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1.
Neurosurgery ; 2022 Mar 07.
Article in English | MEDLINE | ID: covidwho-1724730

ABSTRACT

BACKGROUND: The mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke. OBJECTIVE: To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. METHODS: We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020. RESULTS: The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002). CONCLUSION: COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.

2.
The Egyptian Journal of Radiology and Nuclear Medicine ; 53(1), 2022.
Article in English | EuropePMC | ID: covidwho-1609936

ABSTRACT

Background The occurrence of invasive fungal infections in COVID-19 patients is on surge in countries like India. Several reports related to rhino-nasal-sinus mucormycosis in COVID patients have been published in recent times;however, very less has been reported about invasive pulmonary fungal infections caused mainly by mucor, aspergillus or invasive candida species. We aimed to present 6 sputum culture proved cases of invasive pulmonary fungal infection (four mucormycosis and two invasive candidiasis) in COVID patients, the clues for the diagnosis of fungal invasion as well as difficulties in diagnosing it due to superimposed COVID imaging features. Case presentation The HRCT imaging features of the all 6 patients showed signs of fungal invasion in the form of cavities formation in the pre-existing reverse halo lesions or development of new irregular margined soft tissue attenuating growth within the pre-existing or in newly formed cavities. Five out of six patients were diabetics. Cavities in cases 1, 2, 3 and 4 of mucormycosis were aggressive and relatively larger and showed relatively faster progression into cavities in comparison with cases 5 and 6 of invasive candidiasis. Conclusion In poorly managed diabetics or with other immunosuppressed conditions, invasive fungal infection (mucormycosis, invasive aspergillosis and invasive candidiasis) should be considered in the differential diagnosis of cavitary lung lesions.

3.
Stroke ; 52(4): 1527-1531, 2021 04.
Article in English | MEDLINE | ID: covidwho-1085244

ABSTRACT

Informed consent is a key concept to ensure patient autonomy in clinical trials and routine care. The coronavirus disease 2019 (COVID-19) pandemic has complicated informed consent processes, due to physical distancing precautions and increased physician workload. As such, obtaining timely and adequate patient consent has become a bottleneck for many clinical trials. However, this challenging situation might also present an opportunity to rethink and reappraise our approach to consent in clinical trials. This viewpoint discusses the challenges related to informed consent during the COVID-19 pandemic, whether it could be acceptable to alter current consent processes under these circumstances, and outlines a possible framework with predefined criteria and a system of checks and balances that could allow for alterations of existing consent processes to maximize patient benefit under exceptional circumstances such as the COVID-19 pandemic without undermining patient autonomy.


Subject(s)
COVID-19 , Informed Consent/standards , Pandemics , Randomized Controlled Trials as Topic/standards , Stroke/diagnostic imaging , Stroke/therapy , Aged , COVID-19/epidemiology , Humans , Male , Stroke/epidemiology , Time Factors
6.
Stroke ; 51(8): 2587-2592, 2020 08.
Article in English | MEDLINE | ID: covidwho-680789

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has in some regions overwhelmed the capacity and staffing needs of healthcare systems, necessitating the provision of resources and staff from different disciplines to aid COVID treatment teams. Stroke centers have multidisciplinary clinical and procedural expertise to support COVID treatment teams. Staff safety and patient safety are essential, as are open lines of communication between stroke center leaders and hospital leadership in a pandemic where policies and procedures can change or evolve rapidly. Support needs to be allocated in a way that allows for the continued operation of a fully capable stroke center, with the ability to adjust if stroke center volume or staff attrition requires.


Subject(s)
Coronavirus Infections/therapy , Hospital Departments/organization & administration , Pandemics , Patient Care Team/organization & administration , Pneumonia, Viral/therapy , COVID-19 , Communication , Delivery of Health Care , Humans , Leadership , Occupational Health , Organizational Policy , Personnel Staffing and Scheduling
7.
Stroke ; 51(7): 2273-2275, 2020 07.
Article in English | MEDLINE | ID: covidwho-327109

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, infectious disease control is of utmost importance in acute stroke treatment. This is a new situation for most stroke teams that often leads to uncertainty among physicians, nurses, and technicians who are in immediate contact with patients. The situation is made even more complicated by numerous new regulations and protocols that are released in rapid succession. Herein, we are describing our experience with simulation training for COVID-19 stroke treatment protocols. One week of simulation training allowed us to identify numerous latent safety threats and to adjust our institution-specific protocols to mitigate them. It also helped our physicians and nurses to practice relevant tasks and behavioral patterns (eg, proper donning and doffing PPE, where to dispose potentially contaminated equipment) to minimize their infectious exposure and to adapt to the new situation. We therefore strongly encourage other hospitals to adopt simulation training to prepare their medical teams for code strokes during the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections , Neurology/education , Pandemics , Personnel, Hospital/education , Pneumonia, Viral , Simulation Training , Stroke/therapy , Airway Management/methods , COVID-19 , Communication Barriers , Coronavirus Infections/prevention & control , Endovascular Procedures/education , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Occupational Diseases/prevention & control , Pandemics/prevention & control , Patient Safety , Personal Protective Equipment , Personnel, Hospital/psychology , Pneumonia, Viral/prevention & control , Procedures and Techniques Utilization , Protective Devices , SARS-CoV-2 , Stress, Psychological/prevention & control , Thrombectomy/education , Thrombectomy/methods , Thrombolytic Therapy/methods , Time-to-Treatment
8.
Stroke ; 51(7): 2263-2267, 2020 07.
Article in English | MEDLINE | ID: covidwho-247793

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has broad implications on stroke patient triage. Emergency medical services providers have to ensure timely transfer of patients while minimizing the risk of infectious exposure for themselves, their co-workers, and other patients. This statement paper provides a conceptual framework for acute stroke patient triage and transfer during the COVID-19 pandemic and similar healthcare emergencies in the future.


Subject(s)
Betacoronavirus , Emergency Medical Services/statistics & numerical data , Pandemics , Stroke/epidemiology , Triage , Acute Disease , Asymptomatic Diseases , COVID-19 , Canada/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Delayed Diagnosis , Equipment Contamination , Health Workforce , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Occupational Diseases/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Protective Devices , Resource Allocation , SARS-CoV-2 , Stroke/complications , Stroke/diagnosis , Stroke/therapy , Symptom Assessment , Time-to-Treatment , Transportation of Patients , Travel , Triage/methods , Triage/standards , Unconsciousness/etiology , Workflow
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