Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis / 대한뇌졸중학회지

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.

Iatrogenic post biopsy hemobilia with pseudoaneurysm

Hemobilia is defined as bleeding into the biliary tree from an abnormal communication between a blood vessel and bile duct. It is an uncommon cause of upper gastrointestinal hemorrhage and iatrogenic most of the times. We report a case of hemobilia secondary to percutaneous liver biopsy presenting with classical Quincke's triad in a young lady which was treated with combined biliary balloon sweep thrombectomy and transarterial embolization for complete resolution of symptoms

Time for change: conventional interferon regimes should not be the standard of care for management of Pakistani genotype-3 in chronic Hepatitis C

The aim of the present study was to determine the efficacy and side effect profile of conventional interferon alpha-2b plus ribavirin for treating chronic hepatitis C genotype-3 infections in Pakistan. The study was conducted on treating 220 treatment-naAve individuals at KRL Hospital with conventional interferon given for 6 months. Both the response and side effects were analyzed using simple descriptive statistics. Out of total cohort, 84.92% [169 out of 199] achieved end of treatment response [ETR] while 63.31% [126 out of 199] achieved sustained virological response [SVR]. Leukopenia, gastrointestinal and miscellaneous systemic complaints were the most common adverse effects. In the context of a low ETR and SVR but a similar side effect profile as that of pegylated regimes, conventional therapy needs to be replaced with peg-interferon as the treatment of choice

Intralobar bronchopulmonary sequestration with large aberrant vessel presenting as recurrent pneumonias

Bronchopulmonary sequestration is a rare congenital malformation of the lower respiratory tract comprising of a nonfunctioning lung tissue mass that lacks normal communication with the tracheobronchial tree. The diagnosis may be easily missed as many of the symptoms of bronchopulmonary sequestration overlap with that of other pulmonary diseases. Bronchopulmonary sequestration can be complicated by recurrent infections, hemorrhage and malignant transformation and, therefore, needs to be timely diagnosed and resected to decrease both morbidity and mortality. A high degree of suspicion in the differential diagnosis helps diagnose the positive cases. The parenchymal abnormalities associated with bronchopulmonary sequestration are best visualized using computed tomography, although their appearance is variable. We report the case of a 14 years old boy with intralobar bronchopulmonary sequestration with the sole manifestation of recurrent pneumonias

prospective study of factors predicting postoperative pulmonary complications [PPC] in patients undergoing noncardiothoracic surgery under general anaesthsia in a developing country

Post-operative pulmonary complications after non-cardiothoracic surgery are common and can adversely affect morbidity, mortality and length of hospital stay. Knowledge as regards factors predicting postoperative pulmonary complications in our local setting is imperfect. To study factors predicting post-operative pulmonary complications in developing countries. Data of consecutive 404 patients undergoing non-cardiothoracic surgery under general anesthesia with tracheal intubation was collected prospectively from Jan 2009 to Dec 2010. Chi-square was used for univariate analysis. Multivariate analysis was conducted using forward stepwise logistic regression. The mean age was 36 +/- 18 years with slight male predominence [54% vs 46%]. 22% [n=89] were smokers and the mean Body Mass Index was 23 +/- 4.5 kg/m2 with 35% [n=141] overweight and obese. 5% [n=20] of subjects had pre-existing chronic lung conditions while 23% [n=92] had non-pulmonary chronic conditions. 70% [n=282] of the surgeries were done electively and the mean duration of anesthesia was 78 +/- 44 minutes. The overall postoperative pulmonary complications rate was 8% [n=31] with atelactasis [48%, n=16] followed by bronchospasm [25%, n=8] and pneumonia [16%, n=5] being the commonest complications. The duration of hospital stay was significantly longer [11 +/- 9 days, p=0.00] in patients with post-operative pulmonary complications and 29% [n=9] of them required mechanical ventilation. Logistic Regression analysis identified premorbid chronic chest conditions, emergency surgery and prolonged duration of anesthesia as significant predictors of post-operative pulmonary complications while age, gender, Body Mass Index, smoking history and non-pulmonary premorbids were insignificant in this regard. Post-operative pulmonary complications after non-cardiothoracic surgery are common and lead to increased morbidity and prolonged hospital stay in our setting. We identified pre-existing chest disease, prolonged anesthesia and emergency surgery as significant predictors of post-operative pulmonary complications