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.

uncommon diagnosis of Windsock deformity for a common presentation

We report a two-year-old Indonesian female who presented with vomiting and weight loss for more than one month and was ultimately diagnosed with duodenal obstruction due to a windsock deformity. This is a rare and intrinsic congenital anomaly of the duodenum. The diagnosis as well as immediate and conclusive surgical management is discussed

Unusual presentation of bone metastasis from hepatocellular carcinoma mimicking as breast lump

A 55-year female presented with left breast lump. Her sonomammography was unremarkable. Core biopsy showed it to be metastatic hepatocellular carcinoma [HCC]. Biphasic computerized tomography [CT] of liver confirmed presence of primary liver masses while CT chest showed involvement of left anterior chest wall, rather than primary breast mass. F18-Fluorodeoxyglucose [FDG] positron emission tomography CT [PET-CT] imaging confirmed primary liver tumor with bony metastases

Initial one year pioneering experience in advanced LaparoscopicBariatric Surgery

Background: Obesity is a health and economic risk; individuals with a BMI of >/-30 kg/m2 have 50%-100% increased risk of early death

Objective: To assess the outcomes of advance bariatric procedures namely: Biliopancreatic Diversion [BPD], Mini Gastric Bypass [MGB] and Sleeve Gastrectomy

Design: A Retrospective Study. Setting: King Hamad University Hospital, Bahrain

Method: Eighty-five patients operated for bariatric surgery between July 2012 and August 2013 were reviewed. The following vitals were monitored: excess weight loss, diabetes mellitus [DM], hypertension [HTN], hypercholesterolemia, degenerative joint disease and obstructive sleep apnea [OSA]

Result: Forty-one [95.34%] BPD patients had complete resolution of dyslipidemia, 22 [88%] of DM and 15 [78.94%] of HTN. MGB resulted in complete resolution of HTN in 7 [87.5%] patients and DM in 10 [83.33%]. Dyslipidemia had improved in 2 [66.66%] patients who had Sleeve Gastrectomy and 4 [66.66%] patients with degenerative joint disease

Conclusion: From our experience, bariatric surgery is a feasible and reliable modality for treating obesity and its associated comorbidities. Long-term results may help to enlighten us on the most appropriate procedure for the Arabian Gulf population

Surgical management of Necrotizing Enterocolitis following Congenital Diaphragmatic Hernia Repair

Necrotizing Enterocolitis [NEC] is a significant cause of in-hospital mortality. The pathogenesis remains unclear, but may be associated with Staphylococcus epidermidis related sepsis, hypertonic feeds or other stress. It is also associated with Abdominal Compartment Syndrome [ACS] as documented after complete closure of gastroschisis. While the incidence of NEC is rare, the associated mortality is significant. We report a case of NEC following the repair of a congenital diaphragmatic hernia [CDH]; an unusual yet serious complication. A literature search revealed only one similar case which resulted in mortality. The possibility of serious postoperative complications following the repair of CDH must be considered in any neonate who exhibits deterioration in their general condition