ABSTRACT
Background@#and Purpose There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy. @*Methods@#Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models. @*Results@#We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%–29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively). @*Conclusions@#Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.
ABSTRACT
To assess improvement in functional outcomes following prosthetic fitting after lower limb amputation using a lower extremity functional scale in a cohort of the Pakistani population. Quasi experimental Study. Amputee rehabilitation ward [indoor] / OPD [out patient department] at Armed Forces Institute of Rehabilitation Medicine Rawalpindi. From August 2009 to August 2010. Study was carried out in the amputee rehabilitation ward of the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan. Fifty two consenting lower limb amputees fulfilling the inclusion criteria were enrolled. All patients were provided with modular prosthesis followed by gait training and integrated amputee rehabilitation program. An assessment was done at 0, 4 and 12 weeks after the provision of prosthesis. Results were analyzed by SPSS Version 15. Most of the patients were males [98.1%]. Mean age was 30.17 +/- 9 years. Trauma was the main etiology [99%] followed by tumor [in only 1 patient who had osteosarcoma]. Transtibial amputation level was the commonest [53.8%] followed by transfemoral in 32.7% patients and Syme's [7.7%]. Lower extremity functional scale [LEFS] mean score in the first week was 35.56 [44.5% of maximum function], which improved to 49.40 [61.8% of maximum function] at week 4, and 59.27 [74.09% of maximum function] at the end of week 12. The p-value for each was 0.000. Early and multidisciplinary amputee rehabilitation improves the functional ambulation level, quality of life and satisfaction level of the individual