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Gómez-Porro P, Cabal-Paz B, Valenzuela-Chamorro S, Desanvicente-Celis Z, Sabin-Muñoz J, Ochoa-López C, Flórez C, Enríquez-Calzada S, Martín-García R, Esain-González Í, García-Fleitas B, Silva-Hernández L, Ruiz-Molina Á, Gamo-González E, Durán-Lozano A, Velasco-Calvo R, Alba-Alcántara L, González-Santiago R, Callejas-Díaz A, Brea-Álvarez B, Salazar-Uribe JC, Escamilla-Crespo C, Carneado-Ruiz J. High frequency of endoluminal thrombus in patients with ischaemic stroke following AARS-CoV-2 infection. Neurologia 2024; 39:43-54. [PMID: 38065431 DOI: 10.1016/j.nrleng.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 04/06/2021] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Ischaemic stroke may be a major complication of SARS-CoV-2 infection. Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. METHODS Data were collected retrospectively on consecutive patients with COVID-19 who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). RESULTS During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack). Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%). We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). CONCLUSIONS In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.
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Affiliation(s)
- P Gómez-Porro
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - B Cabal-Paz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - S Valenzuela-Chamorro
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Z Desanvicente-Celis
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - J Sabin-Muñoz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - C Ochoa-López
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - C Flórez
- Universidad CES, Medellín, Colombia
| | - S Enríquez-Calzada
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - R Martín-García
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Í Esain-González
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - B García-Fleitas
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - L Silva-Hernández
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Á Ruiz-Molina
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - E Gamo-González
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - A Durán-Lozano
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - R Velasco-Calvo
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - L Alba-Alcántara
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - R González-Santiago
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - A Callejas-Díaz
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - B Brea-Álvarez
- Servicio de Radiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - C Escamilla-Crespo
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - J Carneado-Ruiz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
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Durantez-Fernández C, Polonio-López B, Martín-Conty JL, Maestre-Miquel C, Viñuela A, López-Izquierdo R, Mordillo-Mateos L, Jorge-Soto C, Otero-Agra M, Dileone M, Rabanales-Sotos J, Martín-Rodríguez F. Comparison of Nine Early Warning Scores for Identification of Short-Term Mortality in Acute Neurological Disease in Emergency Department. J Pers Med 2022; 12:630. [PMID: 35455748 PMCID: PMC9024907 DOI: 10.3390/jpm12040630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The aim was screening the performance of nine Early Warning Scores (EWS), to identify patients at high-risk of premature impairment and to detect intensive care unit (ICU) admissions, as well as to track the 2-, 7-, 14-, and 28-day mortality in a cohort of patients diagnosed with an acute neurological condition. (2) Methods: We conducted a prospective, longitudinal, observational study, calculating the EWS [Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), VitalPAC Early Warning Score (ViEWS), Modified Rapid Emergency Medicine Score (MREMS), Early Warning Score (EWS), Hamilton Early Warning Score (HEWS), Standardised Early Warning Score (SEWS), WHO Prognostic Scored System (WPSS), and Rapid Acute Physiology Score (RAPS)] upon the arrival of patients to the emergency department. (3) Results: In all, 1160 patients were included: 808 patients were hospitalized, 199 cases (17%) required ICU care, and 6% of patients died (64 cases) within 2 days, which rose to 16% (183 cases) within 28 days. The highest area under the curve for predicting the need for ICU admissions was obtained by RAPS and MEWS. For predicting mortality, MREMS obtained the best scores for 2- and 28-day mortality. (4) Conclusions: This is the first study to explore whether several EWS accurately identify the risk of ICU admissions and mortality, at different time points, in patients with acute neurological disorders. Every score analyzed obtained good results, but it is suggested that the use of RAPS, MEWS, and MREMS should be preferred in the acute setting, for patients with neurological impairment.
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Affiliation(s)
- Carlos Durantez-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - Begoña Polonio-López
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - José L. Martín-Conty
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - Clara Maestre-Miquel
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
| | - Antonio Viñuela
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - Raúl López-Izquierdo
- Department of Emergency, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain;
- Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain;
- Prehospital Early Warning Scoring-System Investigation Group, 47005 Valladolid, Spain
| | - Laura Mordillo-Mateos
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (C.D.-F.); (B.P.-L.); (C.M.-M.); (A.V.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
| | - Cristina Jorge-Soto
- Faculty of Nursing, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
- SICRUS Research Group, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- CLINURSID Research Group, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Martín Otero-Agra
- University School of Nursing, University of Vigo, 36001 Pontevedra, Spain;
- REMOSS Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain
| | - Michele Dileone
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain;
- Hospital Virgen del Puerto, Servicio Extremeño de Salud (SES), 10600 Plasencia, Spain
| | - Joseba Rabanales-Sotos
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, 02006 Albacete, Spain;
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain;
- Prehospital Early Warning Scoring-System Investigation Group, 47005 Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain
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Mondal R, Mishra S, Pillai JSK, Sahoo MC. COVID 19 Pandemic and biomedical waste management practices in healthcare system. J Family Med Prim Care 2022; 11:439-446. [PMID: 35360761 PMCID: PMC8963639 DOI: 10.4103/jfmpc.jfmpc_1139_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/11/2021] [Accepted: 11/24/2021] [Indexed: 12/18/2022] Open
Abstract
The whole world was shaken with the pandemic of Coronavirus Disease (COVID-19) in end of the year 2019. Due to its novel origin, it was required to follow all precautions possible. Dealing with the massive amount of infectious healthcare waste became an enormous challenge. This review identifies the impacts of the pandemic on biomedical waste management. This systematic review was made by using keywords "biomedical waste" and "COVID 19" in open access databases like PubMed, Science Direct, Scopus, Google Scholers etc. 2124 articles downloaded and 765 found duplicate and 634 not related to the topic. after scrutiny with inclusion criteria 102 articles were considered to analyze the practices related to biomedical waste management during pandemic using PRISMA guideline.. The COVID-19 waste segregation, collection, storage, transportation, and disposal are a big challenge with all stakeholders. In order to control the virus spread, strict monitoring of the complete waste management cycle is required. Adoption of appropriate guidelines is paramount to worker safety and containment of infection. Sustainable recycling methods are needed to deal with the ever-increasing plastic waste resulting from mandatory personal protective equipment (PPE) usage. The situation also demands a rethinking of the healthcare system. Overall, there was an increase in BMW generation, and municipal waste had increased globally. Pandemic preparedness requires a global public health strategy and long-term investments. This will be vital for making a robust community capable enough to fight against any public health pressures in the future, as well as the pandemic tremors. Systematized efforts from all stakeholders, at all levels, not only refines epidemic preparation but also helps to attain a sustainable development of health for a healthier future.
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Affiliation(s)
- Ramkrishna Mondal
- Department of Hospital Administration, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Siddharth Mishra
- Department of Hospital Administration, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jawahar S. K. Pillai
- Department of Hospital Administration, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mukunda C. Sahoo
- Department of Hospital Administration, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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4
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Alonso de Leciñana M. [Impact of the COVID-19 pandemic on stroke care]. HIPERTENSION Y RIESGO VASCULAR 2021; 38:161-163. [PMID: 34483078 PMCID: PMC8339573 DOI: 10.1016/j.hipert.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022]
Affiliation(s)
- María Alonso de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, Madrid, España.
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5
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Das AK, Islam MN, Billah MM, Sarker A. COVID-19 pandemic and healthcare solid waste management strategy - A mini-review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 778:146220. [PMID: 33711590 PMCID: PMC7932852 DOI: 10.1016/j.scitotenv.2021.146220] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 05/09/2023]
Abstract
Healthcare waste comprises the waste generated by healthcare facilities, medical laboratories and biomedical research facilities. Improper treatment of this waste poses serious risks of disease transmission to waste pickers, waste workers, health workers, patients, and the community in general through exposure to infectious agents. Poor management of the waste emits harmful and deleterious contaminants into society. However, contamination of highly contagious agents such as the COVID-19 virus has created enormous instability in healthcare waste handling and subsequent recycling because of the volume of the waste generated and its contagious nature. Several countries have adopted safety measures to combat this contamination and manage healthcare waste; however, these measures are insufficient and vary depending on the context of the country. In addition, the WHO has set out guidelines for management of healthcare waste. These guidelines are helping to manage the highly contagious healthcare waste resulting from the current pandemic. Proper healthcare waste management may add value by reducing the spread of the COVID-19 virus and increasing the recyclability of materials instead of sending them to landfill. Disinfecting and sorting out healthcare waste facilitates sustainable management and allows their utilization for valuable purposes. This review discusses the different healthcare solid waste management strategies practiced in different countries, the challenges faced during this management, and the possible solutions for overcoming these challenges. It also provides useful insights into healthcare solid waste management scenarios during the COVID-19 pandemic and a possible way forward.
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Affiliation(s)
- Atanu Kumar Das
- Department of Forest Biomaterials and Technology, Swedish University of Agricultural Sciences, SE-90183 Umeå, Sweden.
| | - Md Nazrul Islam
- Forestry and Wood Technology Discipline, Khulna University, Khulna 9208, Bangladesh
| | - Md Morsaline Billah
- Biotechnology and Genetic Engineering Discipline, Khulna University, Khulna 9208, Bangladesh
| | - Asim Sarker
- Umeå International School of Public Health, Umeå University, SE-90187 Umeå, Sweden
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6
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Das AK, Islam MN, Billah MM, Sarker A. COVID-19 pandemic and healthcare solid waste management strategy - A mini-review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 778:146220. [PMID: 33711590 DOI: 10.1016/j.scitotenv.2021.1462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 05/23/2023]
Abstract
Healthcare waste comprises the waste generated by healthcare facilities, medical laboratories and biomedical research facilities. Improper treatment of this waste poses serious risks of disease transmission to waste pickers, waste workers, health workers, patients, and the community in general through exposure to infectious agents. Poor management of the waste emits harmful and deleterious contaminants into society. However, contamination of highly contagious agents such as the COVID-19 virus has created enormous instability in healthcare waste handling and subsequent recycling because of the volume of the waste generated and its contagious nature. Several countries have adopted safety measures to combat this contamination and manage healthcare waste; however, these measures are insufficient and vary depending on the context of the country. In addition, the WHO has set out guidelines for management of healthcare waste. These guidelines are helping to manage the highly contagious healthcare waste resulting from the current pandemic. Proper healthcare waste management may add value by reducing the spread of the COVID-19 virus and increasing the recyclability of materials instead of sending them to landfill. Disinfecting and sorting out healthcare waste facilitates sustainable management and allows their utilization for valuable purposes. This review discusses the different healthcare solid waste management strategies practiced in different countries, the challenges faced during this management, and the possible solutions for overcoming these challenges. It also provides useful insights into healthcare solid waste management scenarios during the COVID-19 pandemic and a possible way forward.
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Affiliation(s)
- Atanu Kumar Das
- Department of Forest Biomaterials and Technology, Swedish University of Agricultural Sciences, SE-90183 Umeå, Sweden.
| | - Md Nazrul Islam
- Forestry and Wood Technology Discipline, Khulna University, Khulna 9208, Bangladesh
| | - Md Morsaline Billah
- Biotechnology and Genetic Engineering Discipline, Khulna University, Khulna 9208, Bangladesh
| | - Asim Sarker
- Umeå International School of Public Health, Umeå University, SE-90187 Umeå, Sweden
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7
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Alonso de Leciñana M, Castellanos M, Ayo-Martín Ó, Morales A. Stroke care during the COVID-19 outbreak in Spain: the experience of Spanish stroke units. Stroke Vasc Neurol 2021; 6:267-273. [PMID: 33277364 PMCID: PMC7722359 DOI: 10.1136/svn-2020-000678] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Spain has been heavily affected by COVID-19. Reallocation of resources for managing the outbreak might have caused a disruption in stroke care. This study analyses the impact on stroke care of reorganising the healthcare system in response to the first COVID-19 outbreak peak in Spain and the strategies adopted by Spanish stroke units to deal with this impact. MATERIALS AND METHODS We obtained data from a structured survey sent to the responsible of stroke units across the country. We recorded the number of strokes, stroke code activations, intravenous thrombolysis treatments and mechanical thrombectomies during February and March 2019 and 2020. We also collected information on the impact on workflow metrics and on the availability of specialised neurological care and rehabilitation treatments, the characteristics of stroke care for patients with SARS-CoV-2 infection and the impact on human resources. We compared the activity data between 2019 and 2020 and the information on activity and impact on stroke care between regions classified according to the disease incidence rate. RESULTS Fifty-seven (75%) of all stroke units in Spain responded to the survey. There was an overall reduction in admissions for all stroke types during the outbreak's peak and in the number of stroke code activations and intravenous thrombolysis treatments, results that were independent of the COVID-19 incidence rate. Participants reported a delay in workflow metrics and a reduction of admissions to stroke units, outpatient clinics and rehabilitation therapies. Specific pathways and protocols for managing stroke patients with SARS-CoV-2 infection have been established. CONCLUSION The COVID-19 outbreak has jeopardised all phases of stroke care. As a consequence, some patients with stroke did not receive adequate treatment.
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Affiliation(s)
- María Alonso de Leciñana
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research-IdiPAZ. La Paz University Hospital. Universidad Autónoma de Madrid, Madrid, Spain
| | - Mar Castellanos
- Department of Neurology, Complexo Hospitalario Universitario A Coruña. Biomedical Research Institute of A Coruña, A Coruña, Spain
| | - Óscar Ayo-Martín
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Ana Morales
- Department of Neurology, University Clinic Hospital Virgen de la Arrixaca, Murcia, Spain
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8
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Gómez-Porro P, Cabal-Paz B, Valenzuela-Chamorro S, Desanvicente Z, Sabin-Muñoz J, Ochoa-López C, Flórez C, Enríquez-Calzada S, Martín-García R, Esain-González Í, García-Fleitas B, Silva-Hernández L, Ruiz-Molina Á, Gamo-González E, Durán-Lozano A, Velasco-Calvo R, Alba-Alcántara L, González-Santiago R, Callejas-Díaz A, Brea-Álvarez B, Salazar-Uribe JC, Escamilla-Crespo C, Carneado-Ruiz J. High frequency of endoluminal thrombus in patients with ischaemic stroke following SARS-CoV-2 infection. Neurologia 2021; 39:S0213-4853(21)00084-0. [PMID: 34103174 PMCID: PMC8112291 DOI: 10.1016/j.nrl.2021.04.012] [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: 09/06/2020] [Accepted: 04/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ischaemic stroke may be a major complication of SARS-CoV-2 infection. Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. METHODS Data were collected retrospectively on consecutive patients with SARS-CoV-2 infection who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). RESULTS During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack). Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%). We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). CONCLUSIONS In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.
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Affiliation(s)
- P Gómez-Porro
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - B Cabal-Paz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - S Valenzuela-Chamorro
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Z Desanvicente
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Sabin-Muñoz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - C Ochoa-López
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - C Flórez
- Universidad CES, Medellín, Colombia
| | - S Enríquez-Calzada
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - R Martín-García
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Í Esain-González
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - B García-Fleitas
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - L Silva-Hernández
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Á Ruiz-Molina
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - E Gamo-González
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - A Durán-Lozano
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - R Velasco-Calvo
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - L Alba-Alcántara
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - R González-Santiago
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - A Callejas-Díaz
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - B Brea-Álvarez
- Servicio de Radiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - C Escamilla-Crespo
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Carneado-Ruiz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
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Douiri A, Muruet W, Bhalla A, James M, Paley L, Stanley K, Rudd AG, Wolfe CDA, Bray BD. Stroke Care in the United Kingdom During the COVID-19 Pandemic. Stroke 2021; 52:2125-2133. [PMID: 33896223 PMCID: PMC8140645 DOI: 10.1161/strokeaha.120.032253] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Supplemental Digital Content is available in the text. The coronavirus disease 2019 (COVID-19) pandemic has potentially caused indirect harm to patients with other conditions via reduced access to health care services. We aimed to describe the impact of the initial wave of the pandemic on admissions, care quality, and outcomes in patients with acute stroke in the United Kingdom.
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Affiliation(s)
- Abdel Douiri
- School of Population Health and Environmental Sciences (A.D., W.M., A.B., M.J., A.G.R., C.D.A.W., B.D.B.), King's College London, United Kingdom
| | - Walter Muruet
- School of Population Health and Environmental Sciences (A.D., W.M., A.B., M.J., A.G.R., C.D.A.W., B.D.B.), King's College London, United Kingdom
| | - Ajay Bhalla
- School of Population Health and Environmental Sciences (A.D., W.M., A.B., M.J., A.G.R., C.D.A.W., B.D.B.), King's College London, United Kingdom.,Department of Ageing Health and Stroke, Guy's and St Thomas' National Health Service (NHS) Foundation Trust and King's College London, United Kingdom (A.B.)
| | - Martin James
- Royal Devon and Exeter NHS Foundation Trust, United Kingdom (M.J.)
| | - Lizz Paley
- Sentinel Stroke National Audit Programme (L.P., K.S.), King's College London, United Kingdom
| | - Kaili Stanley
- Sentinel Stroke National Audit Programme (L.P., K.S.), King's College London, United Kingdom
| | - Anthony G Rudd
- School of Population Health and Environmental Sciences (A.D., W.M., A.B., M.J., A.G.R., C.D.A.W., B.D.B.), King's College London, United Kingdom
| | - Charles D A Wolfe
- School of Population Health and Environmental Sciences (A.D., W.M., A.B., M.J., A.G.R., C.D.A.W., B.D.B.), King's College London, United Kingdom
| | - Benjamin D Bray
- School of Population Health and Environmental Sciences (A.D., W.M., A.B., M.J., A.G.R., C.D.A.W., B.D.B.), King's College London, United Kingdom
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10
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Cetisli-Korkmaz N, Bilek F, Can-Akman T, Baskan E, Keser I, Dogru-Huzmeli E, Duray M, Aras B, Kilinc B. Rehabilitation strategies and neurological consequences in patients with COVID-19: part I. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1908729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Furkan Bilek
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Firat University, Elazig, Turkey
| | - Tuba Can-Akman
- School of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Emre Baskan
- School of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ilke Keser
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Turkey
| | - Esra Dogru-Huzmeli
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Mehmet Duray
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Suleyman Demirel University, Isparta, Turkey
| | - Bahar Aras
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kutahya Health Sciences University, Kutahya, Turkey
| | - Buse Kilinc
- School of Health Sciences, Department of Physiotherapy and Rehabilitation, KTO Karatay University, Konya, Turkey
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Oladapo BI, Ismail SO, Afolalu TD, Olawade DB, Zahedi M. Review on 3D printing: Fight against COVID-19. MATERIALS CHEMISTRY AND PHYSICS 2021; 258:123943. [PMID: 33106717 PMCID: PMC7578746 DOI: 10.1016/j.matchemphys.2020.123943] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 05/07/2023]
Abstract
The outbreak of coronavirus disease in 2019 (COVID-19) caused by the SARS-CoV-2 virus and its pandemic effects have created a demand for essential medical equipment. To date, there are no specific, clinically significant licensed drugs and vaccines available for COVID-19. Hence, mapping out COVID-19 problems and preventing the spread with relevant technology are very urgent. This study is a review of the work done till October, 2020 on solving COVID-19 with 3D printing. Many patients who need to be hospitalized because of COVID-19 can only survive on bio-macromolecules antiviral respiratory assistance and other medical devices. A bio-cellular face shield with relative comfortability made of bio-macromolecules polymerized polyvinyl chloride (BPVC) and other biomaterials are produced with 3D printers. Summarily, it was evident from this review study that additive manufacturing (AM) is a proffered technology for efficient production of an improved bio-macromolecules capable of significant COVID-19 test and personal protective equipment (PPE) to reduce the effect of COVID-19 on the world economy. Innovative AM applications can play an essential role to combat invisible killers (COVID-19) and its hydra-headed pandemic effects on humans, economics and society.
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Affiliation(s)
- Bankole I Oladapo
- School of Engineering and Sustainable Development, De Montfort University, Leicester, UK
| | - Sikiru O Ismail
- Center for Engineering Research, School of Physics, Engineering and Computer Science, University of Hertfordshire, UK
| | | | - David B Olawade
- Department of Environmental Health Sciences, University of Ibadan, Nigeria
| | - Mohsen Zahedi
- Department of Computer Engineering, University of Isfahan, Iran
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12
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Ramírez-Moreno JM, Portilla-Cuenca JC, Hariramani-Ramchandani R, Rebollo B, Bermejo Casado I, Macías-Sedas P, Ceberino D, Roa-Montero AM, González-Plata A, Casado I, Fernández de Alarcón L. Slump in Hospital Admissions for Stroke, a Fact of an Uncertain Nature That Requires Explanation. Brain Sci 2021; 11:brainsci11010092. [PMID: 33450843 PMCID: PMC7828369 DOI: 10.3390/brainsci11010092] [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: 12/24/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 01/17/2023] Open
Abstract
(1) Background: The impact of the health crisis caused by coronavirus disease 2019 (COVID-19) has provoked collateral effects in the attention to pathologies with time-dependent treatments such as strokes. We compare the healthcare activity of two stroke units in the same periods of 2019 and 2020, with an emphasis on what happened during the state of alarm (SA). (2) Materials and methods. Hospitals in the region implemented contingency plans to contain the pandemic; in this planning, the stroke units were not limited in their operational capacity. The SA was declared on 15 March and remained in place for 10 weeks. For the analysis, the data were grouped by consecutive calendar weeks. (3) Results. When the SA was declared the number of calls to the emergency telephone went from 1225 to 3908 calls per week (318% increase). However, the activation of the stroke code went from 6.6 to 5.0 (p = 0.04) and the activity in both stroke units decreased. The largest drop in hospitalizations was for transient ischemic attacks (TIAs) with 35.7% less, 28 vs. 18, (p = 0.05). Reperfusion therapies fell by 37.5%; Poisson regression model 0.64; (95% confidence interval (CI), 0.43–0.95). The overall activity of the telestroke suffered a reduction of 28.9%. We also observed an increase in hospital mortality. (4) Conclusion. The excessive duration of the pandemic precludes any hope of resolving this public health crisis in the short or medium term. Further studies should be conducted to better understand the multifactorial nature of this dramatic decline in stroke admissions and its negative impact.
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Affiliation(s)
- José M. Ramírez-Moreno
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
- Department of Biomedical Sciences, Extremadura University, 06080 Badajoz, Spain
- Multidisciplinary Research Group of Extremadura (GRIMEX), 06700 Villanueva de la Serena, Spain
- University Institute of Biosanitary Research of Extremadura (INUBE), 06080 Badajoz, Spain;
- Correspondence:
| | | | - Roshan Hariramani-Ramchandani
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Belen Rebollo
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Inés Bermejo Casado
- Department of Neurology, University Hospital of Cáceres, 10003 Cáceres, Spain; (J.C.P.-C.); (I.B.C.)
| | - Pablo Macías-Sedas
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - David Ceberino
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Ana M. Roa-Montero
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Alberto González-Plata
- Department of Neurology, University Hospital of Badajoz, 06080 Badajoz, Spain; (R.H.-R.); (B.R.); (P.M.-S.); (D.C.); (A.M.R.-M.); (A.G.-P.)
| | - Ignacio Casado
- University Institute of Biosanitary Research of Extremadura (INUBE), 06080 Badajoz, Spain;
- Department of Neurology, University Hospital of Cáceres, 10003 Cáceres, Spain; (J.C.P.-C.); (I.B.C.)
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Gonzalez-Fajardo JA, Ansuategui M, Ibarra G, Gómez-Arbeláez D, Garcia-Gutierrez A, Saura P, Barcena E. [Prognosis of patients with COVID-19 presenting acute ischaemic stroke and receiving interventional treatment]. NEUROLOGY PERSPECTIVES 2021; 1:33-38. [PMID: 38620899 PMCID: PMC7934670 DOI: 10.1016/j.neurop.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
Abstract
Objetivo Presentar nuestra experiencia y analizar el pronóstico de pacientes COVID-19 con ictus isquémico agudo por oclusión de grandes vasos tratados con neurointervencionismo (NIV) en la unidad de ictus. Material y métodos Se incluyeron todos los pacientes consecutivos con ictus isquémico agudo debido a oclusión de grandes vasos tratados por NIV en nuestra institución entre marzo y abril de 2020, durante el brote de COVID-19. Se realizó una comparación entre pacientes con COVID-19 y pacientes sin infección por coronavirus. Se comunican los resultados clínicos iniciales y a corto plazo. Resultados Del 1 de marzo al 30 de abril se realizaron 25 procedimientos de NIV por ictus isquémico agudo en nuestra institución. Ocho pacientes eran COVID-19 y 17 eran pacientes no COVID-19. La edad media de los pacientes con COVID-19 fue de 70,1 ± 12,23 años, y 7 fueron hombres (87,5%, p = 0,006). Mientras que todos los pacientes sin COVID procedían de urgencias, solo 5 pacientes con COVID-19 (62,5%) fueron atendidos desde urgencias por ictus (p = 0,01). Tres pacientes procedían de hospitalización. La tasa de mortalidad en pacientes sin COVID-19 fue del 5,8%, pero en pacientes con COVID-19 fue considerablemente alta (50%). Ningún parámetro analítico difirió entre ambos grupos. No se registraron hemorragias en esta serie.En comparación con el mismo período del año pasado, se observó una disminución de la actividad neurointervencionista del 39%. Conclusiones La mejor terapia médica y de NIV desembocó en malos resultados y una mortalidad dramática. La pandemia de COVID-19 dificultó significativamente el funcionamiento normal de los servicios de urgencias y la atención de estos pacientes con ictus.
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Affiliation(s)
- J A Gonzalez-Fajardo
- Servicio de Cirugía Vascular, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Ansuategui
- Servicio de Cirugía Vascular, Hospital Universitario 12 de Octubre, Madrid, España
| | - G Ibarra
- Servicio de Cirugía Vascular, Hospital Universitario 12 de Octubre, Madrid, España
| | - D Gómez-Arbeláez
- Servicio de Cirugía Vascular, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Garcia-Gutierrez
- Servicio de Cirugía Vascular, Hospital Universitario 12 de Octubre, Madrid, España
| | - P Saura
- Unidad de Neurointervencionismo Radiológico, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Barcena
- Unidad de Neurointervencionismo Radiológico, Hospital Universitario 12 de Octubre, Madrid, España
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González-Ortiz S, Medrano S, Maiques JM, Capellades J. Challenges in Neuroimaging in COVID-19 Pandemia. Front Neurol 2020; 11:579079. [PMID: 33329320 PMCID: PMC7734130 DOI: 10.3389/fneur.2020.579079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Sofía González-Ortiz
- Neuroradiology Section, Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Santiago Medrano
- Neuroradiology Section, Radiology Department, Hospital del Mar, Barcelona, Spain
| | - José María Maiques
- Neuroradiology Section, Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Jaume Capellades
- Neuroradiology Section, Radiology Department, Hospital del Mar, Barcelona, Spain
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15
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Dula AN, Gealogo Brown G, Aggarwal A, Clark KL. Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go? JMIR Aging 2020; 3:e21608. [PMID: 33006936 PMCID: PMC7581311 DOI: 10.2196/21608] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/18/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022] Open
Abstract
Despite the evidence suggesting a high rate of cerebrovascular complications in patients with SARS-CoV-2, reports have indicated decreasing rates of new ischemic stroke diagnoses during the COVID-19 pandemic. The observed decrease in emergency department (ED) visits is unsurprising during this major crisis, as patients are likely to prioritize avoiding exposure to SARS-CoV-2 over addressing what they may perceive as mild symptoms of headache, lethargy, difficulty speaking, and numbness. In the central and south Texas regions where we practice, we suspect that patient admission, treatment, and discharge volumes for acute stroke treatment have decreased significantly since COVID-19–related shelter-at-home orders were issued. Symptoms of stroke are frequently noticed by a family member, friend, or community member before they are recognized by the patients themselves, and these symptoms may be going unnoticed due to limited face-to-face encounters. This possibility emphasizes the importance of patient education regarding stroke warning signs and symptoms during the current period of isolation and social-distancing. The south Texas population, already saddled with above-average rates of cardiovascular and cerebrovascular disease, has a higher stroke mortality rate compared to Texas and U.S. averages; however, the number of patients presenting to EDs with acute ischemic stroke diagnoses is lower than average. In our viewpoint, we aim to present the relative literature to date and outline our ongoing analyses of the highly affected and diverse stroke populations in San Antonio and Austin, Texas, to answer a simple question: where did all our stroke patients go?
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Affiliation(s)
- Adrienne Nicole Dula
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States.,Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Gretchel Gealogo Brown
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Aarushi Aggarwal
- Long School of Medicine, University of Texas Health, San Antonio, TX, United States
| | - Kal L Clark
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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16
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Venketasubramanian N. Stroke Care Services in Singapore During COVID-19 Pandemic-A National Perspective. Front Neurol 2020; 11:780. [PMID: 32849231 PMCID: PMC7399214 DOI: 10.3389/fneur.2020.00780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022] Open
Abstract
Stroke is a significant cause of admission to Singapore's acute care hospitals. Because of the current COVID-19 pandemic, there have been major changes in the stroke care system. On calling for the public ambulance, those suspected to have COVID-19 infection are taken to the National Center for Infectious Diseases. Otherwise, on arrival at the emergency room, all cases with fever or respiratory symptoms [COVID-19 suspect patients (CSPs)] are evaluated separately by staff wearing full personal protective equipment (PPE). Triage is not delayed. CSPs needing hyperacute therapies are sent to a specially prepared scanner; if not, imaging is deferred to the latter part of the day. CSPs are managed in isolation rooms, and sent to the acute stroke unit (ASU) if two consecutive COVID-19 swabs are negative. Investigation and rehabilitation are done within the room. ASU rounds are attended by essential members, communication by electronic means. Multidisciplinary team rounds have largely ceased, and discussions are via electronic platforms. Patient transfer and staff movement are minimized. All hospital staff wear face-masks, infection control is strictly enforced. Visitors are not allowed; staff make daily calls to update families. Mild stroke patients may be sent home with rehabilitation advice. Out-patient rehabilitation centers are closed. Patients return for out-patient visits only if needed; medications are sent to their home, and nurses make essential home visits. Stroke support and rehabilitation activities have started on-line. Continuing medical education activities are mainly by webinars. Stroke research has been severely hampered. Overall, evidence-based stroke care is delivered in a re-organized manner, with a clear eye on infection control.
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17
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Fuentes B, Alonso de Leciñana M, Calleja-Castaño P, Carneado-Ruiz J, Egido-Herrero J, Gil-Núñez A, Masjuán-Vallejo J, Vivancos-Mora J, Rodríguez-Pardo J, Riera-López N, Ximénez-Carrillo Á, Cruz-Culebras A, Gómez-Escalonilla C, Díez-Tejedor E. Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan. Neurologia 2020; 35:363-371. [PMID: 32563566 PMCID: PMC7241395 DOI: 10.1016/j.nrl.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid. METHODS We conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy). RESULTS The survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%. CONCLUSIONS The organisational changes made in response to the SARS-Co2 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up.
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Affiliation(s)
- B Fuentes
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España.
| | - M Alonso de Leciñana
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España
| | - P Calleja-Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Carneado-Ruiz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, España
| | - J Egido-Herrero
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, España
| | - A Gil-Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, España
| | - J Masjuán-Vallejo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, ALcalá de Henares (Madrid), España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - J Rodríguez-Pardo
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España
| | - N Riera-López
- Servicio de Urgencias Médicas de Madrid, SUMMA 112, Madrid, España
| | - Á Ximénez-Carrillo
- Servicio de Neurología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - A Cruz-Culebras
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, ALcalá de Henares (Madrid), España
| | - C Gómez-Escalonilla
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, España
| | - E Díez-Tejedor
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España
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18
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Fuentes B, Alonso de Leciñana M, Calleja-Castaño P, Carneado-Ruiz J, Egido-Herrero J, Gil-Núñez A, Masjuán-Vallejo J, Vivancos-Mora J, Rodríguez-Pardo J, Riera-López N, Ximénez-Carrillo Á, Cruz-Culebras A, Gómez-Escalonilla C, Díez-Tejedor E. Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan. NEUROLOGÍA (ENGLISH EDITION) 2020. [PMCID: PMC7334907 DOI: 10.1016/j.nrleng.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Wira CR, Goyal M, Southerland AM, Sheth KN, McNair ND, Khosravani H, Leonard A, Panagos P. Pandemic Guidance for Stroke Centers Aiding COVID-19 Treatment Teams. Stroke 2020; 51:2587-2592. [PMID: 32716826 PMCID: PMC7326321 DOI: 10.1161/strokeaha.120.030749] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has in some regions overwhelmed the capacity and staffing needs of healthcare systems, necessitating the provision of resources and staff from different disciplines to aid COVID treatment teams. Stroke centers have multidisciplinary clinical and procedural expertise to support COVID treatment teams. Staff safety and patient safety are essential, as are open lines of communication between stroke center leaders and hospital leadership in a pandemic where policies and procedures can change or evolve rapidly. Support needs to be allocated in a way that allows for the continued operation of a fully capable stroke center, with the ability to adjust if stroke center volume or staff attrition requires.
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Affiliation(s)
- Charles R Wira
- Yale Department of Emergency Medicine and Yale Stroke Program, New Haven, CT (C.R.W.)
| | - Mayank Goyal
- Departments of Clinical Neurosciences and Diagnostic Imaging, University of Calgary, Canada (M.G.)
| | - Andrew M Southerland
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville (A.M.S.)
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine & Yale New Haven Hospital, New Haven, CT (K.N.S.)
| | | | - Houman Khosravani
- Neurology Quality and Innovation Laboratory (NQIL), Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada (H.K.)
| | | | - Peter Panagos
- Division of Emergency Medicine, Washington University School of Medicine in St. Louis, MO (P.P.)
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Barrios-López J, Rego-García I, Muñoz Martínez C, Romero-Fábrega J, Rivero Rodríguez M, Ruiz Giménez J, Escamilla-Sevilla F, Mínguez-Castellanos A, Fernández Pérez M. Ischaemic stroke and SARS-CoV-2 infection: a causal or incidental association? NEUROLOGÍA (ENGLISH EDITION) 2020. [PMCID: PMC7253983 DOI: 10.1016/j.nrleng.2020.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Ischaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection. Materials and methods We describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients. Results The association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental. Conclusions Systemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.
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Affiliation(s)
- J.M. Barrios-López
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Corresponding author.
| | - I. Rego-García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - C. Muñoz Martínez
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J.C. Romero-Fábrega
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M. Rivero Rodríguez
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J.A. Ruiz Giménez
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
| | - F. Escamilla-Sevilla
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
| | - A. Mínguez-Castellanos
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
| | - M.D. Fernández Pérez
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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21
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Barrios-López JM, Rego-García I, Muñoz Martínez C, Romero-Fábrega JC, Rivero Rodríguez M, Ruiz Giménez JA, Escamilla-Sevilla F, Mínguez-Castellanos A, Fernández Pérez MD. Ischaemic stroke and SARS-CoV-2 infection: A causal or incidental association? Neurologia 2020; 35:295-302. [PMID: 32448674 PMCID: PMC7211755 DOI: 10.1016/j.nrl.2020.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Ischaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection. METHODS We describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients. RESULTS The association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental. CONCLUSIONS Systemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.
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Affiliation(s)
- J M Barrios-López
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - I Rego-García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - C Muñoz Martínez
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - J C Romero-Fábrega
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M Rivero Rodríguez
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, España
| | - J A Ruiz Giménez
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, España
| | - F Escamilla-Sevilla
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, España
| | - A Mínguez-Castellanos
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, España
| | - M D Fernández Pérez
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
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Trejo-Gabriel-Galán JM. Stroke as a complication and prognostic factor of COVID-19. Neurologia 2020; 35:318-322. [PMID: 32493597 PMCID: PMC7200328 DOI: 10.1016/j.nrl.2020.04.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Contradictory data have been reported on the incidence of stroke in patients with COVID-19 and the risk of SARS-CoV-2 infection among patients with history of stroke. METHODS This study systematically reviews case series reporting stroke as a complication of COVID-19, and analyses the prognosis of patients with COVID-19 and history of stroke. The pathophysiological mechanisms of stroke in patients with COVID-19 are also reviewed. CONCLUSIONS History of stroke increases the risk of death due to COVID-19 by 3 times. Stroke currently seems not to be one of the main complications of COVID-19.
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Papi C, Spagni G, Alexandre A, Calabresi P, Della Marca G, Broccolini A. Unprotected stroke management in an undiagnosed case of Severe Acute Respiratory Syndrome Coronavirus 2 infection. J Stroke Cerebrovasc Dis 2020; 29:104981. [PMID: 32807416 PMCID: PMC7245230 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 12/20/2022] Open
Abstract
Coronavirus disease 19 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this scenario, managing acute medical conditions, such as stroke, requires a timely treatment together with proper strategies that minimize the risk of infection spreading to health care workers and other patients. We report the case of a 79-year-old woman, who was admitted for a wake-up stroke due to occlusion of the left middle cerebral artery. She was treated outside the COVID-19-dedicated track of the hospital because she had no concomitant signs or symptoms suggestive of SARS-CoV-2 infection nor recent contact with other infected individuals. Post-mortem nasal and pharyngeal swab was positive for SARS-CoV-2 infection. We propose that hyperacute stroke patients should be tested for SARS-CoV-2 infection at admission and then managed as having COVID-19 until cleared by a negative result. We are aware that such measure results in some delay of the acute treatment of stroke, which could be minimal using well-exercised containment protocols.
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Affiliation(s)
- Claudia Papi
- Area Neuroscienze, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gregorio Spagni
- Area Neuroscienze, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Alexandre
- Area Diagnostica per Immagini, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Calabresi
- Area Neuroscienze, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giacomo Della Marca
- Area Neuroscienze, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Aldobrando Broccolini
- Area Neuroscienze, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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