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Objectives: The COVID-19 pandemic disrupted many facets of healthcare including patients delaying medical care for potentially life-threatening conditions. This study sought to compare specific key outcomes related to ischemic stroke that occurred before and during the COVID-19 pandemic. We assessed mortality rates, morbidity rates, and the administration of thrombolytics in patients with ischemic stroke admitted to emergency departments (ED) in the Stroke Belt, a region of the United States with historically worse stroke outcomes. Method(s): Cerner Real-World Data was used to identify patients residing in the Stroke Belt (Southeastern United States) who were admitted to the ED with ICD-10 codes indicating acute ischemic stroke. We determined in-hospital and 30-day mortality rates, morbidity rates (physical disability tracked 1-year post-ischemic stroke), and administration of thrombolytics for acute ischemic stroke patients before the COVID-19 pandemic (March 2019-February 2020) and during the pandemic (March 2020-February 2021). Result(s): In the defined period prior to COVID-19, 2,338 patients presented to the ED with ischemic strokes (49.5% male;mean age 64.8, SD:15.23;69.6% white). During COVID-19, 2,052 ischemic stroke patients presented to the ED (50.9% male;mean age 65.8, SD:15.04;71.5% white). Our analyses show a significant decrease in thrombolytic administration during the pandemic compared to before the pandemic (12.2% and 14.5%, respectively;p<0.05). There was no significant difference in rates of in-hospital mortality, 30-day mortality, or morbidity following ischemic strokes. Conclusion(s): The findings of our study suggest a reduction in ischemic stroke related ED encounters during the COVID-19 period, but no differences were observed in mortality and morbidity rates in ischemic stroke compared to before the pandemic. Future studies are required to determine if these trends were true in other regions of the United States, as well as to investigate other potential covariates linked to outcomes before and during the COVID-19 pandemic.Copyright © 2023
ABSTRACT
A "Stroke" is a neurological disease due to poor blood flowing to the brain, resulting in body cell death. It is ranked second as the most common cause of death globally. The "World Health Organization" estimates that about 15 million people suffer a stroke annually. Most stroke survivors have gait disorders, and most patients cannot walk without assistance. Physiotherapy is crucial for stroke patients to recover and maintain their mobility, functionality, and well-being. In the last 20 years, the replacement of physiotherapists with wearable robotics has become essential due to the developing technology, the need for economic growth, and the challenging health circumstances around the world, such as the COVID-19 pandemic recently. Lower Limb Exoskeleton (LLE) represents the solution for stroke patients under such circumstances, though its performance is a critical challenge paid attention to in the industry. This challenge has motivated the researchers to investigate the application of gait rehabilitation. This review presents and discusses the developments in the control system of LLE over the last decade. It also explores the limitations, new directions, and recommendations in LLE development according to the literature.
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Background: The Coronavirus Disease 2019 (COVID-19) pandemic had disrupted established medical care systems worldwide, especially for highly time-sensitive acute conditions such as stroke. Strategies to maintain the quality of stroke care during the COVID-19 outbreak are crucial to prevent indirect mortality and disability due to suboptimal care. Objective: We conducted a single center analysis to compare the time-based measures for acute ischemic stroke care quality before and during the COVID-19 pandemic. Methods: A retrospective study was done utilizing the Registry of Stroke Care Quality (RES-Q) database. All acute ischemic stroke patients who presented within 4.5 hours of symptom onset in Makati Medical Center were included. Patient characteristics, treatment received, in-hospital time-based measures of stroke care quality and clinical outcomes were compared between the two periods-pre-COVID-19 and COVID-19. Results: There were 151 patients during the pre-COVID-19 period and 108 patients during the COVID-19 period who presented to the hospital with acute ischemic strokes within 4.5 hours of symptom onset. There was significantly higher NIHSS scores on admission and MRS scores on discharge during the COVID-19 period. There was no significant difference in the door-to-scan time, door-to-needle time and door-to-groin time between the two periods. Conclusion: There is no significant change in the acute ischemic stroke care quality on the basis of in-hospital time-based measures: door-to-scan time, door-to-needle time, and door-to-groin time, between the pre-COVID-19 and COVID-19 periods. Further studies on pre-hospital challenges are recommended to identify specific targets for improvements in stroke care during pandemics. © 2023, ASEAN Neurological Association. All rights reserved.
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Background: While the COVID-19 pandemic affected more than thirty million people world-wide, still the true link between COVID-19 and the incidence of stroke remains to be eluci-dated. Method(s): Herein, we briefly discuss virology of COVID-19 and approaches for diagnosis and treatment of COVID-19 patients, as well as the mechanisms that link stroke and COVID-19. Result(s): Many pathophysiologic and immunologic mechanisms have been implicated in stroke occurring among patients with COVID-19. COVID-19 pandemic has, in different ways, negative im-pacts on the care of stroke patients world-wide, and still, neurologists have to face many challenges to improve the care of stroke patients during such crisis. Conclusion(s): Although the control of the COVID-19 is of crucial importance, at the same time, the management of stroke must not be neglected. Therefore, preserving care for critical conditions such as stroke, and providing strategies to ensure this continues, have a priority even during the cri-sis. Till vaccine is available for COVID-19, strategies for rapid diagnosis and those for treating patients with that disease are evolving. Further studies are warranted.Copyright © 2021 Bentham Science Publishers.
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Introduction: The UK Stroke pathway has been well developed since the introduction of the National Stroke Strategy in 2007 (Department of Health, 2007). Music Therapy (MT) is an AHP that has less presence within the current stroke pathway. In line with the national guidelines for Stroke rehabilitation (NICE, 2013), music therapy targets specific patient rehabilitation goals integrating a multi-disciplinary approach to therapy. Chiltern Music Therapy funded a 12-month, 1 day a week pilot MT service at Buckinghamshire Neuro Rehab Unit between 2020-2021. Method(s): The MT service comprised of a mixture of individual and group sessions. 27 patients were seen. Demographics, techniques, outcomes and feedback data was collected by the therapist, aiming to identify the benefits of MT for patients during the pandemic and how the pilot service enhanced standard therapies. Result(s): Patients accessed 86.5 hours of face-to-face (FtF) MT during the Covid-19 pandemic. 72% of SMART goals were fully or partially achieved. Data suggests MT reduces stress and anxiety, improves mood, and helps patients feel hopeful about the future;MT enhances patient engagement with therapy interventions;MT input increases patient's positive development in the areas of communication, cognition, motor skills, emotional expression, sense of self and behaviour. Staff and patient feedback was overwhelmingly positive. Conclusion(s): Introducing a MT service into existing therapy provision for stroke patients provided opportunities for FtF interaction during the Covid-19 pandemic. MT meets multiple national standards and guidelines for stroke. MT enhances patient engagement with therapy interventions, assists achieving rehab goals whilst reducing stress and anxiety and improving mood.
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Introduction: Stroke remains the largest cause of disability in the UK and skills assessment are a prerequisite for accurate diagnosis and treatment plans from healthcare professionals.The objectives of the study were to explore registered nurses' perceived barriers in relation to stroke assessment and finally to identify gaps from the research and enhance improvements for improving patients care. Method(s): An interpretive qualitative study utilising semi-structured interviews for data collection was the initial methodology.However, this methodology was disregarded due to the COVID-19 pandemic. The researcher opted to write a personal reflection from both a student and heath professional perspective, using both self-reflexivity and auto ethnography methodology (Hughes and Pennington,2017) and applying Clarke's 6 stages of the thematic analysis (Braun and Clarke, 2012). Result(s): The interpretive self reflection study identified three main themes by the researcher. These themes focused on anger and frustration;responsibilities as a health professional and feelings of powerless as a female student. Conclusion(s): COVID-19 restrictions meant there were limitations using the original semi-structured interviews from Registered Nurses with different levels of experience.Further discussion needs to be around undertaking the original semi-structure interviews when the incidence Covid-19 wanes, to identify weather these themes are generic to the stroke environment or unique to the pandemic. Recommendations are to fully complete the study in the post-pandemic period to assess,analyse and develop a stroke programme to educate, support and nurture the knowledge and skills required to deliver stroke care in future .
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COVID-19 had an unprecedented effect on acute stroke services, both directly and indirectly. Intracerebral haemorrhage (ICH) appears to be increasing as a percentage of stroke patients post COVID-19 and is reported to have risen in Grampian from 13.6% of total strokes in 2019, to 17.7% in 2021. In this descriptive analysis we use the NHS Grampian Stroke audit data to explore the factors which could have contributed to this rise. The number of ICH patients on anticoagulation increased from 16.7% in 2019 to 18.4% in 2021. Of these, the proportion on a direct oral anticoagulant (DOAC) has increased from 66.7% in 2018 to 78.3% in 2021. Of the patients that were on anticoagulation, the proportion with a diagnosis of hypertension was similar between 2019 (52.9%) and 2021 (52.0%) but rose to 60% in 2022. In 2019, all ICH patients diagnosed with hypertension were on an antihypertensive. Whereas, in 2021 23.1% of ICH patients had a diagnosis of hypertension but were not on any antihypertensive treatment. The rise in the number of intracerebral haemorrhages post COVID-19 will likely be multifactorial. In this descriptive analysis there appears to be an increase in the number of ICH patients on anticoagulation, and also an increase in patients with untreated hypertension. Potential confounders include excess alcohol use or stress both of which increase the risk of ICH and are known to have risen during COVID-19.
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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.
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Background and Purpose: With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. However, there is limited data on the clinical characteristics, stroke mechanism, and outcomes of patients who have a stroke and COVID-19. Method(s): We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 15, 2020, and April 19, 2020, within a major health system in New York, the current global epicenter of the pandemic. We compared the clinical characteristics of stroke patients with a concurrent diagnosis of COVID-19 to stroke patients without COVID-19 (contemporary controls). In addition, we compared patients to a historical cohort of patients with ischemic stroke discharged from our hospital system between March 15, 2019, and April 15, 2019 (historical controls). Result(s): During the study period in 2020, out of 3556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to contemporary controls (30.4%, P=0.003) and historical controls (25.0%, P<0.001). When compared with contemporary controls, COVID-19 positive patients had higher admission National Institutes of Health Stroke Scale score and higher peak D-dimer levels. When compared with historical controls, COVID-19 positive patients were more likely to be younger men with elevated troponin, higher admission National Institutes of Health Stroke Scale score, and higher erythrocyte sedimentation rate. Patients with COVID-19 and stroke had significantly higher mortality than historical and contemporary controls. Conclusion(s): We observed a low rate of imaging-confirmed ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased. Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.
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Introduction: During the Covid-19 pandemic it was recognised by MTW, a reconfiguration of the acute hospital would be required to create extra bed capacity and protect vulnerable patient groups. Alongside the pandemic the Kent and Medway stroke reconfiguration occurred (Winidbank, 2015). Since July 2020, MTW Stroke Unit admission data shows an average rise of 107% in activity. In December 2020, 'The Hilton Stroke Pathway' (HSP) was developed as a 6 month rehabilitation pilot to increase the MTW bed-base away from the acute site . The pathway consisted of an innovative virtual and homecare rehabilitation service in collaboration with Hilton Nursing Partners. Method(s): The pilots were evaluated using 5 key criteria: financial performance, clinical service delivery, quality of care, patient experience and stakeholder feedback. The pathway is overseen by MTW therapists, discharge liaison services and Hilton care. The aim of the pathway: Enable safe discharge home for stroke patients requiring specialist rehabilitation as soon as they were medically fit. Ensure patients rehabilitation was delivered safely and effectively. Provide a flexible service supporting patients with a range of therapy need. Provide nursing and care support as required. There are 3 levels of support: recovery, moderate and intensive. The MDT discussed which level was most appropriate for the patient. This was then reviewed as patients improved. Initially the therapy was overseen virtually by the OT, PT and SALT team. However, due to complexity of some of the patients' rehabilitation needs, therapy staff shifted to face-to-face therapy sessions. Due to the success of the pilot phase MTW decided to transition the pathway to business as usual. As part of this the pathway was reviewed in collaboration with KCFHT and therapy outcome measures were collected. Monthly monitoring meetings continue with Hilton, to ensure ongoing quality of care and effectiveness of the pathway Results: Since the beginning of the pilot the pathway has achieved positive results in SSNAP. Between January and June 2021 92.2% required OT, 84.4% required PT and 63.3% required SALT. The results in chart 1-2 are from Jan - April 2022. Chart 1 shows patient outcomes for destination on discharge. Chart 2 shows the difference in Therapy Outcome Measure (TOMs) admission and discharge scores. There has been a significant difference in the TOMS in three domains (significant difference=0.5)(Enderby and John, 2019), impairments, activity and participation. The biggest improvements has been seen in activity and participation meaning the HSP are enabling patients to integrate back into society and their occupational roles in life. The pilot evidenced using multi-organisational working has enabled earlier and safer discharges home. The new pathway has allowed for flexible acute bed capacity following the closure of stroke services at Medway hospital and during the challenges that accompanied the Covid-19 pandemic. The HSP has shown significant improvement with functional outcomes and integration back into occupational roles. In 2022 52% of the patients did not require further social care at the end of the pathway. SSNAP data shows a higher intensity of therapy was provided with an average of 34 minutes of OT, 37 minute of PT and 14 mins of SALT per day, whilst on the pathway. Therefore, MTW and Hilton Nursing Partners are keen for continuation of this pathway into future stroke development. Additionally, collaboration with KCHFT community neurorehabiliation team enabled the West Kent stroke rehabilitation pathways to be defined seen in Chart 3. The integration of Hilton Nursing Partners and the MTW MDT enabled safe and effective facilitation for stroke patients into their homes, whilst achieving high levels of independence. Conclusion(s): The stroke service demonstrated what can be achieved in a short timeframe and in challenging circumstances. The implementation was robust and a positive use of NHS resources to proactively enable changes in stroke service provision required across West Kent The pathway was well received by patients and staff, providing a direction of travel towards community-based stroke rehabilitation services which reflect the national guidelines for stroke services (RCP, 2016;NICE, 2013).
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Background: The $21.7 million NSW Telestroke Service was a 2019 NSW Government election commitment. Implementation of the service is a collaboration between South Eastern Sydney Local Health District, the NSW Agency for Clinical Innovation, eHealth NSW and the NSW Ministry of Health. Between March 2020 and June 2022, the telestroke service launched at 23 sites across regional and rural NSW, providing access to specialist stroke physicians for rapid assessment, diagnosis and treatment through virtual care. The service has treated over 2200 patients with a reperfusion rate for acute ischaemic stroke patients of 34%. Aim(s): To understand the factors driving the successful implementation of a major project led by multiple health organisations in a complex environment. Interrogating and documenting the success factors will help NSW Health agencies implement similar large-scale, complex projects. Method(s): The implementation team adopted a reflective approach to draw out key lessons during the implementation at each site. Lessons learnt discussions were held at a local and program-wide level, focusing on areas including resourcing, leadership, education and training, and sustainability. Result(s): Key elements of successful implementation highlighted by the reflective lessons learnt approach include: * Division of responsibility that reflected the strengths of each partner agency * Clear implementation roadmap including comprehensive implementation and training packages * Flexibility to adapt the implementation approach based on contextual factors and intervening events * Strong executive support at each partner agency * Upfront focus on sustainability to identify and mitigate issues early on The telestroke service was implemented by the target schedule, despite the significant impacts caused by the COVID-19 pandemic and natural disasters. The service was a finalist in the 2021 NSW Premier's Awards. Conclusion(s): The implementation of telestroke can offer insights for partner agencies into the key factors driving success of transformative projects to improve access to healthcare.
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Introduction: Quality improvement activities have traditionally been face-to-face, a model limited in reach and regional and remote inequities. The coronavirus pandemic (COVID-19) necessitated adaptation to an interactive digital format which led to the development of the National Webinar Series. Aims: To improve stroke patient outcomes and reduce inequities in the provision care through a national digital quality improvement program. Methods: Collaborating with state and territory hospitals, specialists stroke experts and other expert organisations, we piloted a national digital interactive quality improvement program. The program utilised data and evidence from the National Stroke Audit and Clinical Guidelines for Stroke Management to support clinicians to identify barriers and gaps and provide effective improvements in quality of care. A secure webinar environment facilitated collaboration between sites and states, and a peer-topeer model allows opportunities for exemplary hospitals to share strategies for improvement Results: From July- December 2021, 940 health professionals, from 235 sites, attended our webinars. The online format has successfully enabled nationally equitable access for professional development, regardless of location, and continuity of education throughout disruptive lockdowns/ border closures. Topics include discharge planning and 'My Stroke Journey', audit, living guidelines, stroke prevention, sexuality, delirium, and best practice smoking cessation. Participants surveys showed that 93% agreed the program would help improve national consistency in stroke care, 100% recognised the training value for staff new to stroke, 91% would recommend the webinars to others and 100% were interested in future webinars. Conclusion/Discussion: We have learned from health professionals participating in our National Webinars that the webinars educational model could be an effective tool for patient support post-discharge from hospital. COVID-19 has placed a strain on hospitals and staffing. As a result, stroke patients are being discharged early and aren't receiving all the information they need to transition from hospital to home and support their recovery.
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Introduction: Despite being an AHA Class 1 recommendation to achieve a blood pressure (BP) < 130/80 for secondary stroke prevention, only an estimated 20% of the general population can achieve this benchmark. Furthermore, it has been suggested that stroke patients may be at higher risk for an inability to achieve this goal. We aimed to examine real world clinic data to evaluate BP control among stroke patients. Method(s): We conducted a population-based retrospective study using electronic health records collected during routine care at our institution for all adult patients 18 years or older with a diagnosis for stroke between January 2019 to November 2021. BP measurements were taken in an outpatient setting between 90 and 180 days from the index stroke. Descriptive statistics using R (R Core Team, 2022, r-project.org) were reported as the mean and standard deviation for continuous variables and frequencies and proportions for categorical variables. Result(s): Our review identified a total of 1,583 patients with a new diagnosis of acute ischemic stroke (AIS: 1,252;79.1%) or intracerebral hemorrhage (ICH: 331;20.9%). AIS patients were 45.7% female with a mean age of 68 years old, compared to 47.7% female and 59 years old for ICH patients. AIS patients had a higher proportion of secondary medical issues, including 34.7% with diabetes, 33.0% congestive heart failure, 19.2% cardiac disease, and 33.9% renal disease (compared to 22.2%, 16.1%, 8.8%, 19.2% respectively for ICH patients). In follow-up, only 11.7% of AIS patients were at goal (defined as a BP < 130/80) at 3 months, 17.3% at 6 months, 11.6% at 9 months, and 8.9% at 12 month follow-up. Conversely, ICH patients were slightly better controlled with 21.6%, 32.8%, 15.8%, and 12.2% controlled at 3, 6, 9, and 12 month follow-up respectively. Patients with stroke after March 2020 (post-COVID19 pandemic) had lower rates of blood pressure control compared to those diagnosed one year prior to the pandemic. Conclusion(s): Patients with AIS have lower rates of BP control compared to the general population, which was further amplified by the COVID19 pandemic. These results may suggest that stroke patients face unique barriers in BP management and highlight the need to perform targeted treatment for this especially vulnerable group.
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INTRODUCTION: In the coronavirus disease 2019 (COVID-19) pandemic, there may be a decrease in the number of acute stroke intervention and acute treatment, and delays in treatment periods. In this study, it was aimed to compare the clinical features of patients presenting with acute stroke during the COVID-19 pandemic and in the pre-pandemic period. METHODS: Patients hospitalized with the diagnosis of cerebrovascular disease (CVD) between January 01, 2019 and May 31, 2021 were included in the study. Demographic characteristics and stroke risk factors of the patients were recorded. Stroke type and ischemic disease subtypes were determined, and patients' admission National Institutes of Health Stroke Scale (NIHSS) score, symptom-door time, door-consultation time, door-to-door Needle time and door-groin puncture time, intravenous tissue type plasminogen activator (IV tPA) and endovascular thrombectomy (EVT) applications were recorded. Discharge modified Rankin Scale (mRS) and NIHSS scores and mortality rates were evaluated. Patients hospitalized in two separate periods of 14 months each were compared by dividing them into pre-pandemic and pandemic periods. RESULTS: Before COVID-19, 316 patients (female 45.25%, age: 66.75±13.68 years) and during the pandemic period 341 (female 41.94%, age: 68.34±13.55 years) patients were included in the study. During the pandemic period, an increase in the number of hemorrhagic CVD and transient ischemic attacks, a decrease in the number of ischemic stroke and cerebral venous thrombosis (CVT) hospitalizations, a decrease in cardioembolic strokes and an increase in lacuner ischemic CVD subtypes were observed (p<0.01). The number of large vessel atherosclerosis, IV tPA and EVT were found to be similar before and after the pandemic. In the pandemic period, although it did not reach statistical significance compared to the pre-pandemic period, prolongation was recorded in the symptom-door, door-consultation, door-needle and door-groin puncture times (p>0.05). The COVID-19 test was positive after hospitalization in 5 (1.8%) patients with ischemic stroke hospitalized during the pandemic period. During the pandemic period, admission NIHSS, discharge NIHSS and mRS scores and mortality rates were found to be significantly higher between hemorrhagic and ischemic stroke patients (p<0.01). DISCUSSION AND CONCLUSION: The COVID-19 pandemic adversely affects the management of acute stroke. The duration of acute stroke treatment is delayed due to pre-hospital and in-hospital reasons. With the heavy burden of stroke during the pandemic period, poor clinical outcome and high mortality are observed.
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Objective Admission to the hospital for an acute cerebrovascular condition such as stroke or brain hemorrhage can be a traumatic and disorienting experience for patients and their family members. The COVID-19 pandemic has further intensified this experience in addition to exacerbating clinician and resident burnout. To ameliorate some of these concerns, a team of resident and medical student trainees implemented a virtual shared medical appointment (vSMA) program for inpatients with acute cerebrovascular disorders and their caregivers. This study hypothesized that an early intervention vSMA improves patient and caregiver health literacy and preparedness, simultaneously educates trainees on effective communication skills, and reduces clinician burnout. Methods Patients and caregivers of admitted patients were screened through the neurosurgery, neurocritical care, and neurology electronic medical record census. A weekly 60- minute secure virtual session consisted of introductions, a 10- minute standardized presentation on cerebrovascular disease management, followed by participant-guided discussion. Participants completed pre- and post-surveys. We report data on this feasibility study and present challenges, both expected and unforeseen. Results A total of 170 patients were screened;13 patients and 26 caregivers participated in at least 1 session. A total of 6 different healthcare providers facilitated sessions. The vSMA program received overwhelmingly positive feedback from caregivers. Surveys demonstrated 96.4% of caregivers and 75% of patients were satisfied with the session. 96.4% of caregivers and 87.5% of patients would recommend this type of appointment to a friend or family member. 88.8% of providers felt validated by conducting the session. The participant group had a 20% greater percentage of patients discharged home without home needs compared to the non-participant group. The primary obstacle encountered included technological frustrations with the consent process and the sessions themselves. Conclusions Implementation of a vSMA program at a tertiary care center during a pandemic was feasible. Themes caregivers expressed on the post-survey included better understanding of caring for a stroke patient, and coping with the unpredictability of a patient's prognosis. The pandemic has precipitated shifts towards telehealth, but our study highlights the importance of avoiding marginalization of the elderly and less technologically inclined populations (Table Presented).
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Background: The coronavirus disease 2019 (COVID-19) pandemic has led the implementation of institutional infection control protocols. This study will determine the effects of these protocols on outcomes of acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT). Methods: Uninterrupted time series analysis of the impact of COVID-19 safety protocols on AIS patients undergoing EVT. We analyze data from prospectively collected quality improvement databases at 6 centers from March 11, 2019 to March 10, 2021. The primary outcome is 90-day modified Rankin Score (mRS). The secondary outcomes are angiographic time metrics. Results: Preliminary analysis of one stroke center included 214 EVT patients (n=150 pre-pandemic). Baseline characteristics were comparable between the two periods. Time metrics last seen normal to puncture (305.7 vs 407.2 min;p=0.05) and hospital arrival to puncture (80.4 vs 121.2 min;p=0.04) were significantly longer during pandemic compared to pre-pandemic. We found no significant difference in 90-day mRS (2.0 vs 2.2;p=0.506) or successful EVT rate (89.6% vs 90%;p=0.93). Conclusions: Our results indicate an increase in key time metrics of EVT in AIS during pandemic, likely related to infection control measures. Despite the delays, we found no difference in clinical outcomes between the two periods.
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Background & Aim: Multilineage-differentiating stress enduring (Muse) cells, collectable as pluripotent surface marker SSEA-3-positive, are naturally existing non-tumorigenic pluripotent stem cells that distribute in the bone marrow, peripheral blood, connective tissue of every organ, and exhibit triploblastic differentiation and self-renewability at a single cell level. They are also contained in cultured MSCs and fibroblasts as several percent, and are expandable to a clinical scale. Circulating Muse cells, both endogenous and intravenously injected exogenous cells, selectively home to damaged tissue by sensing sphingosine-1-phosphate (S1P), one of the general alert signals produced by the damaged tissue, and then spontaneously differentiate into multiple tissue-constituent cells to replace damaged/ apoptotic cells. In this manner, they repair tissues. In addition, they have a specific immunomodulatory system, represented by HLA-G expression, allowing allogenic-Muse cells to directly administrate to patients without HLA-matching or long-term immunosuppressant (Figure Presented) treatment, and to remain in the host tissue as differentiated functional cells for more than half a year, as shown by animal models. Methods, Results & Conclusion: For these characteristics, intravenous drip is the main route of treatment and do not require surgery for their administration, nor do they require gene introduction or cytokine treatment to be rendered pluripotency and/or differentiation. Currently, clinical trials using intravenously administered donor- Muse cells have been conducted for myocardial infarction, stroke, epidermolysis bullosa, spinal cord injury, perinatal hypoxic ischemic encephalopathy, amyotrophic lateral sclerosis and COVID19-ARDS, all by intravenous drip of donor-derived Muse cell formula, CL2020, without HLA-matching or immunosuppressant treatment. The result of randomized, double-blind, placebo-controlled clinical trial in stroke patients confirmed safety and efficacy of Muse cell-based product for up to 52 weeks (1 year). Muse cells may safely provide beneficial effects compatible with the ‘body’s natural repair systems’ by a simple cost- effective strategy;collection, expansion and intravenous drip.
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Introduction: The COVID-19 pandemic substantially modified the normal functioning of health systems in the world, promoting, among other problems, delays in the care of patients with acute diseases such as stroke. We analyze the particularities of our population with acute stroke before and during the pandemic. Materials and methods: Prospective cohort of adult patients admitted to the British Hospital of Buenos Aires for ischemic stroke between March 20, 2020 and March 20, 2021 and compared with patients admitted in the same time interval during the previous year. Results: One hundred and twenty-one patients were included;the 51.2% (n = 62) were male and the average age was 70.4 years (SD 19.9). COVID nasopharyngeal swab was performed in 104 (85.6%) patients, resulting positive in 11 of them (9.1%);in 4 patients, stroke was the first manifestation of the COVID infection. Stroke of undetermined cause was more frequent during the pandemic (P <.05), there was a 21% decrease in the total number of consultations for ischemic stroke and a 4-h delay (IQR 0-2.5) in the window period during pandemic. Conclusion: The pandemic has a negative impact on the evaluation of stroke patients. Future changes in outpatient and inpatient care and patient information must continue to avoid delays in care, even as all eyes are focused on patients infected with COVID 19.
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Objective: The purpose is to identify the peculiarities of the parameters of red blood cells (RBC) and hemostasis in patients with strokes associated with coronavirus infection. Design and method: A total of 124 patients (48.5 + 1.9 years) with impairments of cerebral circulation due to COVID-19 (confirmed by positive PCR test) had been examined. Among them, 74 patients had ischemic stroke, 25- transient ischaemic attack, 17- intracerebral hemorrhage, 8- subarachnoid hemorrhage. The parameters of hemostasis were measured by standard methods, electrical, viscoelastic parameters of RBC - by dielectrophoresis. Results: 71 patients (the 1st group) showed signs of intravascular coagulation and thrombosis: accelerated platelet-leukocyte aggregation, increased levels of coagulation products, reduced fibrinolysis activity (p = 0.001-0.04). The levels of D-dimer, fibrinogen, ESR, platelet count were higher in this group compared to the second one (p < 0.01). A moderate increase of RBC summarized rigidity, viscosity was noted. The level of RBC hemolysis was associated with platelet count (r = 0.735,p = 0.03), D-dimer (r = 0.482, p < 0.05), fibrinogen level (r = 0.374, p = 0.04). In 2nd group (53 persons), the markers of thrombosis had moderate deviations. Sharply reduced RBC deformability with increased summarized rigidity, viscosity was dominant coupled with the background of high electrical conductivity of cell membranes compared to the indicators in the 1st group (p < 0.01). There was a decrease of membrane capacity, surface charge, cell dipole moment, polarizability than those in the 1st group (p = 0.0001-0.05). A sharp decrease of RBC deformability creates obstacles to overcoming small-diameter capillaries, leading to violations of microcirculatory blood flow. RBC deformability was associated with levels of ferritin (r = 0.451, p = 0.02), HbA1c (r = 0.480, p = 0.03), uric acid (r = -0.371, p < 0.05), LDL cholesterol (r = 0.461, p = 0.02). Incubation of blood samples in vitro for 10 min with riboflavin, nicotinamide, inosine, which ensures RBC energy metabolism, restored the reduced RBC deformability (p < 0.01), altered cell morphology (p = 0.04), decreased RBC aggregation (p < 0.001). Conclusions: The revealed features of parameters of RBC hemostasis in stroke patients with coronavirus infection are associated with two independent pathogenetic mechanisms: thrombotic and hemorheologic. The thrombotic variant is due to procoagulant state and an activity of inflammation. The hemorheologic variant is caused by decrease of RBC energy metabolism, activity of enzymes.
ABSTRACT
Background and aims: Vaccination against SARS-CoV-2 has been associated with rare occurrences of cerebral venous thromboses. Very little data exist about arterial ischemic strokes. We have assessed the features of ischemic strokes occurring shortly after vaccination against SARS-CoV-2 in the Cremona area, Italy. Methods: From February 1, to July 31, 2021, all patients with ischemic stroke within four weeks of vaccination against COVID-19 admitted to our stroke unit were consecutively collected, and their main features were compared with those of all other patients with ischemic strokes admitted during the same period. Results: Sixteen strokes shortly after vaccination were collected. They represented 10.5% of all ischemic strokes. Median interval from vaccination was 12 days (range 1-24). Fifteen (93.8%) had received the BNT162b2 (Pfizer-BioNTech) vaccine and 1 (6.2%) the ChAdOx1 nCoV- 19 (AstraZeneca). Two patients (12.5%) had mild thrombocytopenia on admission (128,000 and 142,000/ml), without any evidence of bleeding or venous thrombosis. Thrombolysis and/or thrombectomy were carried out in 4 cases (25.0%). When compared with 137 strokes without recent vaccination, none of the demographic, clinical, and laboratory features of post-vaccination strokes were significantly different. Conclusions: This is the largest description of ischemic strokes shortly after COVID-19 vaccination. Strokes features were mostly similar to those of other stroke patients. Thus, the relatively high percentage of such patients probably relates to the very high fraction of elderly people vaccinated against SARS-CoV-2 in the Cremona area, rather than to a consequence of vaccination. These data may also be useful to counsel patients about future vaccinations.