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1.
JAMA Netw Open ; 4(9): e2126334, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1427027

ABSTRACT

Importance: The COVID-19 pandemic has delayed medical consultations, possibly leading to the diagnosis of gastrointestinal cancer at advanced stages. Objective: To evaluate stage at diagnosis among patients with gastrointestinal cancer in Japan before and during the COVID-19 pandemic. Design, Setting, and Participants: This retrospective cohort study included patients in a hospital-based cancer registry who were diagnosed with gastrointestinal cancer (ie, esophageal, gastric, colorectal, pancreatic, liver, and biliary tract cancers) between January 2016 and December 2020 at 2 tertiary Japanese hospitals. Exposures: The pre-COVID-19 period was defined as January 2017 to February 2020, and the COVID-19 period was defined as March 2020 to December 2020. Main Outcome and Measure: Monthly numbers of patients with newly diagnosed cancer were aggregated, classified by stage, and compared. Results: The study evaluated 5167 patients, including 4218 patients (2825 [67.0%] men; mean [SD] age, 71.3 [10.9] years) in the pre-COVID-19 period and 949 patients (607 [64.0%] men; mean [SD] age, 71.8 [10.7] years) in the COVID-19 period. Comparing the pre-COVID-19 period with the COVID-19 period, significant decreases were observed in the mean (SD) number of patients with newly diagnosed gastric cancer (30.63 [6.62] patients/month vs 22.40 [5.85] patients/month; -26.87% change; P < .001) and colorectal cancer (41.61 [6.81] patients/month vs 36.00 [6.72] patients/month; -13.47% change; P = .03). Significant decreases were also observed in the mean (SD) number of cases of stage I gastric cancer (21.55 [5.66] cases/month vs 13.90 [5.99] cases/month; -35.51% change; P < .001), stage 0 colorectal cancer (10.58 [3.36] cases/month vs 7.10 [4.10] cases/month; -32.89% change; P = .008), and stage I colorectal cancer (10.16 [3.14] cases/month vs 6.70 [2.91] cases/month; -34.04% change; P = .003). No significant increases were observed for esophageal, gastric, pancreatic, liver, or biliary tract cancers. A significant decrease was observed in the mean (SD) number of cases per month of stage II colorectal cancer (7.42 [3.06] cases/month vs 4.80 [1.75] cases/month; -35.32% change; P = .01); a significant increase was observed for the mean (SD) number of cases per month of stage III colorectal cancer (7.18 [2.85] cases/month vs 12.10 [2.42] cases/month; 68.42% change; P < .001). Conclusions and Relevance: In this cohort study of patients in a hospital-based cancer registry form Japan, significantly fewer patients were diagnosed with stage I gastric and colorectal cancers during the COVID-19 pandemic. Thus, the number of screening-detected cancers might have decreased, and colorectal cancer may have been diagnosed at more advanced stages.


Subject(s)
Biliary Tract Neoplasms/diagnosis , COVID-19 , Early Detection of Cancer , Gastrointestinal Neoplasms/diagnosis , Liver Neoplasms/diagnosis , Pancreatic Neoplasms/diagnosis , Pandemics , Aged , Aged, 80 and over , Delayed Diagnosis/trends , Female , Humans , Japan , Male , Mass Screening , Middle Aged , Neoplasm Staging , Retrospective Studies , SARS-CoV-2
2.
Oncology (Williston Park) ; 35(8): 459, 2021 08 09.
Article in English | MEDLINE | ID: covidwho-1359547

ABSTRACT

ONCOLOGY® co-editor-in-chief Howard S. Hochster, MD, reviews research on delays in oncology care as a results of the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Delayed Diagnosis/trends , Early Detection of Cancer/trends , Neoplasms/diagnosis , Time-to-Treatment/trends , Humans , Medical Oncology/standards , Outcome and Process Assessment, Health Care , Risk Factors , Time-to-Treatment/statistics & numerical data
4.
Arch Argent Pediatr ; 119(4): 224-229, 2021 08.
Article in English, Spanish | MEDLINE | ID: covidwho-1325943

ABSTRACT

INTRODUCTION: Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. METHODS: Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. RESULTS: The total number of appendicitis cases went down by 25% (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44% (n = 22) versus 37% (n = 22) (p = 0.22) in 2019. No differences were observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42% (n = 21). The incidence of complications was 6% versus 7.5% in the previous period (p = 0.75). One patient was COVID-19 positive. CONCLUSION: Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Introducción. La apendicitis constituye la principal causa de abdomen agudo quirúrgico en pediatría. Durante la pandemia por COVID-19, se replantearon las estrategias de manejo y disminuyeron las consultas en las guardias, lo que podría asociarse a diagnósticos tardíos y complicaciones. El objetivo de este estudio fue analizar el impacto de la pandemia en los niños con apendicitis aguda. Métodos. Estudio analítico retrospectivo comparativo de pacientes pediátricos con apendicitis aguda durante los cinco meses del confinamiento por COVID-19 versus los meses equivalentes del año previo. Se analizaron la incidencia, la clínica, el estadio, el abordaje quirúrgico y las complicaciones. Resultados. Los casos totales de apendicitis se redujeron un 25% (n = 67 versus n = 50 en 2020). El tiempo medio hasta la consulta fue de 24 horas en ambos períodos (p = 0,989). La incidencia de peritonitis fue del 44% (n = 22) versus el 37% (n = 22) (p = 0,22) en 2019. No se evidenció diferencia en los estadios de enfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un 42% (n = 21). La incidencia de complicaciones fue del 6%, contra 7,5% en el período previo (p = 0,75). Un paciente fue COVID-19 positivo. Conclusión. A pesar de la reducción en el número de casos de apendicitis, no se evidenció una demora en la consulta en nuestra población. El mayor impacto se asoció a la readecuación del manejo, evitando el abordaje laparoscópico para reducir la diseminación del virus.


Subject(s)
Appendectomy/trends , Appendicitis , COVID-19/prevention & control , Delayed Diagnosis/trends , Health Services Accessibility/trends , Practice Patterns, Physicians'/trends , Acute Disease , Adolescent , Appendectomy/methods , Appendicitis/diagnosis , Appendicitis/epidemiology , Appendicitis/surgery , Argentina/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Child , Child, Preschool , Female , Hospitals, General , Humans , Incidence , Infant , Infant, Newborn , Laparoscopy/trends , Male , Pandemics/prevention & control , Retrospective Studies , Tertiary Care Centers
5.
J Surg Oncol ; 124(3): 261-267, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1272214

ABSTRACT

OBJECTIVE: At the end of 1 year of the coronavirus disease (COVID-19) pandemic, we aimed to reveal the changes in breast cancer cases in the context of cause and effect based on the data of surgically treated patients in our institution. PATIENTS AND METHODS: Patients with breast cancer were divided into two groups. Group 1 consisted of patients who were operated in the year before the COVID-19 pandemic, and Group 2 consisted of patients who were operated within the first year of the pandemic. Tumor size, axillary lymph node positivity, distant organ metastasis status, neoadjuvant chemotherapy, and type of surgery performed were compared between the two groups. RESULTS: The tumor size, axillary lymph node positivity, and neoadjuvant chemotherapy were higher in Group 2 than in Group 1 (p = .005, p = .012, p = .042, respectively). In addition, the number of breast-conserving surgery + sentinel lymph node biopsy were lower, while the number of mastectomy and modified radical mastectomy were higher in Group 2 than in Group 1 (p = .034). CONCLUSION: Patients presented with larger breast tumors and increased axillary involvement during the pandemic. Moreover, distant organ metastases may increase in the future.


Subject(s)
Breast Neoplasms/diagnosis , COVID-19 , Delayed Diagnosis/trends , Health Services Accessibility/trends , Patient Acceptance of Health Care/statistics & numerical data , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Female , Humans , Lymph Node Excision/trends , Lymphatic Metastasis , Mastectomy/methods , Mastectomy/trends , Middle Aged , Neoadjuvant Therapy , Retrospective Studies , Tumor Burden , Turkey
6.
Dermatol Clin ; 39(4): 627-637, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1252656

ABSTRACT

The COVID-19 pandemic has presented a unique set of challenges to cancer care centers around the world. Diagnostic and treatment delays associated with lockdown periods may be expected to increase the total number of avoidable skin cancer deaths. During this unprecedented time, dermatologists have been pressed to balance early surgical interventions for skin cancer with the risk of viral transmission. This article summarizes evidenced-based recommendations for the surgical management of cutaneous melanoma, keratinocyte cancer, and Merkel cell carcinoma during the COVID-19 pandemic. Additional long-term studies are required to determine the effect of COVID-19 on skin cancer outcomes.


Subject(s)
Clinical Decision-Making/methods , Delayed Diagnosis/trends , Skin Neoplasms/epidemiology , Skin Neoplasms/therapy , Time-to-Treatment/trends , Health Services Accessibility/trends , Humans , Patient Acceptance of Health Care/statistics & numerical data , Time Factors
7.
Am J Emerg Med ; 48: 1-11, 2021 10.
Article in English | MEDLINE | ID: covidwho-1163280

ABSTRACT

PURPOSE: Patients evaluated in the emergency department (ED) who have concerning symptoms suggestive of a cancer diagnosis are mostly referred to the quick diagnosis unit of our tertiary hospital. This study analyzed the impact of the Covid-19 pandemic on the volume, disease patterns, and accessibility to essential investigations of patients with suspected cancer referred by the ED to this unit. METHODS: Trends in referrals were analyzed from January 1 to July 8, 2020 and the corresponding dates of 2019. Only non-Covid-19 conditions were evaluated. Three time-based cohorts were defined: prepandemic (January 1-February 19), pandemic (February 19-April 22), and postpandemic (April 22-July 8). Along with descriptive statistics, linear regression was used to test for time trends with weekly referrals as the dependent variable. RESULTS: There were 384, 193, and 450 patients referred during the prepandemic, pandemic, and postpandemic periods, respectively. Following an increasing rate, referrals decreased to unprecedented levels in the pandemic period (average weekly slope: -2.1 cases), then increasing again until near normalization. Waiting times to most diagnostic procedures including radiology, endoscopic, nuclear medicine, and biopsy/cytology during the pandemic period were significantly delayed and time-to-diagnosis was considerably longer (19.72 ± 10.37 days vs. 8.33 ± 3.94 days in prepandemic and 13.49 ± 6.45 days in postpandemic period; P < 0.001 in both). Compared to other cohorts, pandemic cohort patients were more likely to have unintentional weight loss and fever of unknown origin as referral indications while anemia and lymphadenopathy were less common. Patients from the pandemic cohort had a significantly lower rate of malignancies and higher of benign gastrointestinal disorders (40.93% vs. 19.53% and 20.89% in prepandemic and postpandemic periods, respectively; P < 0.001 in both), most notably irritable bowel disease, and of mental and behavioral disorders (15.54% vs. 3.39% and 6.00% in prepandemic and postpandemic periods, respectively; P < 0.001 in both). CONCLUSIONS: As our hospital switched its traditional care to one focused on Covid-19 patients, recognized indicators of healthcare quality of quick diagnosis units were severely disrupted. The clinical patterns of presentation and diagnosis of the pandemic period suggested that mass media-generated mental and behavioral responses with distressing symptoms played a significant role in most of these patients.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/trends , Health Services Accessibility/trends , Neoplasms/diagnosis , Quick Diagnosis Units/trends , Referral and Consultation/trends , Adolescent , Adult , Aged , Aged, 80 and over , Delayed Diagnosis/trends , Diagnosis, Differential , Emergency Service, Hospital/organization & administration , Female , Follow-Up Studies , Humans , Linear Models , Male , Middle Aged , Observer Variation , Reproducibility of Results , Retrospective Studies , Spain , Tertiary Care Centers , Young Adult
8.
Ann R Coll Surg Engl ; 103(4): 250-254, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1122496

ABSTRACT

INTRODUCTION: The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. METHODS: A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. RESULTS: A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score (p = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, p = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% (p < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% (p < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% (p < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (p < 0.001). CONCLUSIONS: The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.


Subject(s)
Appendectomy/trends , Appendicitis/diagnosis , Appendicitis/surgery , COVID-19/prevention & control , Health Services Accessibility/trends , Patient Acceptance of Health Care/statistics & numerical data , Practice Patterns, Physicians'/trends , Acute Disease , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Appendectomy/methods , Appendicitis/drug therapy , Appendicitis/epidemiology , Conservative Treatment/methods , Conservative Treatment/trends , Delayed Diagnosis/trends , Female , Humans , Incidence , Male , Middle Aged , Pandemics , Prospective Studies , Severity of Illness Index , United Kingdom/epidemiology
9.
Intern Emerg Med ; 16(8): 2261-2268, 2021 11.
Article in English | MEDLINE | ID: covidwho-1111348

ABSTRACT

The emergence of Covid-19 has caused a pandemic and is a major public health concern. Covid-19 has fundamentally challenged the global health care system in all aspects. However, there is a growing concern for the subsequent detrimental effects of continuing delays or adjustments on time-dependent treatments for Covid-19 negative patients. Patients arriving to the ED with STEMIs and acute CVA are currently presumed to have delays due to Covid-19 related concerns. The objective of this paper is to evaluate the implications of the Covid-19 pandemic on non-Covid19 patients in emergency care settings. We conducted a retrospective study from February 2020 to April 2020 and compared this to a parallel period in 2019 to assess the impact of the Covid-19 pandemic on three distinct non-Covid-19 ED diagnosis that require immediate intervention. Our primary outcome measures were time to primary PCI in acute STEMI, time to fibrinolysis in acute CVA, and time to femoral hip fracture correction surgery. Our secondary outcome measure included a composite outcome of length of stay in hospital and mortality. From 1 February 2020 to 30 April 2020, the total referrals to ED diagnosed with STEMI, Hip fracture and CVA of which required intervention were 197 within Covid-19 group 2020 compared to 250 in the control group 2019. Mean duration to intervention (PCI, surgery and tPA, respectively) did not differ between COVID-19 group and 2019 group. Among femoral hip fracture patients', the referral numbers to ED were significantly lower in Covid-19 era (p = 0.040) and the hospitalization stay was significantly shorter (p = 0.003). Among CVA patients', we found statistical differences among the number of referrals and the patients' age. Coping with the Covid-19 pandemic presents a challenge for the general healthcare system. Our results suggest that with proper management, despite the obstacles of isolation policies and social distancing, any negative impact on the quality of health care for the non-Covid-19 patients can be minimized in the emergency department setting.


Subject(s)
COVID-19/epidemiology , Emergency Medical Services/trends , Emergency Service, Hospital/trends , Health Services Accessibility/trends , Time-to-Treatment/trends , Delayed Diagnosis/trends , Humans , Retrospective Studies
10.
Am J Clin Pathol ; 155(1): 64-68, 2021 Jan 04.
Article in English | MEDLINE | ID: covidwho-1066246

ABSTRACT

OBJECTIVES: We performed data collection concerning the coronavirus disease 2019 (COVID-19) pandemic-related delay in the diagnosis of cancers to individuate proper corrective procedures. METHODS: A comparison was made among the number of first pathologic diagnoses of malignancy made from weeks 11 to 20 of 2018, 2019, and 2020 at seven anatomic pathology units serving secondary care hospitals in northern-central Italy. RESULTS: Cancer diagnoses fell in 2020 by 44.9% compared with the average number recorded in 2018 and 2019. Melanoma and nonmelanoma skin cancer represented 56.7% of all missing diagnoses. The diagnostic decrease in colorectal (-46.6%), prostate (-45%), and bladder (-43.6%) cancer was the most relevant among internal malignancies; for prostate, however, high-grade tumors were only moderately affected (-21.7%). CONCLUSIONS: Diagnosis of cutaneous malignancies was mostly affected by the lockdown; among internal malignancies, corrective actions were mostly needed for colorectal cancer and invasive bladder cancer.


Subject(s)
COVID-19/prevention & control , Delayed Diagnosis/trends , Early Detection of Cancer/trends , Neoplasms/diagnosis , Physical Distancing , COVID-19/epidemiology , Humans , Italy/epidemiology , Pandemics
13.
J Stroke Cerebrovasc Dis ; 30(6): 105569, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1002839

ABSTRACT

BACKGROUND AND PURPOSE: Delayed evaluation of stroke may contribute to COVID-19 pandemic-related morbidity and mortality. This study evaluated patient characteristics, process measures and outcomes associated with the decline in stroke presentation during the early pandemic. METHODS: Volumes of stroke presentations, intravenous thrombolytic administrations, and mechanical thrombectomies from 52 hospitals from January 1-June 30, 2020 were analyzed with piecewise linear regression and linear spline models. Univariate analysis compared pandemic (case) and pre-pandemic (control) groups defined in relation to the nadir of daily strokes during the study period. Significantly different patient characteristics were further evaluated with logistic regression, and significantly different process measures and outcomes were re-analyzed after propensity score matching. RESULTS: Analysis of 7,389 patients found daily stroke volumes decreased 0.91/day from March 12-26 (p < 0.0001), reaching a nadir 35.0% less than expected, and increased 0.15 strokes/day from March 27-June 23, 2020 (p < 0.0001). Intravenous thrombolytic administrations decreased 3.3/week from February 19-March 31 (p = 0.0023), reaching a nadir 33.4% less than expected, and increased 1.4 administrations/week from April 1-June 23 (p < 0.0001). Mechanical thrombectomy volumes decreased by 1.5/week from February 19-March 31, 2020 (p = 0.0039), reaching a nadir 11.3% less than expected. The pandemic group was more likely to ambulate independently at baseline (p = 0.02, OR = 1.60, 95% CI = 1.08-2.42), and less likely to present with mild stroke symptoms (NIH Stroke Scale ≤ 5; p = 0.04, OR = 1.01, 95% CI = 1.00-1.02). Process measures and outcomes of each group did not differ, including door-to-needle time, door-to-puncture time, and successful mechanical thrombectomy rate. CONCLUSION: Stroke presentations and acute interventions decreased during the early COVID-19 pandemic, at least in part due to patients with lower baseline functional status and milder symptoms not seeking medical care. Public health messaging and initiatives should target these populations.


Subject(s)
COVID-19 , Delayed Diagnosis/trends , Outcome and Process Assessment, Health Care/trends , Patient Acceptance of Health Care , Stroke/therapy , Thrombectomy/trends , Thrombolytic Therapy/trends , Time-to-Treatment/trends , Aged , Aged, 80 and over , Female , Functional Status , Humans , Male , Middle Aged , Quality Indicators, Health Care/trends , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Stroke/diagnosis , Stroke/physiopathology , Time Factors , Treatment Outcome
16.
J Clin Pathol ; 74(3): 187-189, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-607931

ABSTRACT

AIMS: We performed an audit to evaluate the impact of the COVID-19 pandemic-related delay in the diagnosis of major cancers at a Pathology Unit of a Secondary Care Hospital Network in Italy. METHODS: A comparison was made among the number of first cellular pathological diagnoses of malignancy made from the 11th to the 20th week of the years 2018-2020. RESULTS: Cancer diagnoses fell in 2020 by 39% compared with the average number recorded in 2018 and 2019. Prostate cancer (75%) bladder cancer (66%) and colorectal cancer (CRC; 62%) had the greatest decrease. CRC was identified as carrying a potentially important diagnostic delay. CONCLUSIONS: For CRC corrective procedures (continuing mass screening tests; patient triage by family physicians; diagnostic procedures alternative to colonoscopy; predictive evaluation on biopsy samples) were advised. Our simple audit model is widely applicable to avoid pandemic-related delay in clinical diagnosis of cancer.


Subject(s)
COVID-19/prevention & control , Delayed Diagnosis/trends , Early Detection of Cancer/trends , Neoplasms/diagnosis , Pathology, Clinical/trends , Physical Distancing , COVID-19/epidemiology , Humans , Italy/epidemiology , Medical Audit , Neoplasms/epidemiology , Pandemics
18.
J Neurointerv Surg ; 12(7): 639-642, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-432969

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disrupted established care paths worldwide. Patient awareness of the pandemic and executive limitations imposed on public life have changed the perception of when to seek care for acute conditions in some cases. We sought to study whether there is a delay in presentation for acute ischemic stroke patients in the first month of the pandemic in the US. METHODS: The interval between last-known-well (LKW) time and presentation of 710 consecutive patients presenting with acute ischemic strokes to 12 stroke centers across the US were extracted from a prospectively maintained quality database. We analyzed the timing and severity of the presentation in the baseline period from February to March 2019 and compared results with the timeframe of February and March 2020. RESULTS: There were 320 patients in the 2-month baseline period in 2019, there was a marked decrease in patients from February to March of 2020 (227 patients in February, and 163 patients in March). There was no difference in the severity of the presentation between groups and no difference in age between the baseline and the COVID period. The mean interval from LKW to the presentation was significantly longer in the COVID period (603±1035 min) compared with the baseline period (442±435 min, P<0.02). CONCLUSION: We present data supporting an association between public awareness and limitations imposed on public life during the COVID-19 pandemic in the US and a delay in presentation for acute ischemic stroke patients to a stroke center.


Subject(s)
Betacoronavirus , Brain Ischemia/epidemiology , Coronavirus Infections/epidemiology , Delayed Diagnosis/trends , Pneumonia, Viral/epidemiology , Stroke/epidemiology , Acute Disease , Aged , Aged, 80 and over , Brain Ischemia/diagnosis , COVID-19 , Coronavirus Infections/diagnosis , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Practice Guidelines as Topic/standards , Retrospective Studies , SARS-CoV-2 , Stroke/diagnosis
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