ABSTRACT
On April 9 and 10, 2022, over 79 scholars and 230 attendees met online to share their research on the health and medical humanities in the Middle East and North Africa (MENA) region at the 2nd International Conference on the Medical Humanities in the Middle East (online). This meeting was the second convening of experts since the successful 2018 in-person conference in Doha, Qatar at the Sheraton Hotel. The 2022 conference was jointly sponsored by VCUArts Qatar and Weill Cornell Medicine – Qatar, and was convened by Drs. Alan Weber, Byrad Yyelland, and Mohamud Verjee. The diversity and increase in submissions from 2018 to 2022 testify to the growing importance of humanism in medicine in the region. The published s in this special issue of QScience Connect provide a comprehensive overview of the medical and health humanities as they are currently practiced and researched in the Middle East region. For example, the first keynote speech, "Is the Beauty Industry a Virus Invading the Medical Profession?" by Iraqi surgeon and visual artist Dr. Ala Bashir, addressed a critical issue in the region, the growing popularity of cosmetic surgery and the unlicensed and unregulated nature of the industry. The second keynote speech by health humanities professor Paul Crawford (University of Nottingham) entitled "Towards Creative Public Health: The Contribution of the Medical and Health Humanities," provided an overview of recent international initiatives to harness the arts for health education, healing, and wellness. The other presentations from researchers in Kuwait, UK, Jordan, US, Turkey, Israel, Iran, Qatar, Iraq, UAE, India, and Egypt represented the full range of the medical and health humanities that are developing internationally, including the history of medicine, medical sociology and anthropology, narrative medicine, literature and medicine, graphic medicine, healthcare communications, art therapy, the visual arts, film and medicine, and medical ethics. In addition, a panel of premedical and medical students led by Maryam Arabi and Abdallah Tom provided their perspectives on the topic with respect to the educational needs of students. A group of gerontology experts composed of Mark Clarfield, Regina Roller-Wirnsberger, and Desmond O'Neill directed a workshop on publishing research on the health and medical humanities in scientific scholarly journals. Authors Shahd Alshammari and Robin Fetherston gave dramatic readings from their fiction and non-fiction works. Three posters published on the website added to the oral presentations (https://qatar-weill.cornell.edu/event/medical-humanities-in-the-middle-east/posters). Three of the oral presentations spoke to ethics in medical humanities within the Middle East. Banu Buruk and Berna Arda shared the Turkish National Artificial Intelligence Strategy (TNAIS) report which describes methods for determining and initiating national priorities related to AI. This report identifies four ethical values and eight ethical principles worthy of examination since almost one in five AI strategies are applied in the health sciences. The authors discussed TNAIS and concomitant ethical issues, concluding with recommendations for dealing with conflicts as they arise. Alya Al Shakaki then presented on ethical questions related to use of the gene-editing tool, CRISPR-Cas9, which enables "designer babies". CRISPR has been used in China to create babies that are immune to HIV and thereby able to create offspring with similar immunities;however, what happens to individual autonomy in such cases? Scholars of Islamic bioethics ask two questions: which cells will be edited and what is the aim of the editing? Editing confined to one individual without affecting the offspring is considered acceptable but human dignity must be protected. Fahad Ahmed, Yazgı Beriy Altun Güzelderen and Sefik Yurdakul shared their research on publications written by Turkish authors that have been retracted from scientific journals. In a study of PubMEd, Scopus and Web of Science databases, they identified 147 pub ications that had been removed due to duplication and irrelevant studies. Six presentations were related to the history of medicine in the Middle East. Dmitry Balalykin tied the apodictic method (the method of rational and rigorous proof), typically accepted as the method of knowledge in the natural sciences, to the development of medicine as seen in anatomical dissections, clinical systematization and general pathology in Greek and medieval Islamic medicine. Balalykin cited Galen and Muhammad ibn Zakariya as pivotal influences. Katarzyna Gromek then discussed the history of perfumes as medical agents in early Islamic states;for example, scenting clothes, mostly undergarments, shirts, dresses, and bed linens, was also thought to increase therapeutic health effects, both in the sick and healthy. Fatima Saadatmand continued the historical discussion with a look at mystical applications of arithmetic, Ariṯmāṭῑqῑ in Arabic, in treating disease throughout the 9th to 13th centuries through an examination of ancient texts and modern writings. Abdulnaser Kaadan's historical research moves us into the writings of Avicenna (Ibn Sina) related to the diagnosis and treatment of breast lesions and the relevance of this historical work to current medicine. Amanda Caterina Leong then shared her work on the writings of Qajar Iranian Princess Taj al-Saltana in 19th century Iran, who discussed systemic challenges in reactions to Iran's cholera epidemic and subsequent health care perils related to a corrupt patriarchy. Leong connected this work to current governmental handlings of COVID-19 issues. Finally, Forozan Falahatpishe examined the invisibility of autopsy within Islamic medicine. Of interest to mystics, theologians and philosophers as well as physicians, the autopsy has been historically avoided within the Avestan (ancient Iranian) approach to Islamic medicine because it has been perceived as a violation against the sanctity of the human body. Nevertheless, surgery has thrived within the Islamic world. Art therapy in the Gulf was well represented by two full panels, one of which presented by Trish Bedford, Mowafa Househ, and Dr. Jens Schneider surveyed current art therapy practices including development of an art therapy app for making initial assessments powered by AI. In addition, Michelle Dixon, Natalia Gómez Carlier, Sara Powell, Mariam El-Halawani, and Alan Weber detailed in the paper, "Art Therapy Service Provision during the COVID-19 Pandemic in the Gulf Cooperation Council (GCC)" how services provision shifted abruptly to online telehealth. Natalia Gómez Carlier and Sara Powell additionally reported on their art therapy pilot dyadic (parent/caregiver and child) telemedicine program for children living with Autism Spectrum Disorder. In a panel dedicated to healthcare communications, one paper described the best practices in communication skills with visually impaired patients (Dr. Nahla Khalaf Ali, Dr. Abdulsalam S. Sultan, Muna Hameed Faris, Muna Muneer Ahmed, Mohammed Modar Hameed, and Dr. Marab younis Abdullah Al-Fathy). A paper by Raji Anand and Dr. Sohaila Cheema included usage data that demonstrated that digital tools such as Mailchimp direct-mail campaigns can effectively promote positive public health behaviors. Another successful intervention for public health awareness was described in the panel "On Film and Medicine: Reflections on 'Medfest Egypt', an international 'film for health' forum," chaired by Khalid Ali, Mina El Naggar, and Robert Abrams. Gatherings such as the 2nd International Conference on the Medical Humanities in the Middle East are designed to share the latest research findings among area experts, to help form new research collaborations, and to encourage translational medicine projects in which insights and pilot and full-scale studies of the medical and health humanities can be harnessed to revise medical education curricula, improve training for health sciences students, enhance clinical practice and ultimately improve patient outcomes to create more equitable, satisfying, and effectiv healthcare systems. Additionally, medical and health experiences can form the basis of artistic expression since health, disease, and illness represent key milestones in the universal life course. [ FROM AUTHOR] Copyright of QScience Connect is the property of Hamad bin Khalifa University Press (HBKU Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
SARS-CoV-2 infects endothelial cells, induces a hypercoagulable state, and, in extreme cases, can provoke a “cytokine storm.” These etiopathological mechanisms, in addition to the hemodynamic and respiratory compromises characterizing severe COVID-19, can culminate in the emergence of various acute stroke phenotypes, such as arterial and venous thromboses, and hemorrhages. COVID-19-associated strokes have been encountered in younger patients with no cerebrovascular risk factors but the disease is also found to target older patients with comorbidities who are more likely to contract the more severe forms of the disease. Anticoagulation, antiplatelets, statins, thrombolysis and endovascular thrombectomy remain the cornerstone therapies for patients with ischemic strokes and COVID-19. An important aspect of secondary stroke prevention is blood pressure management recommendations which are currently being revisited as renin-angiotensin-aldosterone antagonists were initially thought to be detrimental to infected patients due to the interaction of the virions with ACE2 receptors. We also focus our attention on the reshaping of all aspects of stroke care during the pandemic, from the prehospital stage to telehealth. © 2021 Elsevier Inc. All rights reserved.
ABSTRACT
Background: Coronavirus 2019 (COVID19) has impacted acute stroke (AS) care with several reports globally showing drops in AS volumes during the pandemic. We studied the impact of COVID19 on AS and transient ischemic attack (TIA) care in a health system serving Southeast Michigan as we rolled out a policy aimed at limiting admissions and transfers. Methods: In this retrospective study conducted at 2 hospitals, we included consecutive patients presenting to the emergency department (ED) for whom a Stroke Alert (SA) was activated during the period 3/20 to 5/20/20 (COVID) and a similar period in 2019 (pre-COVID). We compared demographics, time metrics, and discharge outcomes. Results: 264 patients were seen pre-COVID compared to 121 during COVID (p<0.001). Patients seen during COVID had an equal proportion of males (55% vs 51%, p=0.444), were majority African American (57 vs 58%, p=0.74), but had a higher presenting NIHSS (median: 5 vs 2, p=0.01) and longer times since last-known-well to ED arrival (median: 9.4 vs 4.8 hours, p=0.03) compared to pre-COVID. Fewer patients were transferred from other centers (42 vs 27% p=0.008). SA activation on arrival (median: 9.6 vs 15 min, p=0.004) and imaging initiation from arrival (median: 26.4 vs 34.8 min, p=0.042) were faster as well as a trend toward statistical significance for time to tPA administration (median: 37.8 vs 51 min, p=0.051) compared to pre-COVID. There were higher rates of AS and TIA (69% vs 55%) and lower rates of stroke mimics (17 vs 37%, p<0.001). Patients discharged from the stroke unit had significantly higher discharge NIHSS (median: 3 vs 2, p=0.002) and were more likely to have an unfavorable discharge mRS (3-6) (56 vs 33%, p=0.004). There were no significant differences in medical, social histories, time to first pass for patient undergoing thrombectomy and stroke etiologies between the groups. In 2020, 9 patients (8%) were COVID19 positive, 2 had unfavorable mRS 3-5 while 3 died. Conclusion: There was greater than 50% reduction in stroke admissions during the COVID19 pandemic which is consistent with other reports. Although patients were managed more quickly, they tended to have more severe strokes, fewer stroke mimic diagnoses, and worse outcomes compared to patients treated in the pre-COVID period.
ABSTRACT
Background: We propose that social distancing policies during COVID-19 may have negatively impacted the timely administration of intravenous tPA and mechanical thrombectomy (MT) in acute ischemic strokes (AIS). Methods: In this retrospective study conducted at 2 large stroke centers serving Southeast Michigan, we included consecutive patients admitted to our stroke unit from 3/20/20 to 5/20/20 (COVID) and a similar epoch in 2019 (pre-COVID). We compared demographics and time metrics. Results: 247 patients with AIS were included in the tPA analysis, 167 (68%) in 2019 vs 80 (32%) in 2020. Overall mean age was 67.2, 60% male and 49% African Americans (AA). tPA was given in 13/80 in 2019 vs 17/167 patients in 2019 (16% vs 10%, p=0.143). There was no difference in tPA rates between AA and non-AA in 2020. There was a trend toward faster tPA administration in 2020 vs 2019 (median: 37.8 vs 51 min, p=0.051), significant among AA (37.8 vs 58.8 min, p=0.029). Mild/rapidly improving strokes was less frequently a tPA exclusion in 2020 vs 2019 (0% vs 10%). Delayed presentation was significantly less frequent among non-AA in 2020 vs 2019 (54% vs 66%, p=0.045) but there was a trend toward more frequent delayed presentations in AA vs non-AA in 2020 (76 vs 54%, P=0.073). 69 patients were eligible to receive MT, 42 (61%) in 2019 and 27 (39%) in 2020. Mean age was 67.9 and 36% were AA. No differences were detected between 2019 and 2020 in MT rates or time metrics. In 2020, there was a slight trend toward lower MT rates for AA vs non-AA patients (69% vs 30%, p=0.10). Conclusion: During the COVID-19 pandemic in Detroit there was a trend toward faster tPA administration compared to the same period pre-COVID, especially among AA. There was no significant difference in MT rates or time metrics. In our AA-majority city, there was a trend towards more delayed presentations and lower MT rates among AA during COVID. The reasons for these differences are yet to be determined and warrant further research.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Inflammation affects atherosclerotic plaque vulnerability and promotes a thrombogenic environment. We report a series of 6 patients with COVID-19 with acute ischemic stroke due to intraluminal carotid artery thrombus presenting during an 8-day period. Six patients were included (5 men) with a mean age of 65.8 years (range, 55-78 years). COVID-19 was diagnosed by detection of Severe Acute Respiratory Syndrome coronavirus 2 in 5 patients and was presumed due to typical clinical and imaging findings in 1 patient. All patients had vascular risk factors including diabetes (83%), hyperlipidemia (100%), and smoking (17%). Four patients presented with large infarcts with initial NIHSS scores of 24-30. During their hospitalization, all patients had elevated D-dimer and C-reactive protein levels, 5 patients had elevated lactate dehydrogenase and ferritin levels, 3 had elevated interleukin-6 levels, and 2 had elevated troponin levels. Inflammation related to COVID-19 may result in rupture of vulnerable atherosclerotic plaques, resulting in thrombosis and acute ischemic stroke.