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1.
J Stroke Cerebrovasc Dis ; 30(8): 105857, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1213403

ABSTRACT

OBJECTIVE: To characterize differences in disposition arrangement among rehab-eligible stroke patients at a Comprehensive Stroke Center before and during the COVID-19 pandemic. MATERIALS AND METHODS: We retrospectively analyzed a prospective registry for demographics, hospital course, and discharge dispositions of rehab-eligible acute stroke survivors admitted 6 months prior to (10/2019-03/2020) and during (04/2020-09/2020) the COVID-19 pandemic. The primary outcome was discharge to an inpatient rehabilitation facility (IRF) as opposed to other facilities using descriptive statistics, and IRF versus home using unadjusted and adjusted backward stepwise logistic regression. RESULTS: Of the 507 rehab-eligible stroke survivors, there was no difference in age, premorbid disability, or stroke severity between study periods (p>0.05). There was a 9% absolute decrease in discharges to an IRF during the pandemic (32.1% vs. 41.1%, p=0.04), which translated to 38% lower odds of being discharged to IRF versus home in unadjusted regression (OR 0.62, 95%CI 0.42-0.92, p=0.016). The lower odds of discharge to IRF persisted in the multivariable model (aOR 0.16, 95%CI 0.09-0.31, p<0.001) despite a significant increase in discharge disability (median discharge mRS 4 [IQR 2-4] vs. 2 [IQR 1-3], p<0.001) during the pandemic. CONCLUSIONS: Admission for stroke during the COVID-19 pandemic was associated with a significantly lower probability of being discharged to an IRF. This effect persisted despite adjustment for predictors of IRF disposition, including functional disability at discharge. Potential reasons for this disparity are explored.


Subject(s)
COVID-19 , Patient Discharge/trends , Patient Transfer/trends , Practice Patterns, Physicians'/trends , Stroke Rehabilitation/trends , Stroke/therapy , Aged , Disability Evaluation , Female , Humans , Male , Middle Aged , New Jersey , Recovery of Function , Registries , Retrospective Studies , Stroke/diagnosis , Stroke/physiopathology , Time Factors
2.
J Neurointerv Surg ; 2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1072792

ABSTRACT

BACKGROUND: Unprecedented workflow shifts during the coronavirus disease 2019 (COVID-19) pandemic have contributed to delays in acute care delivery, but whether it adversely affected endovascular thrombectomy metrics in acute large vessel occlusion (LVO) is unknown. METHODS: We performed a retrospective review of observational data from 14 comprehensive stroke centers in nine US states with acute LVO. EVT metrics were compared between March to July 2019 against March to July 2020 (primary analysis), and between state-specific pre-peak and peak COVID-19 months (secondary analysis), with multivariable adjustment. RESULTS: Of the 1364 patients included in the primary analysis (51% female, median NIHSS 14 [IQR 7-21], and 74% of whom underwent EVT), there was no difference in the primary outcome of door-to-puncture (DTP) time between the 2019 control period and the COVID-19 period (median 71 vs 67 min, P=0.10). After adjustment for variables associated with faster DTP, and clustering by site, there remained a trend toward shorter DTP during the pandemic (ßadj=-73.2, 95% CI -153.8-7.4, Pp=0.07). There was no difference in DTP times according to local COVID-19 peaks vs pre-peak months in unadjusted or adjusted multivariable regression (ßadj=-3.85, 95% CI -36.9-29.2, P=0.80). In this final multivariable model (secondary analysis), faster DTP times were significantly associated with transfer from an outside institution (ßadj=-46.44, 95% CI -62.8 to - -30.0, P<0.01) and higher NIHSS (ßadj=-2.15, 95% CI -4.2to - -0.1, P=0.05). CONCLUSIONS: In this multi-center study, there was no delay in EVT among patients treated for intracranial occlusion during the COVID-19 era compared with the pre-COVID era.

3.
Immunol Invest ; : 1-8, 2021 Feb 03.
Article in English | MEDLINE | ID: covidwho-1060904

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exhibited different clinical manifestations amongst various age cohorts. As the immune microenvironment may play a role in clinical progression, it is crucial to examine molecular interactions to gain insight into host response. Therefore, to elucidate any differences in host response related to age, the present study imputed ligand-receptor interactions within the nasopharyngeal immune microenvironment in patients affected with SARS-COV-2. Tissue purities, the proportion of non-immune cells in the tissue sample, of 467 nasopharyngeal transcriptome profiles were estimated using known mRNA expression signatures of stromal/immune cells. Using the purity estimates and bulk tissue expression values, non-negative linear regression was used to estimate average expression of each gene in the stromal/tumor compartments. The inferred expression profiles were annotated with a curated database of ligand-receptor interactions and assumed as reasonable proxies for the law of mass action, allowing for quantification of directional ligand-receptor complex concentrations under equilibrium. It was found that older patients (>60 years) exhibited decreased interactions with receptors selectin L receptor SELL and increased interactions with pro-inflammatory chemokine receptors CXCR2 and CCR1. Younger patients showed increased interactions with various members of the TNF receptor super family (TNFRSF). The interactions were further related to immune cell subtypes, with older patients predicted to have less CD8+ and CD4+ resting T cells but increased neutrophil proportions. Collectively, the results suggest certain ligand-receptor interactions of the nasopharyngeal immune microenvironment are age-associated in response to SARS-CoV-2.

4.
Preprint | SciFinder | ID: ppcovidwho-5316

ABSTRACT

A review. Abstract Under the background of corona virus disease 2019 (COVID-19) epidemic situation a large number of patients cannot be treated in designated hospitals due to local hospital′s limited beds. The isolation and treatment of diagnosed mild and general patients in cabin hospital and cutting off the source of infection from the source are the keys to controlling the epidemic. The establishment and management of medical laboratory in cabin hospital provides scientific and objective laboratory data for clinic which is an indispensable part of the prevention and control measures of COVID-19. In this review the site selection personnel and training infection prevention quality control management and process optimization of medical laboratory are summarized which provides a reference for other mobile cabin hospitals and clearing hospitals.

5.
Emerg Microbes Infect ; 9(1): 1835-1842, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-684751

ABSTRACT

Staff and employees "Zero infection" has been achieved during the whole medical activities in the COVID-19 Fangcang Shelter Hospital in Wuhan, China. This study analyses the personnel and environmental protection status of the East-West Lake Fangcang Shelter Hospital. The HCWs were mostly composed of national medical rescue teams, from different provinces in China. Before the COVID-19 outbreak, 82.64% of the HCWs had already known the proper procedure of wearing masks and other personal protective equipment (PPE). For the total of 634 participants entering the inpatient areas, 99.8% of them took occupational protection trainings via various methods. By carefully training and supervision, most of them were competent to work in the inpatient areas six hours/d, three-four times/week. Besides, 7.8% experienced different types of occupational exposure, which mainly caused by the damage of PPE. Once exposed, the HCWs would disinfect skin or mucous in time. No SARS-CoV-2 RNA was detected in 48 air and environmental samples after regular disinfection and cleaning. To conclude, the bundle including intensive training, strengthened personal protection, strict environmental disinfection and timely remedial measures for occupational exposure had ensured the safety of the East-West Lake Fangcang Shelter Hospital.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/prevention & control , Health Personnel/statistics & numerical data , Occupational Exposure/prevention & control , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/prevention & control , Adult , Betacoronavirus/genetics , COVID-19 , China , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Hospitals, Special/statistics & numerical data , Humans , Male , Middle Aged , Occupational Health , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , SARS-CoV-2 , Young Adult
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