ABSTRACT
Introduction: Stroke units have remarkably reduced morbidity and mortality in patients by bringing together a multidisciplinary team that aids in quick stroke diagnosis, emergency treatment, restoration of homeostasis, prevention of common complications, rehabilitation and secondary prevention. Our audit looks at factors that cause delay in early transfer of patients from emergency department to HASU (hyper-acute stroke unit) and aims to find solutions to reduce transfer time. Method(s): We obtained our data from stroke database maintained by hospital's medical records department. All patients presenting with acute stroke (ischemic and hemorrhagic) during the month of November and December2021 and fulfilling our inclusion criteria were evaluated. Result(s): A total of 138 patients presented to our stroke-care facility in the two months period with 79 eligible for stroke unit admission, out of which 52 (65.8%) were females and 27(34.2%) were males. The mean door to stroke unit time in our study was 278.6 minutes with major delays beyond 4hours caused by non-availability of beds(32.0%), covidrelated issues(25.5%),monetary issues(17.0%) initial referral delays(14.9%) and imaging delays(10.6%) respectively. Conclusion(s): Our audit showed that most of the delays were infrastructure- related like lesser stroke dedicated beds, separate facility for covidaffected stroke patients and no designated Ct scanner/ stroke nurse for acute stroke patients assessment in triage. Additional cause identified was low socioeconomic status hampering affordability of acute stroke care.
ABSTRACT
Ectopia cordis (EC) is a rare congenital condition characterized by a partial or complete defect of the anterior chest wall. It is associated with ventricular and atrial septal defects (ASD), Ebstein's anomaly, truncus arteriosus, transposition of the great vessels, tetralogy of Fallot, and hypoplastic left heart syndrome. This study aimed to explore the cardiac manifestations of EC complicated by coronavirus disease 2019 (COVID-19). A 23-year-old male, born with EC, was admitted to the hospital for acute cough and fever. The patient was diagnosed with EC and ASD by computed tomography and COVID-19 via a polymerase chain reaction swab test. Patients with ECs rarely survive till adulthood. However, due to the rarity of this syndrome, upon literature review, we did not find a case of EC with concurrent COVID-19 infection. The patient underwent the required investigations and conventional treatment such as fluid resuscitation, antibiotics administration, and full code cardiopulmonary resuscitation. The interventions performed were unsuccessful, and the patient died. This case demonstrates a patient who lived with EC and its associated cardiac anomalies but died of COVID-19 and its complications despite full resuscitation attempts. Our findings suggest that patients with EC may survive to adulthood if they have an incomplete EC, fewer intracardiac defects except for ASD, and an absence of an omphalocele.
ABSTRACT
The rapid tests had no role. The standards were laid down and an attempt was made to streamline the diagnostic work. Why enough tests are not being done for Corona-virus? Why so late and so little? Why there is so much diserepancy in the results between the lab? We have developed the test overnight in Pakistan, why not to be allowed to start testing on a mass scale? Why few labs are over-performing than the expectations? Why cannot other labs do when kit and equipment is there? There were many such like questions which made the news. The media need something to talk and that something should pertain to the current situation.