breda Flynn Murphy
- Speech and Language Therapy Department, Midland Regional Hospital Tullamore & Portlaoise, Offaly, Ireland
| | - Maria Cremin
- Speech and Language Therapy Department, University Hospital Kerry, Kerry, Ireland
| | - Denise Hilton
- Speech and Language Therapy Department, Cavan General Hospital, Cavan, Ireland
| | - Jenni Cavaliere
- Speech and Language Therapy Department, University Hospital Waterford, Waterford, Ireland
| | - Jacinta Curley
- Speech and Language Therapy Department, Wexford General Hospital, Wexford, Ireland
| | - Andrea Moloney
- Speech and Language Therapy Department, St. Luke's Hospital, Kilkenny, Ireland
| | - Grace Flanagan
- Speech and Language Therapy Department, Sligo University Hospital, Sligo, Ireland
| | - Alice Whyte
- Speech and Language Therapy Department, Naas General Hospital, Kildare, Ireland
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154
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Qureshi AI, Baskett WI, Huang W, Ishfaq MF, Naqvi SH, French BR, Siddiq F, Gomez CR, Shyu CR. Utilization and Outcomes of Acute Revascularization Treatment in Ischemic Stroke Patients with SARS-CoV-2 Infection. J Stroke Cerebrovasc Dis 2021; 31:106157. [PMID: 34689049 PMCID: PMC8498748 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/20/2022] Open
Abstract
Objectives Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy). Materials and Methods We analyzed the data from 62 healthcare facilities to determine the odds of receiving acute revascularization treatments in severe acute respiratory syndrome coronavirus infected patients and determined the odds of composite of death and non-routine discharge with severe acute respiratory syndrome coronavirus infected and non-infected patients undergoing acute revascularization treatments after adjusting for potential confounders. Results Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments (odds ratio 0.6, 95% confidence interval 0.5–0.8, p = 0.0001). Among ischemic stroke patients who received acute revascularization treatments, severe acute respiratory syndrome coronavirus infection was associated with increased odds of death or non-routine discharge (odds ratio 3.0, 95% confidence interval 1.8–5.1). The higher odds death or non-routine discharge (odds ratio 2.1, 95% confidence interval 1.9–2.3) with severe acute respiratory syndrome coronavirus infection were observed in all ischemic stroke patients without any modifying effect of acute revascularization treatments (interaction term for death (p = 0.9) or death or non-routine discharge (p = 0.2). Conclusions Patients with acute ischemic stroke with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments. Severe acute respiratory syndrome coronavirus infection was associated with a significantly higher rate of death or non-routine discharge among acute ischemic stroke patients receiving revascularization treatments.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Insititute and Department of Nuerology, University of Missouri, One Hospital Dr., CE507, Columbia MO 65212, USA
| | - William I Baskett
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Wei Huang
- Zeenat Qureshi Stroke Insititute and Department of Nuerology, University of Missouri, One Hospital Dr., CE507, Columbia MO 65212, USA.
| | | | - S Hasan Naqvi
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Brandi R French
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Farhan Siddiq
- Division of Neurosurgery, University of Missouri, Columbia, MO, USA
| | - Camilo R Gomez
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA; Department of Medicine, University of Missouri, Columbia, MO, USA; Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
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155
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Been Sayeed SKJ, Chandra Das S, Mahmud R, Moniruzzaman M, Rahman MM. Acute Ischemic Stroke With Central Retinal Artery Occlusion as a Rare Presentation of COVID-19 Disease. Cureus 2021; 13:e17469. [PMID: 34589363 PMCID: PMC8464349 DOI: 10.7759/cureus.17469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/12/2022] Open
Abstract
In this report, we present a case where the patient developed a border-zone ischemic stroke with central retinal artery occlusion (RAO) following coronavirus disease 2019 (COVID-19) disease. The COVID-19 disease has been described to induce inflammatory changes that predispose to thrombotic disease in both venous and arterial circulation. Angiotensin-converting enzyme 2 (ACE2) receptor expression in the blood vessel with which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds is the cornerstone of inflammation although the pathogenesis of central RAO is multifactorial. The effects of COVID-19 inflammatory and pro-coagulant state on cerebral and retinal vascular systems are still inadequately understood. Combined presentation of central RAO with ischemic stroke has not been documented in the literature yet. As of now, no guidelines exist regarding treatment modalities to be employed in such instances. Hence, further research is warranted regarding the treatment of this condition with respect to the association with COVID-19.
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Affiliation(s)
| | - Subir Chandra Das
- Clinical Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | - Reaz Mahmud
- Neurology, Dhaka Medical College Hospital, Dhaka, BGD
| | - Md Moniruzzaman
- Clinical Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD
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156
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Sedlaczek O, Wagner W, Dempfle CE. [COVID-19-induced coagulopathy and thrombosis manifestations]. Radiologe 2021; 61:909-914. [PMID: 34559248 PMCID: PMC8461592 DOI: 10.1007/s00117-021-00901-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 12/15/2022]
Abstract
Klinisches Problem Klinisch wird COVID-19 („corona virus disease“ 2019) zunehmend als systemische Erkrankung gesehen, in deren Zentrum eine Multiorganbeteiligung durch einen hyperkoagulatorischen Zustand im Sinne einer Vaskulopathie steht. Therapeutische Standardverfahren Eine Behandlung mit Thrombozytenfunktionshemmern oder Heparinen erscheint die logische Konsequenz. Die aktuelle Studienlage, zumindest für ASS, ergibt allerdings keine Hinweise auf eine Wirksamkeit. Diagnostik Entsprechend der zu nennenswerten Anteilen primär mikrostrukturellen Gefäßveränderungen sollte die radiologische Diagnostik nicht nur Makrogefäßpathologien, sondern auch Hinweise auf diffuse Perfusionsstörungen darstellen. Leistungsfähigkeit In der Lunge sind beispielsweise Perfusionsausfälle nachweisbar, die nur teilweise durch pulmonalarterielle Füllungsdefekte zu erklären sind. Ähnliche Befunde zeigen sich in fast allen Organsystemen. Empfehlung für die Praxis Eine therapeutische Intervention mittels niedermolekularer Heparine bei hospitalisierten Patienten in situationsadaptierter Dosierung ist indiziert und wird ausführlich besprochen. Bei Nachweis von Mikro- und Makrogefäßthrombosierung im Rahmen von COVID-19 spielt die erweiterte radiologische Diagnostik eine zentrale Rolle und ist die Basis der Therapie und Sekundärprävention.
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Affiliation(s)
- O Sedlaczek
- Radiology Cooperation Uni/DKFZ, Division of Radiology, NCT, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland. .,Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Heidelberg, Deutschland.
| | - W Wagner
- Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Heidelberg, Deutschland.,Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Deutschland
| | - C E Dempfle
- Coagulation Center Mannheim, Mannheim, Deutschland
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157
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Alkhalifah MM, Banda R, Alqudihy S, Qureshi S, Al-Tawfiq JA. Stroke Incidence and Outcome in a Population With COVID-19. Neurohospitalist 2021; 12:213-217. [PMID: 35401913 PMCID: PMC8977424 DOI: 10.1177/19418744211043323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose: COVID-19 is associated with systemic thromboembolism including stroke. The
study evaluated the 30-days stroke incidence in SARS-CoV-2 PCR positive
patients and described the outcome of such patients. Methods: This is a retrospective study of consecutive patients with a positive
SARS-CoV-2 PCR test between March 1st, 2020 and August 30th, 2020. The study
included COVID-19 patients who were hospitalized and had a stroke within 30
days from the positive PCR test. Results: During the study period, there were 4301 patients with a positive SARS-CoV-2
PCR test. Of those, 1786 patients (41.5%) were hospitalized and 4 patients
developed a stroke within 30 days. The 30-days stroke incidence was 0.09%
and 0.2% of all and hospitalized patients, respectively. The mean age of
stroke patients was 78 years and 2 died during the same hospitalization. The
4 patients had comorbidities, one had pre-existing atrial fibrillation and
all had ischemic stroke. Conclusion: This study showed a low 30-day incidence of stroke among COVID-19
patients.
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Affiliation(s)
- Moayd M. Alkhalifah
- Neurology Unit, Neurosciences Institute, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Ramzi Banda
- Neurology Unit, Neurosciences Institute, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Shukri Alqudihy
- Hospital Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Shireen Qureshi
- Neurology Unit, Neurosciences Institute, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Disease Division, Indiana University School of Medicine, IN, USA
- Infectious Disease Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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158
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Jiang DH, Roy DJ, Gu BJ, Hassett LC, McCoy RG. Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A State-of-the-Art Review. JACC Basic Transl Sci 2021; 6:796-811. [PMID: 34541421 PMCID: PMC8442719 DOI: 10.1016/j.jacbts.2021.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/22/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023]
Abstract
The vast majority of patients (>99%) with severe acute respiratory syndrome coronavirus 2 survive immediate infection but remain at risk for persistent and/or delayed multisystem. This review of published reports through May 31, 2021, found that manifestations of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) affect between 33% and 98% of coronavirus disease 2019 survivors and comprise a wide range of symptoms and complications in the pulmonary, cardiovascular, neurologic, psychiatric, gastrointestinal, renal, endocrine, and musculoskeletal systems in both adult and pediatric populations. Additional complications are likely to emerge and be identified over time. Although data on PASC risk factors and vulnerable populations are scarce, evidence points to a disproportionate impact on racial/ethnic minorities, older patients, patients with preexisting conditions, and rural residents. Concerted efforts by researchers, health systems, public health agencies, payers, and governments are urgently needed to better understand and mitigate the long-term effects of PASC on individual and population health.
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Affiliation(s)
- David H. Jiang
- Division of Health Care Delivery and Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Darius J. Roy
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brett J. Gu
- School of Medicine, Yale University; New Haven, Connecticut, USA
| | | | - Rozalina G. McCoy
- Division of Health Care Delivery and Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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159
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Chao WC, Wu CL, Huang JA, Chai JW, Teng CL, Lee WL, Fu YC, Chen SA. Association between Early Absolute Neutrophil Count and Level of D-Dimer among Patients with COVID-19 Infection in Central Taiwan. J Clin Med 2021; 10:jcm10173891. [PMID: 34501339 PMCID: PMC8432119 DOI: 10.3390/jcm10173891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/17/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
Thromboembolism is a critical event in patients with coronavirus disease (COVID)-19 infection and highly associated with neutrophil extracellular traps. D-dimer has been found to be an essential thromboembolism-associated biomarker; however, the association between absolute neutrophil count (ANC) and level of D-dimer in patients with COVID-19 infection remains unclear. In this study, we enrolled consecutive patients with COVID-19 admitted to Taichung Veterans General Hospital (TCVGH), a referral center in central Taiwan with 20 airborne infection isolation rooms. Spearman correlation was used to determine the association between ANC and level of D-dimer in distinct time periods. A total of 28 consecutive patients with COVID-19 infection were enrolled, and 32.1% (9/28) of them required mechanical ventilation. Patients requiring mechanical ventilation had a higher ANC (8225 vs. 3427/µL, p < 0.01) and levels of D-dimer (6.0 vs. 0.6 mg/L, p < 0.01) compared with those without mechanical ventilation. Notably, we identified five patients with image-proven thromboembolic events during the hospital course, with the number of patients with pulmonary embolism, venous thrombosis and acute ischemic stroke were 2, 1, and 2, respectively. We found that ANC within 4 days correlated with the level of D-dimer to a moderate level (r = 0.71, p < 0.05), and the association between ANC and D-dimer no longer exist after day 5. In conclusion, we found highly prevalent thromboembolic events among patients with severe COVID-19 infection in central Taiwan and identified the association between early ANC and D-dimer. More studies are warranted to elucidate the underlying mechanism.
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Affiliation(s)
- Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-C.C.); (C.-L.W.)
- Department of Computer Science, Tunghai University, Taichung 407224, Taiwan
- Department of Automatic Control Engineering, Feng Chia University, Taichung 407802, Taiwan
- Big Data Center, National Chung Hsing University, Taichung 40227, Taiwan
| | - Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-C.C.); (C.-L.W.)
- Department of Computer Science, Tunghai University, Taichung 407224, Taiwan
- Department of Automatic Control Engineering, Feng Chia University, Taichung 407802, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407224, Taiwan
| | - Jin-An Huang
- Department of Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Chieh-Lin Teng
- Division of Hematology and Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Department of Medicine, National Yang-Ming Chiou Tung University, Taipei 112, Taiwan
- Correspondence: (W.-L.L.); (Y.-C.F.)
| | - Yun-Ching Fu
- Section of Pediatric Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiou Tung University, Taipei 112, Taiwan
- Correspondence: (W.-L.L.); (Y.-C.F.)
| | - Shih-Ann Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Institute of Clinical Medicine, National Yang Ming Chiou Tung University, Taipei 112, Taiwan
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160
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Chaughtai S, Soomro R, Chaughtai K, Anwaar W, Chaughtai Z, Asif A, Hossain MA. Large Vessel Stroke Following Multiple Other Strokes and Cardiomyopathy in a Forty-Nine-Year-Old COVID-19 Patient. J Med Cases 2021; 12:238-242. [PMID: 34429796 PMCID: PMC8279282 DOI: 10.14740/jmc3682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
Abstract
The novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made its presence known on the centerstage of worldwide healthcare in 2020. Although it is widely known about its pulmonary presence and ensuing complications, evidence is emerging that there are other organ systems including the cardiovascular and cerebrovascular systems that may be damaged by this virus. There have been reports of large vessel stroke occurring in coronavirus disease 2019 (COVID-19) positive patients, with very few reported in the age group less than 50 years. In this case, we describe a previously healthy 49-year-old male who presented with signs of stroke, and was found to have the novel coronavirus as he had been suffering from upper respiratory tract symptoms for 3 weeks. He subsequently developed further large vessel stroke while in the hospital despite being started on antiplatelet therapy. He was also found to have new onset cardiomyopathy. He was started on anticoagulation and discharged with follow-up for cardiomyopathy testing outpatient. This case begs the question on which anticoagulation to utilize in COVID-19 positive patients to be effective in preventing thrombotic events. It is postulated that a pro-inflammatory state induced by the virus and the virus’ affinity for angiotensin converting enzyme-2 receptors in the cerebral vasculature are predispositions to cause a stroke. The virus also directly damages cardiac myocytes causing a number of cardiac complications including cardiomyopathy. It is crucial that guidelines on anticoagulation choice and indications for when to start anticoagulation be developed in order to prevent the more devastating consequences of thrombosis and embolism and their subsequent clinical sequelae.
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Affiliation(s)
- Saira Chaughtai
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Rabail Soomro
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Khaula Chaughtai
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Waleed Anwaar
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Zeeshan Chaughtai
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Mohammad A Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
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161
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Review of COVID-19, part 2: Musculoskeletal and neuroimaging manifestations including vascular involvement of the aorta and extremities. Clin Imaging 2021; 79:300-313. [PMID: 34388683 PMCID: PMC8349444 DOI: 10.1016/j.clinimag.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world resulting in severe morbidity, mortality and economic hardship, altering the landscape of healthcare forever. Its devastating and most frequent thoracic and cardiac manifestations have been well reported since the start of the pandemic. Its extra-thoracic manifestations are myriad and understanding them is critical in diagnosis and disease management. The role of radiology is growing in the second wave and second year of the pandemic as the multiorgan manifestations of COVID-19 continue to unfold. Musculoskeletal, neurologic and vascular disease processes account for a significant number of COVID-19 complications and understanding their frequency, clinical sequelae and imaging manifestations is vital in guiding management and improving overall survival. The authors aim to provide a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19. In Part I, abdominal manifestations of COVID-19 in adults and multisystem inflammatory syndrome in children will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.
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[Ischemic stroke in coronavirus disease 2019]. Internist (Berl) 2021; 62:1338-1342. [PMID: 34338841 PMCID: PMC8326653 DOI: 10.1007/s00108-021-01110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
Zwei Fälle von Patienten mit der Coronavirus-19-Erkrankung (COVID-19) werden berichtet, bei denen Verschlüsse großer Hirnarterien vorlagen. Diese traten bei einer Patientin in der Früh- als auch im 2. Fall in der Spätphase der COVID-19 auf. Eine Patientin konnte erfolgreich mithilfe der i.v.-Thrombolyse und mechanischer Thrombektomie behandelt werden. Gerinnungsstörungen im Rahmen der COVID-19 können auch bei jüngeren Patienten zu fulminanten Hirninfarkten mit schlechtem Outcome führen. Bezüglich der Ätiologie dieser Gefäßverschlüsse (COVID-19-induzierte Hyperkoagulopathie, Kardiomyopathie, Vaskulitis) besteht weiterer Forschungsbedarf.
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Negrini F, de Sire A, Andrenelli E, Lazzarini SG, Patrini M, Ceravolo MG. Rehabilitation and COVID-19: update of the rapid living systematic review by Cochrane Rehabilitation Field as of April 30, 2021. Eur J Phys Rehabil Med 2021; 57:663-667. [PMID: 34128607 DOI: 10.23736/s1973-9087.21.07125-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy -
| | | | | | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy
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164
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Sierra-Hidalgo F, Aragón Revilla E, Arranz García P, Martínez-Acebes E, Gómez-Moreno SM, Muñoz-Rivas N, Esquivel López A. Increased Incidence of In-Hospital Ischemic Stroke During SARS-CoV-2 Outbreak: A Single-Center Study. Neurocrit Care 2021; 36:208-215. [PMID: 34268645 PMCID: PMC8281805 DOI: 10.1007/s12028-021-01286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Meta-analyses of observational studies report a 1.1-1.7% pooled risk of stroke among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring hospitalization, but consultations for stroke and reperfusion procedures have decreased during the outbreak that occurred during the first half of the year 2020. It is still unclear whether a true increase in the risk of stroke exists among patients with coronavirus disease 2019 (COVID-19). In-hospital ischemic stroke (IHIS) complicated the 0.04-0.06% of all admissions in the pre-COVID-19 era, but its incidence has not been assessed among inpatients with COVID-19. We aimed to compare IHIS incidence among patients with SARS-CoV-2 infection with that of inpatients with non-COVID-19 illnesses from the same outbreak period and from previous periods. METHODS This historical cohort study belongs to the COVID-19@Vallecas cohort. The incidence of IHIS was estimated for patients with SARS-CoV-2 hospitalized during March-April 2020 [COVID-19 cohort (CC)], for patients with non-COVID-19 medical illness hospitalized during the same outbreak period [2020 non-COVID-19 cohort (20NCC)], and for inpatients with non-COVID-19 illness admitted during March-April of the years 2016-2019 [historical non-COVID-19 cohort (HNCC)]. Unadjusted risk of IHIS was compared between the three cohorts, and adjusted incidence rate ratio (IRR) of IHIS between cohorts was obtained by means of Poisson regression. RESULTS Overall, 8126 inpatients were included in this study. Patients in the CC were younger and more commonly men than those from the HNCC and 20NCC. Absolute risk of IHIS was 0.05% for HNCC, 0.23% for 20NCC, and 0.36% for CC, (p = 0.004 for HNCC vs. CC). Cumulative incidence for IHIS by day nine after admission, with death as a competing risk, was 0.09% for HNCC, 0.23% for 20NCC, and 0.50% for CC. In an adjusted Poisson regression model with sex, age, needing of intensive care unit admission, and cohort (HNCC as reference) as covariates, COVID-19 was an independent predictor for IHIS (IRR 6.76, 95% confidence interval 1.66-27.54, p = 0.01). A nonsignificant increase in the risk of IHIS was observed for the 20NCC (IRR 5.62, 95% confidence interval 0.93-33.9, p = 0.06). CONCLUSIONS SARS-CoV-2 outbreak was associated with an increase in the incidence of IHIS when compared with inpatients from a historical cohort. Viral infection itself may be related to the increased risk of IHIS among patients with COVID-19, but in view of our results from the 20NCC, it is likely that other factors, such as hospital saturation and overwhelming of health systems, may have played a role in the increased frequency of IHIS.
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Affiliation(s)
- Fernando Sierra-Hidalgo
- Department of Neurology, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031, Madrid, Spain.
| | - Esther Aragón Revilla
- Department of Neurology, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031, Madrid, Spain
| | - Paz Arranz García
- Department of Medical Administration, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Eva Martínez-Acebes
- Department of Neurology, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031, Madrid, Spain
| | - Sonia Mayra Gómez-Moreno
- Department of Neurology, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031, Madrid, Spain
| | - Nuria Muñoz-Rivas
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Alberto Esquivel López
- Department of Neurology, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031, Madrid, Spain
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Barbosa-Silva MC, Lima MN, Battaglini D, Robba C, Pelosi P, Rocco PRM, Maron-Gutierrez T. Infectious disease-associated encephalopathies. Crit Care 2021; 25:236. [PMID: 34229735 PMCID: PMC8259088 DOI: 10.1186/s13054-021-03659-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023] Open
Abstract
Infectious diseases may affect brain function and cause encephalopathy even when the pathogen does not directly infect the central nervous system, known as infectious disease-associated encephalopathy. The systemic inflammatory process may result in neuroinflammation, with glial cell activation and increased levels of cytokines, reduced neurotrophic factors, blood-brain barrier dysfunction, neurotransmitter metabolism imbalances, and neurotoxicity, and behavioral and cognitive impairments often occur in the late course. Even though infectious disease-associated encephalopathies may cause devastating neurologic and cognitive deficits, the concept of infectious disease-associated encephalopathies is still under-investigated; knowledge of the underlying mechanisms, which may be distinct from those of encephalopathies of non-infectious cause, is still limited. In this review, we focus on the pathophysiology of encephalopathies associated with peripheral (sepsis, malaria, influenza, and COVID-19), emerging therapeutic strategies, and the role of neuroinflammation.
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Affiliation(s)
- Maria C Barbosa-Silva
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Av. Brasil, 4365, Pavilhão 108, sala 45, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Maiara N Lima
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Av. Brasil, 4365, Pavilhão 108, sala 45, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Rio de Janeiro, Brazil
- Rio de Janeiro Network on Neuroinflammation, Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
| | - Tatiana Maron-Gutierrez
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Fiocruz, Av. Brasil, 4365, Pavilhão 108, sala 45, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
- Rio de Janeiro Network on Neuroinflammation, Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil.
- National Institute of Science and Technology on Neuroimmunomodulation, Rio de Janeiro, Rio de Janeiro, Brazil.
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166
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Intracerebral Hemorrhage and Coronavirus Disease 2019 in a Cohort of 282,718 Hospitalized Patients. Neurocrit Care 2021; 36:259-265. [PMID: 34231186 PMCID: PMC8260011 DOI: 10.1007/s12028-021-01297-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/10/2021] [Indexed: 12/24/2022]
Abstract
Background To identify whether the risk of intracerebral hemorrhage is higher in patients with coronavirus disease 2019 (COVID-19), we compared the risk factors, comorbidities, and outcomes in patients intracerebral hemorrhage and COVID-19 and those without COVID-19. Methods We analyzed the data from the Cerner deidentified COVID-19 data set derived from 62 health care facilities. The data set included patients with an emergency department or inpatient encounter with discharge diagnoses codes that could be associated with suspicion of or exposure to COVID-19 or confirmed COVID-19. Results There were a total of 154 (0.2%) and 667 (0.3%) patients with intracerebral hemorrhage among 85,645 patients with COVID-19 and 197,073 patients without COVID-19, respectively. In the multivariate model, there was a lower risk of intracerebral hemorrhage in patients with COVID-19 (odds ratio 0.5; 95% confidence interval 0.5–0.6; p < .0001) after adjustment for sex, age strata, race/ethnicity, hypertension, diabetes mellitus, nicotine dependence/tobacco use, hyperlipidemia, atrial fibrillation, congestive heart failure, long-term anticoagulant use, and alcohol abuse. The proportions of patients who developed pneumonia (58.4% versus 22.5%; p < .0001), acute kidney injury (48.7% versus 31.0%; p < .0001), acute myocardial infarction (11% versus 6.4%; p = .048), sepsis (41.6% versus 22.5%; p < .0001), and respiratory failure (61.7% versus 42.3%; p < .0001) were significantly higher among patients with intracerebral hemorrhage and COVID-19 compared with those without COVID-19. The in-hospital mortality among patients with intracerebral hemorrhage and COVID-19 was significantly higher compared with that among those without COVID-19 (40.3% versus 19.0%; p < .0001). Conclusions Our analysis does not suggest that rates of intracerebral hemorrhage are higher in patients with COVID-19. The higher mortality in patients with intracerebral hemorrhage and COVID-19 compared with those without COVID-19 is likely mediated by higher frequency of comorbidities and adverse in-hospital events. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-021-01297-y.
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167
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[Focus on neurological intensive care medicine. Intensive care studies from 2020/2021]. Anaesthesist 2021; 70:706-713. [PMID: 34191035 PMCID: PMC8243294 DOI: 10.1007/s00101-021-00977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/10/2022]
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168
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COVID-19 and Stroke: A Neurological Perspective. Stroke 2021. [DOI: 10.36255/exonpublications.stroke.covid19.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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169
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Rana A, Nguyen TN, Siegler JE. Stroke and neurointervention in the COVID-19 pandemic: a narrative review. Expert Rev Med Devices 2021; 18:523-531. [PMID: 33966557 DOI: 10.1080/17434440.2021.1928495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: In this review, we will summarize the impact of the COVID-19 pandemic on neurointerventional care for patients with cerebrovascular disease, with a particular emphasis on epidemiology, neurointerventional processes, and lessons learned from paradigm shifts in endovascular care.Areas covered: Peer-reviewed research is summarized regarding the complications of COVID-19 as related to the pandemic's impact on hospital admissions, imaging capabilities, treatment times, and outcomes of neurointerventional cases.Expert opinion: In the first wave of the COVID-19 pandemic, there was a global decline in neuroimaging, use of intravenous thrombolysis, thrombectomy, and coil embolization for ruptured intracranial aneurysms. An early recommendation to utilize general anesthesia and intubate all patients undergoing intervention to avoid an emergent aerosolizing procedure was found to have worse outcomes. The decline in new stroke and subarachnoid hemorrhage diagnoses may be related to patient and/or family fear of seeking acute medical care. A true shift in stroke epidemiology is also possible. As several vaccines become more readily available and the world rebounds from this pandemic, we hope to transform the neurointerventional experiences discussed in this paper into strategies that may improve care delivery of neurologically ill patients during a global crisis.
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Affiliation(s)
- Ameena Rana
- Cooper Medical School of Rowan University, Camden United States
| | - Thanh N Nguyen
- Department of Neurology, Radiology, and Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, United States
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, United States
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Rowe ES, Rowe VD, Hunter J, Gralinski MR, Neves LA. A nephroprotective iodinated contrast agent with cardioprotective properties: A pilot study. J Neuroimaging 2021; 31:706-713. [PMID: 33979019 PMCID: PMC8359965 DOI: 10.1111/jon.12873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Evaluation and treatment of acute ischemic syndromes, in the heart and brain, require vessel visualization by iodinated X-ray contrast agents. However, these contrast agents can induce injury, in both the kidneys and target organs themselves. Sulfobutylether beta cyclodextrin (SBECD) added to iohexol (SBECD-iohexol) (Captisol Enabled-iohexol, Ligand Pharmaceuticals, Inc, San Diego, CA) is currently in clinical trials in cardiovascular procedures, to determine its relative renal safety in high-risk patients. Preclinical studies showed that SBECD-iohexol reduced contrast-induced acute kidney injury in rodent models by blocking apoptosis. The current study was undertaken to determine whether SBECD-iohexol is also cardioprotective, in the male rat ischemia-reperfusion model, compared to iohexol alone. METHODS After anesthesia, the left coronary artery was ligated for 30 min and the ligation released and reperfusion followed for 2 h prior to sacrifice. Groups 1-4 were injected in the tail vein 10 min prior to ischemia with: (1) vehicle; (2) iohexol; (3) SBECD; and (4) SBECD-iohexol. Infarct size, hemodynamics, and serum markers were measured. RESULTS An eight-fold increase in serum creatine kinase in the iohexol-alone group was observed, compared with no increase in the SBECD-iohexol group. The mean arterial pressure and rate pressure product were depressed in the iohexol-alone group, but not in the SBECD-iohexol group, or controls. No difference in infarct size or serum creatinine among the groups was observed. CONCLUSION The results of this study suggest that SBECD-iohexol is superior to iohexol alone, for both the preservation of cardiomyocyte integrity and preservation of myocardial function in myocardial ischemia.
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Affiliation(s)
| | | | - John Hunter
- Neurrow Pharmaceuticals, Inc, Shawnee, Kansas, USA
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171
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Subarachnoid Hemorrhage and COVID-19: An Analysis of 282,718 Patients. World Neurosurg 2021; 151:e615-e620. [PMID: 33940263 PMCID: PMC8086384 DOI: 10.1016/j.wneu.2021.04.089] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 02/07/2023]
Abstract
Background Intracranial hemorrhage (including subarachnoid hemorrhage [SAH]) has been reported in 0.3%–1.2% of patients with coronavirus disease 2019 (COVID-19). However, no study has evaluated the risk of SAH in patients with COVID-19. Methods We analyzed data from 62 health care facilities using the Cerner de-identified COVID-19 dataset. Results There were 86 (0.1%) and 376 (0.2%) patients with SAH among 85,645 patients with COVID-19 and 197,073 patients without COVID-19, respectively. In the multivariate model, there was a lower risk of SAH in patients with COVID-19 (odds ratio 0.5, 95% confidence interval 0.4–0.7, P < 0.0001) after adjusting for sex, age strata, race/ethnicity, hypertension, and nicotine dependence/tobacco use. The proportions of patients who developed pneumonia (58.1% vs. 21.3%, P < 0.0001), acute kidney injury (43% vs. 27.7%, P = 0.0005), septic shock (44.2% vs. 20.7%, P < 0.0001), and respiratory failure (64.0% vs. 39.1%, P < 0.0001) were significantly higher among patients with SAH and COVID-19 compared with patients without COVID-19. The in-hospital mortality among patients with SAH and COVID-19 was significantly higher compared with patients without COVID-19 (31.4% vs. 12.2%, P < 0.0001). Conclusions The risk of SAH was not increased in patients with COVID-19. The higher mortality in patients with SAH and COVID-19 compared with patients without COVID-19 is likely mediated by higher frequency of systemic comorbidities.
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Oliveira V, Seabra M, Rodrigues R, Carvalho V, Mendes M, Pereira D, Caldeiras C, Martins B, Silva R, Azevedo A, Lima MJ, Monteiro C, Varela R, Malheiro S, Abreu M, Azevedo E, Leal Loureiro J, Tedim Cruz V, Silva MR, Magalhães R, Silva C, Maia LF, Correia M. Neuro-COVID frequency and short-term outcome in the Northern Portuguese population. Eur J Neurol 2021; 28:3360-3368. [PMID: 33884707 PMCID: PMC8250949 DOI: 10.1111/ene.14874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 01/26/2023]
Abstract
Background and purpose COVID‐19‐related acute neurological phenotypes are being increasingly recognised, with neurological complications reported in more than 30% of hospitalised patients. However, multicentric studies providing a population‐based perspective are lacking. Methods We conducted a retrospective multicentric study at five hospitals in Northern Portugal, representing 45.1% of all hospitalised patients in this region, between 1 March and 30 June 2020. Results Among 1261 hospitalised COVID‐19 patients, 457 (36.2%) presented neurological manifestations, corresponding to a rate of 357 per 1000 in the North Region. Patients with neurologic manifestations were younger (68.0 vs. 71.2 years, p = 0.002), and the most frequent neurological symptoms were headache (13.4%), delirium (10.1%), and impairment of consciousness (9.7%). Acute well‐defined central nervous system (CNS) involvement was found in 19.1% of patients, corresponding to a rate of 217 per 1000 hospitalised patients in the whole region. Assuming that all patients with severe neurological events were hospitalised, we extrapolated our results to all COVID‐19 patients in the region, estimating that 116 will have a severe neurological event, corresponding to a rate of nine per 1000 (95% CI = 7–11). Overall case fatality in patients presenting neurological manifestations was 19.8%, increasing to 32.6% among those with acute well‐defined CNS involvement. Conclusions We characterised the population of hospitalised COVID‐19 patients in Northern Portugal and found that neurological symptoms are common and associated with a high degree of disability at discharge. CNS involvement with criteria for in‐hospital admission was observed in a significant proportion of patients. This knowledge provides the tools for adequate health planning and for improving COVID‐19 multidisciplinary patient care.
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Affiliation(s)
- Vanessa Oliveira
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Mafalda Seabra
- Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Rita Rodrigues
- Neurology Department, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - Vanessa Carvalho
- Neurology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Michel Mendes
- Neurology Department, Centro Hospitalar Trás-os-Montes e Alto-douro, Vila Real, Portugal
| | - Diogo Pereira
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Catarina Caldeiras
- Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Renata Silva
- Neurology Department, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - Ana Azevedo
- Neurology Department, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - Maria João Lima
- Neurology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Catarina Monteiro
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Ricardo Varela
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Sofia Malheiro
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Miguel Abreu
- Infectious Diseases Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Elsa Azevedo
- Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - José Leal Loureiro
- Neurology Department, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - Vítor Tedim Cruz
- Neurology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.,Epidemiological Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Mário Rui Silva
- Neurology Department, Centro Hospitalar Trás-os-Montes e Alto-douro, Vila Real, Portugal
| | - Rui Magalhães
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Carolina Silva
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Luís F Maia
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal.,Institute of Innovation and Research in Health, University of Porto, Porto, Portugal
| | - Manuel Correia
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
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173
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Veltkamp R, Purrucker JC, Weber R. [Neurovascular manifestations of COVID‑19]. DER NERVENARZT 2021; 92:531-539. [PMID: 33763706 PMCID: PMC7990492 DOI: 10.1007/s00115-021-01104-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/23/2022]
Abstract
Bereits früh nach Beginn der COVID‑19(„coronavirus disease 2019“)-Pandemie wurden Schlaganfälle als Manifestation oder Komplikation einer SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion beschrieben. Aktuelle Metaanalysen berichten eine Schlaganfallrate von etwa 1,5 %. Schlaganfälle bei COVID‑19-Patienten treten zwar häufiger bei schweren Verläufen der Infektion und bei älteren Patienten mit kardiovaskulären Risiken auf. Nicht selten sind aber auch junge Patienten ohne Risikofaktoren betroffen. Die Schlaganfallmechanismen sind vorwiegend embolisch, die Thromben verschließen häufig große intrakranielle Gefäße und betreffen in mehr als 20 % mehrere Gefäßterritorien, während mikroangiopathische Infarkte selten sind. Die genaue Emboliequelle bleibt bei über 40 % der Betroffenen kryptogen. Die durch das Zusammentreffen einer SARS-CoV-2-Infektion und eines Schlaganfalls bedingte Mortalität beträgt mehr als 15–30 %. Während es in manchen europäischen Regionen zu erheblichen Einschränkungen der Akutversorgung von Schlaganfällen gekommen ist, sind die Behandlungsraten für die Rekanalisationstherapie in Deutschland während der 1. Pandemiewelle weitgehend stabil geblieben. Es stellten sich aber 20–30 % weniger Patienten mit v. a. leichteren Schlaganfällen und transitorischen ischämischen Attacken in Krankenhäusern vor. Die vorliegende Übersichtsarbeit fasst die aktuellen Erkenntnisse zur Epidemiologie und Pathogenese COVID‑19-assoziierter Schlaganfälle zusammen und beschreibt die bisherigen Auswirkungen der Pandemie auf die Schlaganfallakutversorgung.
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Affiliation(s)
- Roland Veltkamp
- Neurologische Klinik, Alfried Krupp Krankenhaus Essen, Alfried Krupp Str. 21, 45131, Essen, Deutschland. .,Department of Brain Sciences, Imperial College London, London, Großbritannien. .,Neurologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| | - Jan C Purrucker
- Neurologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ralph Weber
- Neurologische Klinik, Alfried Krupp Krankenhaus Essen, Alfried Krupp Str. 21, 45131, Essen, Deutschland
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Zuber V, Cameron A, Myserlis EP, Bottolo L, Fernandez-Cadenas I, Burgess S, Anderson CD, Dawson J, Gill D. Leveraging genetic data to elucidate the relationship between Covid-19 and ischemic stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.02.25.21252441. [PMID: 33688662 PMCID: PMC7941632 DOI: 10.1101/2021.02.25.21252441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The relationship between coronavirus disease 2019 (Covid-19) and ischemic stroke is poorly defined. We aimed to leverage genetic data to investigate reported associations. METHODS Genetic association estimates for liability to Covid-19 and cardiovascular traits were obtained from large-scale consortia. Analyses primarily focused on critical Covid-19, defined as hospitalization with Covid-19 requiring respiratory support or resulting in death. Cross-trait linkage disequilibrium score regression was used to estimate genetic correlations of critical Covid-19 with ischemic stroke, other related cardiovascular outcomes, and risk factors common to both Covid-19 and cardiovascular disease (body mass index, smoking and chronic inflammation, estimated using C-reactive protein). Mendelian randomization analysis was performed to investigate whether liability to critical Covid-19 was associated with increased risk of any of the cardiovascular outcomes for which genetic correlation was identified. RESULTS There was evidence of genetic correlation between critical Covid-19 and ischemic stroke (r g =0.29, FDR p -value=4.65×10 -3 ), body mass index (r g =0.21, FDR- p -value = 6.26×10 -6 ) and C-reactive protein (r g =0.20, FDR- p -value=1.35×10 -4 ), but none of the other considered traits. In Mendelian randomization analysis, liability to critical Covid-19 was associated with increased risk of ischemic stroke (odds ratio [OR] per logOR increase in genetically predicted critical Covid-19 liability 1.03, 95% confidence interval 1.00-1.06, p -value=0.03). Similar estimates were obtained when considering ischemic stroke subtypes. Consistent estimates were also obtained when performing statistical sensitivity analyses more robust to the inclusion of pleiotropic variants, including multivariable Mendelian randomization analyses adjusting for potential genetic confounding through body mass index, smoking and chronic inflammation. There was no evidence to suggest that genetic liability to ischemic stroke increased the risk of critical Covid-19. CONCLUSIONS These data support that liability to critical Covid-19 is associated with an increased risk of ischemic stroke. The host response predisposing to severe Covid-19 is likely to increase the risk of ischemic stroke, independent of other potentially mitigating risk factors.
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Affiliation(s)
- Verena Zuber
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Dementia Research Institute at Imperial College London, London, UK
| | - Alan Cameron
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Evangelos P. Myserlis
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Leonardo Bottolo
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
| | | | - Stephen Burgess
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christopher D. Anderson
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Clinical Pharmacology and Therapeutics Section, Institute of Medical and Biomedical Education and Institute for Infection and Immunity, St George’s, University of London, London, UK
- Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St George’s University Hospitals NHS Foundation Trust, London, UK
- Novo Nordisk Research Centre Oxford, Old Road Campus, Oxford, UK
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175
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Shchukin I, Fidler M, Koltsov I, Suvorov A. COVID-19 related stroke. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:69-76. [DOI: 10.17116/jnevro202112112269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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