ABSTRACT
Background and Aims: The effect of the COVID pandemic on stroke networks performance are unclear, particularly with consideration of drip & ship versus mothership models. We systematically reviewed and metaanalyzed variations in stroke admissions, rate and timing of reperfusion treatments during the COVID pandemic versus the prepandemic timeframe. Methods: The systematic review followed registered protocol (PROSPERO-CRD42020211535), PRISMA and MOOSE guidelines. We searched MEDLINE, EMBASE and Cochrane CENTRAL until 9/10/ 2020, for studies reporting variations in ischemic stroke admissions, treatment rates and timing in COVID vs control-period. Primary outcome was the weekly admission incidence rate ratio (IRR=admissions during COVID-period/admissions during control-period). Secondary outcomes were (i) changes in rate of patients undergoing reperfusion treatment and (ii) time metrics for pre-and in-hospital phase. Results: Twenty-nine studies were included in qualitative synthesis, with 212960 patients observed for 532 cumulative weeks (325 control-period, 207 COVID-period). COVID-period was associated with a significant reduction in stroke admission rates (IRR=0.69, 95%CI, 0.61-0.79) and a higher relative presentation with large vessel occlusion stroke (RR=1.62, 95%CI, 1.24-2.12). Proportions of patients treated with intravenous thrombolysis remained unchanged, while endovascular treatment increased (RR=1.14, 95%CI, 1.02-1.28). Onset-to-door time was longer for drip&ship compared to mothership model (+32 minutes vs-12 minutes, pmeta-regression =.03). Conclusions: Despite a 35% drop in stroke admissions during the pandemic, proportions of patients receiving reperfusion and time-metrics were not inferior to control-period, justifying allocation of resources to keep stroke networks up and running.
ABSTRACT
Metis is the visible light and UV light imaging coronagraph on board the ESA-NASA mission Solar Orbiter that has been launched February 10th, 2020, from Cape Canaveral. Scope of the mission is to study the Sun up close, taking high-resolution images of the Sun’s poles for the first time, and understanding the Sun-Earth connection. Metis coronagraph will image the solar corona in the linearly polarized broadband visible radiation and in the UV HI Ly-α line from 1.6 to 3 solar radii when at Solar Orbiter perihelion, providing a diagnostics, with unprecedented temporal coverage and spatial resolution, of the structures and dynamics of the full corona. Solar Orbiter commissioning phase big challenge was Covid-19 social distancing phase that affected the way commissioning of a spacecraft and its payload is typically done. Metis coronagraph on-board Solar Orbiter had its additional challenges: to wake up and check the performance of the optical, electrical and thermal subsystems, most of them unchecked since Metis delivery to spacecraft prime, Airbus, in May 2017. The roadmap to the fully commissioned coronagraph is here described throughout the steps from the software functional test, the switch on of the detectors of the two channels, UV and visible, to the optimization of the occulting system and the characterization of the instrumental stray light, one of the most challenging features in a coronagraph. © 2021 ESA and CNES
ABSTRACT
Background: Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and highlights the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke. We conducted a systematic review and meta-analysis to evaluate the aforementioned considerations. Methods: We performed a meta-analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARSCoV- 2 infection status. We used a random-effects model. Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (95%CI). Results: We identified 16 cohort studies including 44,004 patients. Among patients with SARS-CoV- 2, 1.3% (95%CI: 0.9-1.8%;I =88%) were hospitalized for cerebrovascular events, 1.2% (95%CI: 0.8-1.5%;I =85%) for ischemic stroke, and 0.2% (95%CI: 0.1-0.4%;I =69%) for hemorrhagic stroke. Compared to non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds of ischemic stroke (OR=3.58, 95%CI: 1.43-8.92;I =43%) and cryptogenic stroke (OR=3.98, 95%CI: 1.62-9.77;I =0%). Odds for in-hospital mortality were higher among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical stroke patients (OR=5.60, 95%CI: 3.19-9.80;I =45%). SARS-CoV-2 infection status was not associated to the likelihood of receiving intravenous thrombolysis (OR=1.42, 95%CI: 0.65-3.10;I =0%) or endovascular thrombectomy (OR=0.78, 95%CI: 0.35-1.74;I =0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic. Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical controls(OR=1.39, 95%CI: 1.04-1.86;I =0%). Conclusion: SARS-CoV-2 appears to be associated with an increased risk of ischemic stroke,particularly the cryptogenic subtype. SARS-CoV-2 infection in stroke substantially increases themortality risk.
ABSTRACT
BACKGROUND AND PURPOSE: We systematically reviewed available evidence for reports of neurological signs and symptoms in patients with COVID-19 to identify cases with severe acute respiratory syndrome coronavirus (SARS-CoV)-2 infection or immune-mediated reaction in the nervous system. METHODS: We followed PRISMA guidelines and used the MEDLINE, EMBASE, Google Scholar, MedRxiv and ChinaXiv databases to search for articles on COVID-19 and nervous system involvement that were published from 1 January to 24 April 2020. Data on design, sample size, neurological assessment and related work-up were extracted. Biases were assessed with the Newcastle-Ottawa scale. RESULTS: We analysed 27 publications on potential neuroinvasive or parainfectious neurological complications of COVID-19. The reports focused on smell and taste (n = 5) and evaluation of neurological symptoms and signs in cohorts (n = 5). There were cases of Guillain-Barré syndrome/Miller-Fisher syndrome/cranial neuropathy (seven cases), meningitis/encephalitis (nine cases) and various other conditions (five cases). The number of patients with examination of cerebrospinal fluid and, in particular, SARS-CoV-2 polymerase chain reaction was negligible. Two had a positive SARS-CoV-2 polymerase chain reaction examination of cerebrospinal fluid specimen. Study of potential parenchymal involvement with magnetic resonance imaging was rare. Only four reports received a rating of the highest quality standards. CONCLUSIONS: This systematic review failed to establish comprehensive insights into nervous system manifestations of COVID-19 beyond immune-mediated complications in the aftermath of respiratory symptoms. The authors therefore provide guidance for more careful clinical, diagnostic and epidemiological studies to characterize the manifestations and burden of neurological disease caused by SARS-CoV-2 on behalf of the Infectious Disease Panel of the European Academy of Neurology.