Subarachnoid hemorrhages and aneurysms during the SARS-CoV2-pandemia at a tertiary medical center - Analysis of incidence and outcome.

Introduction: During the COVID-19-pandemic a significant decrease of up to 13% of all kinds of medical emergencies was reported. Similar trends were expected for aneurysmal subarachnoid hemorrhages (aSAH) and/or symptomatic aneurysms. Research question: To analyze a correlation of the SARS-CoV2-infection and the incidence of aSAH, and to assess the impact of the pandemic-lockdown on the incidence, the outcome and the course of patients suffering from aSAH and/or aneurysms. Material and methods: From March 16th, 2020 (first lockdown in Germany) to January 31st, 2021, all patients admitted to our hospital were screened by polymerase-chain-reaction (PCR) test for genetic material of SARS-CoV2. During this period, aSAH and symptomatic cerebral aneurysms were assessed and retrospectively compared to a historic longitudinal case-cohort. Results: Of 109.927 PCR-tests, 7.856 (7.15%) revealed a SARS-CoV2-infection. None of the patients mentioned above were tested positively. The number of aSAH and symptomatic aneurysms rose by 20.5% (39 vs. 47 cases) (p â€‹= â€‹0.93). Poor grade aSAH, as well as extensive bleeding-patterns were more often observed (p â€‹= â€‹0.63 and p â€‹= â€‹0.40, respectively), with more symptomatic vasospasms diagnosed (5 vs. 9 patients). Mortality rate increased by 8,4%. Discussion and conclusion: A correlation between SARS-CoV2-infection and the incidence of aSAH could not be established. Still, the overall number and the number of poor-grade aSAHs increased as well as symptomatic aneurysms during the pandemic. Therefore, we might conclude that dedicated neurovascular competence should be retained in designated centers to care for these patients even or especially in special situations affecting the global healthcare system.

Non-ischemic neurovascular emergencies at a supra-regional medical center during the SARS-CoV2-pandemia.

OBJECTIVE: To assess the impact of the lockdown in Germany due to the SARS-CoV2-pandemic on the incidence and the outcome of neurovascular emergencies at a tertiary medical center. METHODS: From March 16th, 2020 (first lockdown in Germany) to January 31st, 2021, all neurosurgical emergencies were included and compared to a longitudinal case-cohort. Cases were descriptively recorded and retrospectively analyzed with respect to incidence and outcome. RESULTS: All emergencies referred to our tertiary medical center decreased by 10% during the pandemic, whereas, neurosurgical emergencies increased by 18.4% (764 vs. 905 cases). Number of specific non-ischemic neurovascular emergencies increased by 29% (95 vs. 123 cases). The difference was not statistically significant (p = 0.53). Mortality rate increased dramatically by 40% during the pandemic throughout all neurovascular cases. As all included patients were negative PCR-tested for SARS-CoV2 the observed increase is unrelated to the virus infection. CONCLUSION: Unexpectedly, according to our data neurovascular emergencies raised in number and severity during the pandemic in Germany at our tertiary referral center. Furthermore, the case fatality increased. Even though our data lack proof of evidence for these findings, we might suggest two possible explanations for the absolute increase in numbers: firstly, patients might have refused to seek medical help while suffering only mild symptoms. Furthermore, as numerous lower-level medical centers restricted admissions, the referral times of patients in need of neurosurgical attention increased. We, therefore, suggest that even in a pandemic situation like the SARS-CoV2/COVID-19, it seems of utmost importance to retain dedicated neurovascular competence in designated centers to care for these emergencies.

Composite global indicators from survey data: the Global Economic Barometers

This paper presents a coincident and a leading composite monthly indicator for the world business cycle—the Global Economic Barometers. Both target the world’s output growth rate and consist of economic tendency surveys results from many countries around the world. The calculation of these indicators comprises two main stages. The first consists of a variable selection procedure, in which a pre-set correlation threshold and the targeted leads to the reference series are used as selection criteria. In the second stage, the selected variables are combined and transformed into the respective composite indicators, computed as the first partial least squares factor with the reference series as response variable. We analyse the characteristics of the two new indicators in a pseudo real-time setting and demonstrate that both are useful additions to the small number of indicators for the global business cycle published so far. Finally, yet importantly, the Barometers were quick to plunge in the beginning of March 2020 and have since then given a reliable real-time reflection of the economic consequences of the Covid-19 pandemic.

Clinical Practice Guideline: Recommendations on the In-hospital Treatment of Patients with COVID-19.

BACKGROUND: The mortality of COVID-19 patients who are admitted to a hospital because of the disease remains high. The implementation of evidence-based treatments can improve the quality of care. METHODS: The new clinical practice guideline is based on publications retrieved by a systematic search in the Medline databases via PubMed and in the Cochrane COVID-19 trial registry, followed by a structured consensus process leading to the adoption of graded recommendations. RESULTS: Therapeutic anticoagulation can be considered in patients who do not require intensive care and have an elevated risk of thromboembolism (for example, those with D-dimer levels ≥ 2 mg/L). For patients in intensive care, therapeutic anticoagulation has no benefit. For patients with hypoxemic respiratory insufficiency, prone positioning and an early therapy attempt with CPAP/noninvasive ventilation (CPAP, continuous positive airway pressure) or high-flow oxygen therapy is recommended. Patients with IgG-seronegativity and, at most, low-flow oxygen should be treated with SARS-CoV-2-specific monoclonal antibodies (at present, casirivimab and imdevimab). Patients needing no more than low-flow oxygen should additionally be treated with janus kinase (JAK) inhibitors. All patients who need oxygen (low-flow, high-flow, noninvasive ventilation/CPAP, invasive ventilation) should be given systemic corticosteroids. Tocilizumab should be given to patients with a high oxygen requirement and progressively severe COVID-19 disease, but not in combination with JAK inhibitors. CONCLUSION: Noninvasive ventilation, high-flow oxygen therapy, prone positioning, and invasive ventilation are important elements of the treatment of hypoxemic patients with COVID-19. A reduction of mortality has been demonstrated for the administration of monoclonal antibodies, JAK inhibitors, corticosteroids, tocilizumab, and therapeutic anticoagulation to specific groups of patients.

Venous thromboembolism in patients with COVID-19 (SARS-CoV-2 infection) - a position paper of the German Society of Angiology (DGA).

As observed in other infections with a systemic inflammatory response, severe COVID-19 is associated with hypercoagulability and a prothrombotic state. Currently, there is growing evidence that pulmonary embolism and thrombosis contribute to adverse outcomes and increased mortality in critically ill patients with COVID-19. The optimal thromboprophylactic regimen for patients with COVID-19 is not known. Whereas pharmacologic thromboprophylaxis is generally recommended for all hospitalized COVID-19 patients, adequate dosing of anticoagulants remains a controversial issue. Therefore, we summarize current evidence from the available literature and, on behalf of the German Society of Angiology (DGA), we aim to provide advice to establish an improved and more uniform strategy for thromboprophylaxis in patients with COVID-19.