Platypnea-Orthodeoxia Syndrome Associated with COVID-19 Pneumonia and Prolonged Treatment Due to Tamsulosin Use: A Case Report

Platypnea-orthodeoxia syndrome (POS) is an extremely rare condition. There are no other cases in the literature where tamsulosin has been reported to prolong POS treatment. A 67-year-old male patient was hospitalized due to COVID-19. He was followed up in the ward after being in the intensive care unit for ten days. There was a significant decrease in saturation (SaO2) when sitting and standing compared to lying. He was diagnosed with POS. However, there was no significant improvement in POS with exercises. After stopping the tamsulosin he was using, there was a dramatic improvement. He was discharged on the 72nd day of his hospitalization. Due to COVID-19, POS is more likely to appear than before. It is a condition that clinicians should recognize. The pathophysiology of POS has not been fully elucidated. The case we present suggests that alpha-blockers may also be related to pathophysiology.©Copyright 2020 by Emergency Physicians Association of Turkey -

The Impact of Covid-19 on the Sustainability of the Accounting Profession: Turkey Case

Nowadays, where the relations between business and society change under the influence of various factors, society expects businesses to create social and environmental values ​​as well as economic value. From this point of view, sustainable business success;in addition to following economic policies aimed at increasing shareholder profits in enterprises, it requires the monitoring and measurement of the effects of business activities on the environment and society, and the use of tools and methods to fulfill these transactions. At this point, the duty of accounting is to provide information about economic activities as well as to provide information to its stakeholders about the social and environmental performance of the enterprise. As of 2019, it is important to reconsider the issue of accounting profession and sustainability in the face of the COVID-19 pandemic affecting the world and the changes experienced and to address the responsibilities of the accounting profession in this process. In this period, which is called the epidemic period caused by COVID-19 and affected all countries of the world, social and economic orders, companies and professions faced many positive and negative effects. This period accelerated the digital transformation, brought services to the agenda, and many professions had to adapt to this digital transformation. There are also professional accountants among these professions. Moreover, accounting professionals are the most important stakeholders and indispensable actors of companies, which are the smallest dynamos of economies. In this context, it is aimed to reveal the relationship between sustainability, the role of accounting and the COVID-19 outbreak in this study. In this study, regarding the professional accountants who assume such a big task in social and economic terms;COVID-19—to determine how the professional accountants are affected positively and negatively during the pandemic period. It is aimed to identify how these effects change business lives and office environments, and in this context, to present a roadmap for the future sustainability of the accounting profession. The study consists of three parts;In the first part, literature research, in the second part, the need for the profession, and in the third part, a survey study was conducted for accounting professionals across Turkey, and the positive and negative situations they experienced during the COVID-19 period and the ways they adapted to these situations were investigated. As a result, when such epidemic periods are encountered again, solutions have been suggested for what kind of a road map to follow in terms of the sustainability of the profession. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

The roles of bun/d-dimer and bun/lactate ratios in indicating mortality in intensive care patients with COVID-19

Aim: Coronavirus disease 2019 (COVID-19) is an epidemic disease with variable symptoms and high mortality rates. Therefore, patient follow-up is very significant. We aimed to investigate whether blood urea nitrogen (BUN), D-dimer and lactate parameters, which are laboratory tests used in follow-up, predict mortality. Material(s) and Method(s): The study included 173 COVID-19 patients hospitalized in the pandemic intensive care unit from March 2020 to June 2020. We retrospectively recorded patient age, gender, comorbidity, radiological involvement, oxygen demand, APACHE scores, in-hospital mortality status, BUN, lactate, and D-dimer levels, BUN/D-dimer ratio (BDR), BUN/lactate ratio (BLR). Then we made the statistical comparison between the groups by grouping the patients as discharged and deceased. Result(s): Among the patients included in the study, 107 (61.8%) were male and 66 (38.2%) were female. The mean ages between those discharged and those who died in the hospital were 73 and 67.5 years, respectively, and there was a statistically significant difference. The median BUN, d-dimer, lactate and BDR, BLR values of the patients in the non-survivor group were significantly higher than those in the survivor group. BLR had the highest diagnostic ratio (25.03) for estimating in-hospital COVID-19 mortality. Discussion(s): We found that BUN, BDR, and BLR levels were reliable predictors of in-hospital mortality in COVID-19 patients. However, BLR was a potent risk assessment tool, especially in defining the risk of in-hospital death.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Cross-sectional, hospital-based analysis of headache types using ICHD-3 criteria in the Middle East, Asia, and Africa: the Head-MENAA study.

BACKGROUND: Headaches are frequent neurological disorders that are yet to be unveiled and treated comprehensively worldwide. Bearing in mind that the distribution of headache subtypes in neurology clinics (NC) is essential for planning appropriate diagnostic and therapeutic approaches, the primary goals of this multi-centric study are to carry out inter-regional comparisons by using current diagnostic criteria with evaluations of neurologists to delineate headache burden. METHODS: A cross-sectional study between April 1 and May 16, 2022 was conducted with the participation of 13 countries from the Middle East, Asia, and Africa. Patients were included in the study on a specific day each week during five consecutive weeks. All volunteers over the age of 18 and whose primary cause for admission was headache were examined. The patients admitted to NC or referred from emergency services/other services were evaluated by neurologists by means of the International Classification of Headache Disorders (ICHD-3) criteria. RESULTS: Among the 13,794 patients encountered in NC, headache was the primary complaint in 30.04%. The headache patients' mean age was 42.85 ± 14.89 (18-95 years), and 74.3% were female. According to the ICHD-3 criteria, 86.7% of the main group had primary headache disorders, 33.5% had secondary headaches, 4% had painful cranial neuropathies along with other facial and headaches, and 5.2% had headaches included in the appendix part showing some overlapping conditions. While the most common primary headache was migraine without aura (36.8%), the most common secondary headache was medication-overuse headache (MOH) (9.8%). Headaches attributed to COVID-19, its secondary complications, or vaccines continue to occur at rates of 1.2%-3.5% in current neurology practice. Pain severity was significantly lower in Ivory Coast and Sudan than in Türkiye, Turkish Republic of Northern Cyprus, Iran, Egypt, Senegal, Tatarstan, and Azerbaijan (p < 0.001). CONCLUSIONS: The study showed that migraine is still the most common motive for admissions to NC in different regions. Furthermore, MOH, an avoidable disorder, is the most common secondary headache type and appears to be a significant problem in all regions. Remarkably, pain perception differs between regions, and pain intensity is lower in Africa than in other regions.

Patient Management in Neurology Intensive Care During COVID-19 Pandemic Period

Objective: This study aims to evaluate data from coronavirus disease-2019 (COVID-19) patients with neurological manifestations hospitalized in the intensive care unit (ICU). Materials and Methods: The study included data from COVID-19 patients with neurological manifestations hospitalized in ICU. Patients' demographic characteristics, risk factors, laboratory results, treatment methods, mechanical ventilation methods, use of non-invasive techniques to meet O-2 requirements, clinical outcome at discharge and after three months, and mortality rates were evaluated. Results: The study included 25 patients. Mean age of the patients was 66.76 +/- 12.93. Fifty two percent of the patients were male. Of the patients 96% had a positive polymerase chain reaction test, and 92% had lung involvement. The comorbidities of the patients were hypertension (48%), diabetes mellitus (28%), coronary artery disease (28%), cerebrovascular disease (20%), cancer (20%), and chronic obstructive pulmonary disease (12%). Seventy two percent of the patients presented with stroke. Of the patients %12 presented with encephalopathy, whereas patients with epilepsy and myasthenia gravis accounted for 8%. Patients' average length of stay in ICU was 13.16 +/- 12.44 days. Pressure-synchronized intermittent mandatory ventilation mode was used in 56% of patients. Number of intubation days was 9.5 +/- 12.26. All patients were treated with favipiravir and antiaggregant, 92% with steroids and antibacterial therapy, 52% with antiaggregant, 20% with plasma therapy, 8% with cytokine filter and immunoglobulin therapy, and 4% with monoclonal antibody therapy. During hospitalization, mortality rate was 48%, good clinical outcome rate was 36%. Conclusion: The rates of poor clinical outcomes are seen to be high during in-hospital treatment and follow-up of COVID-19 patients presenting with neurological symptoms, as well as at discharge.

Virtual Hearings in Arbitration and Evaluation of Virtual Hearings in the Context of the Right to be Heard and Principle of Equal Treatment

Online or virtual arbitration hearings are those wherein participants conduct the hearing via a digital platform. Virtual hearings are not a new concept for arbitration proceedings. Due to coronavirus disease (COVID-19) and the global pandemic announcement on March 11, 2020, arbitration institutions took appropriate measures. Many arbitration centers issued a joint declaration seeking to avoid delays in arbitration proceedings themselves and any other related delays. With this declaration, they invited parties and arbitral tribunals to use existing arbitration rules and case management techniques appropriately to ensure the consistent and predictable continuity of international arbitration during the pandemic, to continue to hear pending cases, and to avoid unnecessary delays in arbitration processes. There is an undeniable connection between virtual hearings and the right to a fair trial. Under Turkish law, within the right to a fair trial, the right to be heard and the principle of equality of the parties are guaranteed by Article 6 of the European Convention on Human Rights and by Article 36 of the Turkish Constitution. In this context, virtual hearings should be considered in terms of the right to a fair trial. Arbitrators must conduct the proceedings in accordance with the parties' and concerned others' right to attend the hearing, the principle of equality, and the parties' right to be heard. Within this framework, this paper first explains virtual hearings in general regarding practices of arbitration institutions and then evaluates the effect of virtual hearings on the arbitral award regarding the right to be heard and the principle of equality.

A cross-sectional evaluation of maternal and perinatal outcomes in pregnancies complicated with COVID-19

Aim: Pregnancy is considered a vulnerable period for women regarding increased risk of respiratory tract infections, altered immunity, and metabolic changes in their bodies. COVID-19 pandemic also possesses a significant risk on pregnant women, but the data on the disease course is insufficient. Therefore, this study aimed to evaluate the maternal and perinatal outcomes in pregnant women diagnosed with COVID-19. Materials and Methods: This cross-sectional study retrospectively evaluated the hospital records of pregnant women admitted to the Obstetrics and Gynecology Department of 19 MayisUniversity Hospital between 01/04/2020 to 30/12/2021 regarding gestational week at birth, basal gestational, and labor characteristics, delivery complications, and perinatal and maternal COVID-19 outcomes.

Anti-nucleocapsid Antibody Response After Two Doses of CoronaVac (R) Among Healthcare Workers

Introduction: The Coronavirus disease-2019 (COVID-19) pandemic that started over two years ago has led to high mortality and morbidity. Vaccine studies have been initiated worldwide to end the pandemic, and the CoronaVac (R) vaccine was first administered to healthcare workers at high risk of COVID-19 in Turkey. In our study, we aimed to investigate serum antibody levels after vaccination. Materials and Methods: Volunteer healthcare workers without COVID-19 disease who received two doses of CoronaVac (R) vaccine 28 days apart and were at least 14 days after the last dose of vaccine were included in this study. Assessment of antibodies against Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) in blood samples from participants was performed using the Elecsys (R) anti-SARS-CoV-2 electrochemiluminescence immunoassay. Samples with a cut-off index (COI) (COI;signal sample/cut-off) <1.0 were considered negative;whereas samples with COI >= 1.0 were deemed positive. Results: A total of 269 healthcare workers, 168 women (62.5%), were included in our study. The mean age of the participants was 37.7 +/- 8.6 (minimum-maximum: 21-62). Antibody levels were positive in 188 (69.9%) of the participants. The median antibody level was 9.2 COI (interquartile ranges=3-34.7). In terms of mean age, the mean age of participants with negative antibodies was higher with a statistically significant difference (p=0.001). The antibody positivity rate of women was higher than that of men (p<0.001). No statistically significant association was found between the time elapsed after vaccination, presence of comorbidities, development of post-vaccine side effects, and antibody levels. It was found that one or more side effects developed in 45.7% of the participants after vaccination. Conclusion: Our study showed that seropositivity developed significantly in healthcare workers after the CoronaVac (R) vaccine. It emphasizes the importance of maintaining infection prevention and control measures and administering the SARS-CoV-2 vaccine for healthcare workers at high risk.

Comparison of COVID-19 patients who underwent thrombectomy with those in the pre-pandemic period in terms of etiology and prognosis.

OBJECTIVE: We aimed at determining the effectiveness of mechanical thrombectomy (MT) in patients with major vessel occlusion and infected with COVID-19, evaluating its clinical outcome and comparing it with non-COVID patients. PATIENTS AND METHODS: During the pandemic, 729 patients who underwent MT in stroke centers due to Acute Ischemic Stroke (AIS) with large vessel occlusion were evaluated. This study included 40 patients with a confirmed COVID-19 diagnosis by a positive PCR test between March 11, 2020, and December 31, 2020. These patients were compared to 409 patients who underwent MT due to major vessel occlusion between March 11, 2019, and December 31, 2019. RESULTS: Of the patients with AIS who are infected with COVID-19, 62.5% were males, and all patients have a median age of 63.5 ± 14.4 years. The median NIHSS score of the COVID-19 group was significantly higher than that of the non-COVID-19 groups. Dissection was significantly more in the COVID-19 group. The mortality rates at 3 months were higher in the COVID-19 groups compared to non-COVID-19 groups. CONCLUSIONS: This study revealed an increased frequency of dissection in patients with COVID-19. COVID-19-related ischemic strokes are associated with worse functional outcomes and higher mortality rates than non-COVID-19 ischemic strokes.

The roles of bun/d-dimer and bun/lactate ratios in indicating mortality in intensive care patients with covid-19

BACKGROUND AND AIM: The 2019 coronavirus disease (COVID-19) is an epidemic disease with variable symptoms and high mortality rates. Therefore, patient follow-up is very significant. We also investigated whether blood urea nitrogen (BUN), D-dimer and lactate parameters, which laboratory tests used in follow-up, predict mortality. METHODS: 173 COVID-19 patients hospitalized in the pandemic intensive care unit within the period from March to June 2020 were included in the study. Retrospectively, we recorded the patient's age, gender, comorbidity, radiological involvement, oxygen demand, APACHE scores, in-hospital mortality status, BUN, lactate, and D-dimer levels, BUN/D-dimer ratio (BDR), BUN/lactate ratio (BLR). Then we made the statistical comparison between the groups by grouping the patients as discharged and deceased. RESULTS: of the patients included in the study, 107 (61.8%) were male and 66 (38.2%) were female. The mean ages between those discharged and those who died in the hospital are 73 and 67.5 years, respectively, and there is a statistically significant difference. The median BUN, d-dimer, lactate and BDR, BLR values of the patients in the survivor group were significantly higher than those in the survivor group. BUN: 38 [25-60] and 23 [14-34] [p < 0.001], respectively;Lactate: 1.81[1.3-2.7] and 1.56 [1.2-1.9] [p < 0.05], respectively;D-dimer: 2430 [1401-4300] and 1710 [965-4204] [p < 0.05], respectively;BDR: 0.016 [0.009- 0.029] and 0.011 [0.007-0.026] [p < 0.05]);. BLR: 19.24 [10.38-30.99] and 14.15 [8.79-22.92] [p < 0.05], respectively). In estimating in-hospital COVID-19 mortality, the area under the curve (AUC) for BUN was the highest (0.74), and the diagnostic odds ratio was the highest for BLR (25.03) CONCLUSIONS: We found that BUN, BDR, and BLR levels were reliable predictors of in-hospital mortality in COVID-19 patients. However, BLR was a potent risk assessment tool, especially in defining the risk of in-hospital death.

The Impact of COVID-19 on Patients with Chronic Kidney Disease and Predictive Factors for Disease Mortality

Objective: We aimed to describe clinical characteristics and course of chronic kidney disease patients with COVID-19 and to identify determinants of in-hospital mortality. Methods: Seventy-one chronic kidney disease patients with COVID-19 were enrolled. The primary endpoint was death from all causes discussed in this article. The relationship between mortality and demographic, clinical, and laboratory data were examined. Results: Of 71 patients, 29 (40.8%) died. Dead were older, were more likely to have low critical oxygen saturation (SpO(2)) and deterioration of renal function, and exhibited less favorable laboratory features, including higher neutrophils, neutrophil to lymphocyte ratio, and systemic immune-inflammation index, as well as a lower lymphocyte. Acute kidney injury rate was high (71.8%) and 23.5% needed dialysis. Disease outcome did not differ across baseline chronic kidney disease stages. Systemic immune-inflammation index had a higher prediction accuracy for in-hospital mortality (AUC = 0.732). Patients in the high systemic immune-inflammation index group were older, had higher peak Cr, higher rate of acute kidney injury (85.3% vs. 59.5%), severe disease (79.4% vs. 35.1%), and mortality (64.7% vs. 18.9%) compared to those in low systemic immune-inflammation index group. Older age (>72 years), SpO(2) <= 90%, high systemic immune-inflammation index, and severe acute kidney injury requiring dialysis were predictors of in-hospital mortality. Conclusion: Chronic kidney disease patients with COVID-19 had a high mortality rate associated with older age, acute kidney injury requiring dialysis, higher systemic immune-inflammation index, and lower SpO(2) . Systemic immune-inflammation index at admission may be used for early identification of those at risk. Interventions for optimal oxygenation, early attenuation of the inflammatory response, and prevention of acute kidney injury may improve the prognosis of chronic kidney disease patients with COVID-19.

Coronavirus (COVID-19) infection and antenatal care in pregnancy

In this review, we evaluated the protection of healthy pregnant women from the COVID-19 infection caused by the new type of coronavirus SARS-CoV-2 and the antenatal care with suspected or diagnosed COVID-19 in the light of current literature.

Interobserver Agreement in the Analysis of Different Radiological Classifications of COVID-19 on Computed Tomography

Introduction: Computed tomography (CT) has approximately 98% sensitivity for Coronavirus disease-2019 (COVID-19). Various algorithms were designed using CT images. However, the interobserver agreement of different radiological classifications of COVID-19 is not yet known. Thus, this study aimed to investigate the interobserver agreement of different radiological classifications of COVID-19. Materials and Methods: This study included 212 patients who were positive on the polymerase chain reaction test and eligible for CT. Four radiologists examined all CT images simultaneously. They reached a consensus that CT images can provide definite findings of COVID-19. The Radiological Society of North America (RSNA) consensus statement, the British Society of Thoracic Imaging (BSTI) structured reporting statement, and COVID-19 Reporting and Data System (CO-RADS) were used. Fleiss' Kappa was used to detect interobserver agreement. Kappa values of 0.00- 0.20 were considered as slight, 0.21-0.40 as fair, 0.41-0.60 as moderate, 0.61-0.80 as substantial, and 0.81-1.00 as near-perfect agreement, and p<0.05 was accepted as significant. Results: A total of 137 patients did not have any pathological CT findings. The most prevalent radiological findings were ground-glass opacities and consolidations. The agreements on all classifications were at near-perfect levels: RSNA, 0.86 (0.82-0.90);BSTI, 0.83 (0.79-0.87), and CO-RADS, 0.82 (0.79-0.86). The RSNA classification has the highest consistency rate, followed by BSTI and CO-RADS. However, substantial and moderate agreements were found in the subcategories of each classification. Conclusion: In this study, some subcategories had a lower agreement, despite the high consistency rates for COVID-19 radiological classification systems in the literature. Therefore, improving the items without consensus can lead to the development of better radiological diagnostic approaches.

Relationship between Antibody Levels and SARS-Cov-2 Reinfection

OBJECTIVE: In this period when mutant strains are increasing all over the world, studies on how much humoral immunity will protect against the Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) are quite limited. The aim of our study is to investigate the positivity and antibody levels of the COVID-19 reverse transcription polymerase chain reaction (RT-PCR) test, the frequency of SARS-CoV-2 re-infection, and the protective antibody level against re-infection. METHODS: Patients who were positive for COVID-19 IgG antibody between 1 July and 31 August were included in our study. The COVID-19 RT-PCR test positivity, age, gender and comorbidities of these patients were recorded before this date. The COVID-19 RT-PCR test positivity of these patients was followed from the National COVID-19 Database between September 1, 2020 and February 28, 2021. RESULTS: 1665 patients (female: male 683: 982, mean age 40.6+/-13.4 years). Among all patients, 14 patients had reinfection and the frequency of reinfection was 0.8%. It was observed that the frequency of reinfection was more frequent in patients with PCR negative (p<0.001). The IgG cut-off value causing reinfection was found to be 11.9 (AUC: 0.844, 79.2% sensitivity, 78.6% specificity) (p<0.001). CONCLUSION: Humoral antibodies against SARS-CoV-2 were protective against COVID-19 reinfection, 0.8% of the patients had reinfection and the resultant reinfection was mostly seen in PCR negative patients who were asymptomatic.

Clinical classification of SARS-CoV-2 positive patients;evaluation of laboratory and radiological findings

Introduction: The sudden emergence and rapid spread of the Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has dangered global health. For this reason, there has been an urgent need to develop strategies to control the spread of the virus. In this study, we aimed to evaluate the clinical, laboratory and chest computed tomography (CT) findings of COVID-19 cases with positive results of SARS-CoV-2 reverse transcription quantitative polymerase chain reaction (RT-qPCR). Materials and Methods: A total of 278 patients aged 18 years and over who had positive SARS-CoV-2 RT-qPCR results and had access to laboratory and chest CT examinations between 15 April 2020 and 31 August 2020 were included in the study. Clinical classification of patients was performed as asymptomatic, mild and severe. Demographic information, laboratory tests and chest CT results of the patients were created with the data obtained from the hospital system and the relevant branch physicians. The data were analyzed statistically. Results: In the study, 150 (54%) of the patients were males and 128 (46%) were females. Forty-two (15%) of these patients were classified as asymptomatic, 200 (72%) as mild and 36 (13%) as severe cases. Mean age of the patients was found to be 45.5 ± 17.5 years and 72 (25.9%) patients were found to have at least one comorbidity. Findings consistent with COVID-19 pneumonia were observed in the chest CT examinations of 42.4% (118/278) of the patients. The rate of findings in chest CT of severe patients (91.7%) was found higher than mild (38.5%) and asymptomatic cases (19%) (p< 0.05). When we examined the laboratory findings;59.4% of the patients had elevated CRP, 42.1% lymphopenia, 41.1% elevated LDH, 40.6% elevated creatinine, 36% elevated AST, 20.1% leukopenia, 8% elevated ALT, 7.2% elevated leukocyte, 5.4% elevated troponin I and 3.3% elevated CK-MB were detected. In severe patients, lymphopenia (83.3%), neutrophil elevation (41.7%), CRP elevation (97.2%), LDH elevation (91.3%), troponin I elevation (21.4%) and AST elevation (63.9%) findings were observed at a higher rate than asymptomatic and mild cases (p< 0.05). Conclusion: In our study, it was shown that the findings of high age, hypertension, diabetes mellitus, dyspnea, lymphopenia and the increase in neutrophil, CRP, LDH, troponin I and AST values were associated with severe clinical presentation. These findings are thought to be helpful in understanding the differences between clinical classes in COVID-19 patients.

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

Brain death diagnosis and management in the pandemic: Expert opinion of the turkish neurological society neurological intensive care scientific working group

In the pandemic year, the number of brain death declarations decreased by more than 50% compared with previous years. The timely diagnosis of brain death is critical in terms of rational use of intensive care facilities, as well as organ transplantation. Apnea testing should not be omitted in patients with COVID-19, and can be performed either with apneic oxygenation method or ventilator-based spontaneous modes when standard prerequisites are met. Complete compliance with personal protection measures and prevention of the environmental escape of the expiratory air via tube clamping or filtering is essential. Other declaration processes should be conducted in accordance with the 2014 guidelines of the Turkish Neurology Association. © 2021 by Turkish Neurological Society Turkish Journal of Neurology published by Galenos Publishing House.