Impact of the COVID-19 pandemic on acute stroke care: An analysis of the 24-month data from a comprehensive stroke center in Shanghai, China.

INTRODUCTION: Whether the coronavirus disease-2019 (COVID-19) pandemic is associated with a long-term negative impact on acute stroke care remains uncertain. This study aims to compare the timing of key aspects of stroke codes between patients before and after the COVID-19 pandemic. METHODS: This retrospective cohort study was conducted at an academic hospital in Shanghai, China and included all adult patients with acute ischemic stroke hospitalized via the emergency department (ED) stroke pathway during the 24 months since the COVID-19 outbreak (COVID-19: January 1, 2020-December 31, 2021). The comparison cohort included patients with ED stroke pathway visits and hospitalizations during the same period (pre-COVID-19: January 1, 2018-December 31, 2019). We compared critical time points of prehospital and intrahospital acute stroke care between patients during the COVID-19 era and patients during the pre-COVID-19 era using t test, χ2 , and Mann-Whitney U test where appropriate. RESULTS: A total of 1194 acute ischemic stroke cases were enrolled, including 606 patients in COVID-19 and 588 patients in pre-COVID-19. During the COVID-19 pandemic, the median onset-to-hospital time was about 108 min longer compared with the same period of pre-COVID-19 (300 vs 192 min, p = 0.01). Accordingly, the median onset-to-needle time was 169 min in COVID-19 and 113 min in pre-COVID-19 (p = 0.0001), and the proportion of patients with onset-to-hospital time within 4.5 h was lower (292/606 [48.2%] vs 328/558 [58.8%], p = 0.0003) during the pandemic period. Furthermore, the median door-to-inpatient admission and door-to-inpatient rehabilitation times increased from 28 to 37 h and from 3 to 4 days (p = 0.014 and 0.0001). CONCLUSIONS: During the 24 months of COVID-19, a prolongation of stroke onset to hospital arrival and to intravenous rt-PA administration times were noted. Meanwhile, acute stroke patients needed to stay in the ED for a longer time before hospitalization. Educational system support and process optimization should be pursued in order to acquire timely delivery of stroke care during the pandemic.

Association of cytomegalovirus infection with hemorheology, endothelin level and prognosis of elderly patients with coronary heart disease

OBJECTIVE: To explore the association of cytomegalovirus(CMV) infection with hemorheology, endothelin level and prognosis of elderly patients with coronary heart disease. METHODS: A total of 86 elderly patients with coronary heart disease who had CMV infection and were treated in the Second Affiliated Hospital of Henan University of Science and Technology from Oct 2017 to Jun 2019 were assigned as the infection group, and 71 patients without CMV infection were chosen as the no infection group. The hemorheological indexes, endothelin level and incidence of adverse cardiovascular events were compared between the two groups, and the relationship between CMV-DNA load and hemorheological indexes, endothelin level was observed. RESULTS: The high shear viscosity, low shear viscosity, plasma viscosity, Hematocrit and endothelin level of the infection group were respectively(6.89+or-0.95)mPa.s,(11.12+or-1.20)mPa.s,(2.31+or-0.45) mPa.s, (53.54+or-4.97)% and(89.34+or-9.63)pg/ml, significantly higher than those of the no infection group(P<0.05). The endothelin level of the patients with CMV-DNA load no less than 1x10~3copies/ml was significantly higher than that of the patients with CMV-DNA load less than 1x10~3 copies/ml(P<0.05). The incidence of adverse cardiovascular events of the infection group was 12.79%, significantly higher than that of the no infection group(P<0.05). CONCLUSION: The CMV infection may raise the levels of hemorheological indexes and endothelin of the elderly patients with coronary heart disease and lead to the increase of incidence of adverse cardiovascular events.

Haze caused by NOx oxidation under restricted residential and industrial activities in a mega city in the south of North China Plain.

The formation of secondary aerosol species, including nitrate and sulfate, induces severe haze in the North China Plain. However, despite substantial reductions in anthropogenic pollutants due to severe restriction of residential and industrial activities in 2020 to stop the spread of COVID-19, haze still formed in Zhengzhou. We compared ionic compositions of PM2.5 during the period of the restriction with that immediately before the restriction and in the comparison period in 2019 to investigate the processes that caused the haze. The average concentration of PM2.5 was 83.9 µg m-3 in the restriction period, 241.8 µg m-3 before the restriction, and 94.0 µg m-3 in 2019. Nitrate was the largest contributor to the PM2.5 in all periods, with an average mass fraction of 24%-30%. The average molar concentration of total nitrogen compounds (NOx + nitrate) was 0.89 µmol m-3 in the restriction period, which was much lower than that in the non-restriction periods (1.85-2.74 µmol m-3). In contrast, the concentration of sulfur compounds (SO2 + sulfate) was 0.34-0.39 µmol m-3 in all periods. The conversion rate of NOx to nitrate (NOR) was 0.35 in the restriction period, significantly higher than that before the restriction (0.26) and in 2019 (0.25). NOR was higher with relative humidity in 40-80% in the restriction period than in the other two periods, whereas the conversion rate of SO2 to sulfate did not, indicating nitrate formation was more efficient during the restriction. When O3 occupied more than half of the oxidants (Ox = O3 + NO2), NOR increased rapidly with the ratio of O3 to Ox and was much higher in the daytime than nighttime. Therefore, haze in the restriction period was caused by increased NOx-to-nitrate conversion driven by photochemical reactions.

Common seasonal respiratory viral infections in children before and during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVES: To describe the incidence of seasonal respiratory viral infections (s-RVIs) before and during the coronavirus disease 2019 (COVID-19) pandemic and to compare virus-specific patient outcomes in pediatric patients. DESIGN: A retrospective cross-sectional study including patient admissions to the Children's National Hospital between October 1, 2015, and December 31, 2020. RESULTS: Among 12,451 patient admissions between March 15 and December 31, 2020 (cohort 1), 8,162 (66%) were tested for severe acute respiratory coronavirus virus 2 (SARS-CoV-2), and 249 (2.0%) were positive. Among 10,986 patient admissions between April 1 and December 31, 2020 (cohort 2), 844 (8%) were tested for s-RV upon admission and 160 were positive. Thus, 1.5% of patient admissions were associated with laboratory-confirmed s-RVIs. Among the 49,901 patient admissions during a viral season between October 1, 2015, and March 31, 2020 (cohort 3), 7,539 (15%) were tested for s-RV upon admission and 4,531 were positive; thus, 9.0% of patient admissions were associated with laboratory-confirmed s-RVIs. hHRV/rENT was the most detected virus, but the detection rate decreased substantially (31% vs 18%; P < .001) during the COVID-19 pandemic. No patients had RSV, influenza, hMPV, hPIV, or hCoV detected upon admission after April 21, 2020. The 3 patient cohorts had no statistically significant difference in the percentage of ICU admissions (10.8% vs 15.0% vs 14.2%; P > .05) or death at discharge (0.8% vs 0.6% vs 0.5%; P > .05). CONCLUSIONS: Compared to COVID-19, s-RVI cases were associated with a higher proportion of inpatient admissions but were similar in ICU admission and death rates in hospitalized pediatric patients. Public health interventions for preventing COVID-19 were highly effective in preventing pediatrics s-RVIs.

Comparison of Clinical Features of COVID-19 vs Seasonal Influenza A and B in US Children.

Importance: Compared with seasonal influenza, the clinical features and epidemiologic characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus 2019 (COVID-19) in US children remain largely unknown. Objective: To describe the similarities and differences in clinical features between COVID-19 and seasonal influenza in US children. Design, Setting, and Participants: This retrospective cohort study included children who were diagnosed with laboratory-confirmed COVID-19 between March 25 and May 15, 2020, and children diagnosed with seasonal influenza between October 1, 2019, and June 6, 2020, at Children's National Hospital in the District of Columbia. Exposures: COVID-19 or influenza A or B. Main Outcomes and Measures: Rates of hospitalization, admission to the intensive care unit, and mechanical ventilator use and the association between underlying medical conditions, clinical symptoms, and COVID-19 vs seasonal influenza. Results: The study included 315 patients diagnosed with COVID-19 (164 [52%] male; median age, 8.3 years [range, 0.03-35.6 years]) and 1402 patients diagnosed with seasonal influenza (743 [53%] male; median age, 3.9 years [range, 0.04-40.4 years]). Patients with COVID-19 and those with seasonal influenza had a similar hospitalization rate (54 [17%] vs 291 [21%], P = .15), intensive care unit admission rate (18 [6%] vs 98 [7%], P = .42), and use of mechanical ventilators (10 [3%] vs 27 [2%], P = .17). More patients hospitalized with COVID-19 than with seasonal influenza reported fever (41 [76%] vs 159 [55%], P = .005), diarrhea or vomiting (14 [26%] vs 36 [12%], P = .01), headache (6 [11%] vs 9 [3%], P = .01), body ache or myalgia (12 [22%] vs 20 [7%], P = .001), and chest pain (6 [11%] vs 9 [3%], P = .01). Differences between patients hospitalized with COVID-19 vs influenza who reported cough (24 [48%] vs 90 [31%], P = .05) and shortness of breath (16 [30%] vs 59 [20%], P = .13) were not statistically significant. Conclusions and Relevance: In this cohort study of US children with COVID-19 or seasonal influenza, there was no difference in hospitalization rates, intensive care unit admission rates, and mechanical ventilator use between the 2 groups. More patients hospitalized with COVID-19 than with seasonal influenza reported clinical symptoms at the time of diagnosis.

Severe Coronavirus Disease-2019 in Children and Young Adults in the Washington, DC, Metropolitan Region.

Despite worldwide spread of severe acute respiratory syndrome coronavirus-2, few publications have reported the potential for severe disease in the pediatric population. We report 177 infected children and young adults, including 44 hospitalized and 9 critically ill patients, with a comparison of patient characteristics between infected hospitalized and nonhospitalized cohorts, as well as critically ill and noncritically ill cohorts. Children <1 year and adolescents and young adults >15 years of age were over-represented among hospitalized patients (P = .07). Adolescents and young adults were over-represented among the critically ill cohort (P = .02).