Rehabilitation of children and adolescents with diabetes during Coronavirus Pandemic in comparison to the year before the pandemic

Background during the pandemic a decrease of more than 30% of pediatric rehabilitations was seen in the year 2020. These data are are provided by the German Rentenversicherung (DRV). DRV is not the only provider of pediatric rehabilitations. DPV database can analyse data independent of the funding provider and a comparison of the prepandemic year with the pandemic years 2020/21 can be performed. Methods Comparison of inpatient rehabilitation of 11 pediatric rehabilitation clinics in the years 2019 (pre pandemic) and 2020/21. Monthly analysis of number of admissions, duration of stay, HbA1c, and BMI development. Comparison of rehabilitation in east and west German clinics and subanalysis of age below and above 12 years. Results In 2019 in total 2237 children and adolescents with type 1 diabetes were admitted, in 2020 a reduction to 1455 (-35%) and no improvement in 2021 (n=1447) was seen. A dramatic decrease was evident in April and May 2020 during the first lockdown. During the first lockdown the duration of stay in the clinic was siginificantly reduced. The eastern German clinics remained with more stable admissions in this period. HbA1c showed a significant increase during the first lockdown (April 2019: 8.19% (7.94, 8.44);April 2020: 8.68% (8.25, 9.11);April 2021 7.94% (7.63, 8.24)). The age stratified analysis showed a higher HbAc1 level in the adolescents compared to the children. BMI-SDS was 0.29 (0.24, 0.33) in 2019, increased to 0.35 (0.29;0.41) in 2020 and further increased to 0.41 (0.35;0.46) in 2021. Conclusion We saw a significant reduction of the number of pediatric diabetes rehabilitations in the Coronavirus Pandemic and no improvment of this decrease during 2021.

Beyond rich and poor: Identifying global development constellations

Motivation: The COVID-19 pandemic is the most recent instance of global development problems being liable to occur anywhere, challenging the assumption of a world divided into “developed” and “developing” countries. Recent scholarship has increasingly opted for the term “global development” to capture this changing geography of development problems. Purpose: Our article contributes to these debates by proposing a novel empirical approach to localize global development problems in country contexts worldwide. Methods and approach: Our approach rests on a universal understanding of “development.” We identify countries that are particularly relevant for global problem-solving and consider not only the problem dimension but also countries' capacities to address these problems. Findings: Our results show that countries with the most severe combinations of problems cover a range as broad as Afghanistan, Nigeria, and the United States. Two thirds of countries with above-average contributions to global problems are governed by authoritarian regimes. We also find that middle income countries, whether lower-middle or upper-middle as defined by the World Bank, have little in common apart from their income level. Policy implications: Our analysis shows that traditional development concepts of a binary world order and of foreign aid as financial transfer to remedy imbalances are not enough to address constellations of global problems and capacity that have long evolved beyond rich and poor. © 2022 The Authors. Development Policy Review published by John Wiley & Sons Ltd on behalf of ODI.

COVID pandemic versus pre-pandemic care of stroke patients within the Florida Stroke Registry

Background: The coronavirus 2019 (COVID-19) pandemic has affected all aspects of stroke care delivery and resource allocation. We sought to study this effect utilizing the Florida Stroke Registry (FSR), which collects data from hospitals in large metropolitan cities and small communities, each facing pandemic peaks at different timepoints and within various healthcare system organizations. Methods: From March 2019 to March 2021, the FSR identified 82,899 patients with the final diagnosis of ischemic stroke and TIA. Stroke care metrics were compared in patients enrolled during the COVID-19 pandemic (March 2020 to February 2021) to those enrolled in the immediate pre-pandemic year. These metrics included utilization of intravenous thrombolytic (IVT), Endovascular therapy (EVT), Door-To-Needle time (DTN), Door-To-Puncture time (DTP), Door-To-Computed Tomography time (DTCT) and overall Defect-Free Care (DFC). Results: Pre-pandemic patients (n= 41,929, 49.0% female, mean age 70.1 ± 14.6 years, 64.3% white, 20.4% black, 15.3% Hispanic) had similar demographics to pandemic patients (48.8% female, mean age 69.9 ± 14.4 years, 65.4% white, 19.9% black, 14.7% Hispanic). Pandemic stroke patients had more severe presentations (median NIHSS 3 [IQR 8] vs 3 [7], p < .0001), longer onset-to-arrival time (242 [677] vs 229 [654] minutes, p = 0.002), and were more likely to arrive via emergency medical services (62.3% vs. 60.8%, p < .0001) than pre-pandemic stroke patients. Although both groups received IVT equally (13.4% vs. 13.5%, p = 0.67), pandemic stroke patients were more likely to receive EVT (7.0% vs. 6.5%, p = 0.005) and had longer DTP (84 [60] vs. 81 [64] minutes, p = 0.01), shorter DTCT (22 [52] vs 23 [56] minutes, p = 0.01) and similar DTN (36 [22] vs. 37 [22] minutes, p = 0.05) times, with an increased DFC rate of 2.2% (86.6% vs. 84.4%, p < .0001). Conclusions: In this large registry based study, we found that compared to pre-pandemic care, ischemic stroke patients treated during the COVID19 pandemic presented sicker and later to the hospital and were more likely to receive EVT, but had longer door-to-puncture times. Despite many healthcare delivery challenges imposed by COVID19, Florida hospitals within the FSR maintained high quality of stroke care overall.

Intravenous tPA for acute ischemic stroke in patients with COVID-19

Objective: To evaluate the safety and efficacy of IV tPA in patients with stroke and COVID-19. Background: Coronavirus disease 2019 (COVID-19) is associated with increased risk of acute ischemic stroke (AIS), however, there is a paucity of data regarding outcomes after administration of intravenous tissue plasminogen activator (IV tPA) for stroke in patients with COVID-19. Design/Methods: We present a multi-center case series from 9 centers in the United States of patients with acute neurological deficits consistent with AIS and COVID-19 who were treated with IV tPA. Results: We identified 13 patients (mean age 62 (±9.8) years, 9 (69.2%) male). All received IV tPA and 3 cases also underwent mechanical thrombectomy. All patients had systemic symptoms consistent with COVID-19 at the time of admission: fever (5 patients), cough (7 patients), and dyspnea (8 patients). The median admission NIH stroke scale (NIHSS) score was 14.5 (range 3- 26) and most patients (61.5%) improved at follow up (median NIHSS score 7.5, range 0-25). No systemic or symptomatic intracranial hemorrhages were seen. Stroke mechanisms included cardioembolic (3 patients), large artery atherosclerosis (2 patients), small vessel disease (1 patient), embolic stroke of undetermined source (3 patients), and cryptogenic with incomplete investigation (1 patient). Three patients were determined to have transient ischemic attacks or aborted strokes. Two out of 12 (16.6%) patients had elevated fibrinogen levels on admission (mean 262.2 ± 87.5 mg/dl), and 7 out of 11 (63.6%) patients had an elevated D-dimer level (mean 4284.6 ±3368.9 ng/ml). Conclusions: IV tPA may be safe and efficacious in COVID-19, but larger studies are needed to validate these results.

What is the Preferred Screening Tool for COVID-19 in Asymptomatic Patients Undergoing a Surgical or Diagnostic Procedure?

INTRODUCTION: Since the outbreak of COVID-19, measures were taken to protect healthcare staff from infection, to prevent infection of patients admitted to the hospital and to distribute PPE according to need. To assure the proper protection without overuse of limited supply of these equipments, screening of patients before surgical or diagnostic procedure was implemented. This study evaluates the results of this screening. METHOD: All patients screened for COVID-19 before procedure warranting either general, locoregional anaesthesia or sedation were included. Screening included a symptom questionnaire by phone, PCR and HRCT chest testing. Surgical or procedural details were registered together with actions taken based on screening results. RESULTS: Three hundred ninety-eight screenings were performed on 386 patients. The symptom questionnaire was completed in 72% of screenings. In 371 screenings, PCR testing was performed and negative. HRCT chest found 18 cases where COVID-19 could not be excluded, with negative PCR testing. Three patients had their surgery postponed due to inconclusive screening, and additional measures were taken in three other patients. There were incidental findings in 14% of HRCT chest scans. DISCUSSION: Pre-operative screening will differentiate if PPE is needed for procedures and which patients can safely have elective surgery during this COVID-19 pandemic and in the times to come. HRCT chest has no additional value in the pre-operative screening of asymptomatic patients. Screening can be performed with a symptom questionnaire, and additional screening with PCR testing in high-risk patient groups should be considered.