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1.
Turkish Journal of Intensive Care ; 20:213-213, 2022.
Article in English | Academic Search Complete | ID: covidwho-1756053

ABSTRACT

Amaç: Otoimmün nöromüsküler bir hastalık olan Myastenia gravis (MG), şiddetli COVID-19 için bir risk faktörü olabilir. Şu anda, COVID-19’un MG hastalarını nasıl etkilediği net bilinmemektedir. MG’de COVID-19’un yönetimine yönelik mevcut kılavuzlar, uzmanların teorik olarak fikir birliğine dayanmaktadır. Amacımız, eşlik eden COVID-19 enfeksyonu eşlik eden MG hastalarında plazmaferez tedavisinin prognoz üzerine etkinliğini vurgulamaktır. Olgu: Elli beş yaş erkek hasta -24 yıldır MG tanısı ile takipli- acil servise 2 gündür devam eden nefes darlığı ve 4 gün önce yapılan COVID PZR testi pozitifliği ile başvurdu. Favipiravir kullanmıyordu. Nörolojik muayede solunum sıkıntısı ve bilateral parsiyel oftalmoparezi mevcuttu. HRCT’de bilateral yaygın opasiteler ve buzlu cam görünümü mevcuttu. COVID-19 pnomonisi ve miyatenik kriz ön tanısı ile nöroloji yoğun bakım ünitesine yatırıldı. Yatış esnasında nazal kanul ile 6 l/dk O2 tedavisi başlandı. Ancak SO2 ’de progesif düşüş nedeni (Şekil 1) ile HFNC ile O2 desteğine geçildi. Favipiravire ek olarak antibiyoterapi (seftriakson) başlandı (Tablo 1) ve 2 doz konvelan plazma tedavisi uygulandı. Ancak solunum sıkıntısında progresyon nedeni ile 3. gün 1000 mg/gün puls steroid tedavisine geçildi. Beşinci gün progresif hipoksemisi nedeni ile entübe edildi (Şekil 2). Altıncı gün bir kür sitokin filtesi uygulandı. Sekizinci gün miyastenik kriz nedeni ile 5 gün günlük plamaferez yapıldı. Herhangi bir kompliaksyon oluşmadı. On üçüncü günde hasta ekstube oldu. Yatışının 20. günü azothıpurin 25 mg/gün, oral prendnizlon 32 mg/gün ve pridostigmin 5/gün ile tam iyilik hali ile taburcu edildi. Sonuç: COVID-19’un bir krizi tetiklediği bu hastada, plazmaferez uygulamasının, hastanın miyastenik krizinin tetikleyicilerinden biri olabilecek COVID-19 enfeksiyonuna bağlı enflamatuvar sitokinleri ortadan kaldırarak iyileşmeyi hızlandırdığına inanıyoruz. COVID-19 tedavisi olarak plazma değişiminin etkinliğini değerlendirmek için çalışmalar devam etmektedir. Hali hazırda mevcut olan intravenöz immünoglobulin (ÍVÍG), COVID-19’a karşı koruyucu antikorlara sahip olmayabilir, bu nedenle, bu olguda plazmaferez tercih edildi. Biz bu özel durumda plazmaferezin, IVIG’ye göre daha güvenle tercih edilebilir olduğunu ve prognoz üzerine olumlu etkisini vurgulamak istedik. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

2.
Stroke Vasc Neurol ; 6(4): 542-552, 2021 12.
Article in English | MEDLINE | ID: covidwho-1153702

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.


Subject(s)
COVID-19 , Intracranial Aneurysm , Subarachnoid Hemorrhage , Cross-Sectional Studies , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/epidemiology , Intracranial Aneurysm/therapy , Pandemics , Prospective Studies , Retrospective Studies , SARS-CoV-2 , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/epidemiology , Treatment Outcome
3.
J Stroke Cerebrovasc Dis ; 29(9): 104938, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-210006

ABSTRACT

BACKGROUND AND PURPOSE: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. METHODS: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. CONCLUSION: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Hospitalization/trends , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/trends , Stroke/epidemiology , Stroke/therapy , COVID-19 , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/virology , Healthcare Disparities/trends , Hospital Mortality/trends , Host-Pathogen Interactions , Humans , Incidence , Interrupted Time Series Analysis , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Prospective Studies , Registries , Retrospective Studies , Risk Factors , SARS-CoV-2 , Stroke/diagnosis , Stroke/mortality , Time Factors , Treatment Outcome
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