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1.
Work ; 68(1): 77-80, 2021.
Article in English | MEDLINE | ID: covidwho-2198518

ABSTRACT

BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, rehabilitation facilities have become less accessible for patients with a stroke. Lack of early, intensive rehabilitation misses the opportunity for recovery during the critical time window of endogenous plasticity and improvement post-stroke. OBJECTIVES: The purpose of this commentary was to highlighting the benefits of telework and telerehabilitation programs for workers with a stroke during the COVID-19 pandemic. METHODS: Relevant publications regarding the management of individuals with a stroke, telerehabilitation and teleworking in the setting of COVID-19 were reviewed. RESULTS: Previous studies showed that telerehabilitation can effectively provide an alternate method of promoting recovery for patients with a stroke. With the physical distancing precautions in place for mitigating viral spread, teleworking can also provide a method for long term recovery and improvements in quality of life after a stroke. CONCLUSIONS: Overall, this commentary addresses the benefits of physically distant, safe and effective alternatives to support individuals who live with a stroke during COVID-19 pandemic.


Subject(s)
Disabled Persons/rehabilitation , Stroke/complications , Telerehabilitation/methods , Teleworking , Work/statistics & numerical data , Adult , COVID-19/prevention & control , Disabled Persons/statistics & numerical data , Female , Humans , Male , Middle Aged , Pandemics/prevention & control , Pandemics/statistics & numerical data , Telerehabilitation/trends , Work/trends
2.
PLoS One ; 17(8): e0266118, 2022.
Article in English | MEDLINE | ID: covidwho-2196883

ABSTRACT

BACKGROUND: Immunization stress-related responses presenting as stroke-like symptoms could develop following COVID-19 vaccination. Therefore, this study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination in Thailand. METHODS: We conducted a retrospective study of the secondary data of reported adverse events after COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Two majority types of vaccines were used at the beginning of the vaccination campaign, including CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca). Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score. The affected side was evaluated for associations with the injection site. RESULTS: Overall, 221 patients were diagnosed with immunization stress-related responses (stroke-like symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28-42) years in patients receiving CoronaVac and 46 (33.5-60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16-960) min and 30 (8.8-750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (68.9%) developed symptoms on the left side of the body; 99.5% of the patients receiving CoronaVac and 100% of those receiving ChAdOx1 had a good outcome (modified Rankin scores ≤2, indicating slight or no disability). CONCLUSIONS: Immunization stress-related responses presenting as stroke-like symptoms can develop after COVID-19 vaccination. Symptoms more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.


Subject(s)
COVID-19 Vaccines , COVID-19 , Stroke , Adult , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , ChAdOx1 nCoV-19 , Female , Humans , Male , Middle Aged , Retrospective Studies , Stroke/chemically induced , Thailand , Vaccination/adverse effects
4.
arxiv; 2023.
Preprint in English | PREPRINT-ARXIV | ID: ppzbmed-2301.09322v1

ABSTRACT

Cerebral Microbleeds (CMBs), typically captured as hypointensities from susceptibility-weighted imaging (SWI), are particularly important for the study of dementia, cerebrovascular disease, and normal aging. Recent studies on COVID-19 have shown an increase in CMBs of coronavirus cases. Automatic detection of CMBs is challenging due to the small size and amount of CMBs making the classes highly imbalanced, lack of publicly available annotated data, and similarity with CMB mimics such as calcifications, irons, and veins. Hence, the existing deep learning methods are mostly trained on very limited research data and fail to generalize to unseen data with high variability and cannot be used in clinical setups. To this end, we propose an efficient 3D deep learning framework that is actively trained on multi-domain data. Two public datasets assigned for normal aging, stroke, and Alzheimer's disease analysis as well as an in-house dataset for COVID-19 assessment are used to train and evaluate the models. The obtained results show that the proposed method is robust to low-resolution images and achieves 78% recall and 80% precision on the entire test set with an average false positive of 1.6 per scan.


Subject(s)
Alzheimer Disease , Cerebrovascular Disorders , COVID-19 , Stroke , Dementia
5.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.16.23284620

ABSTRACT

Background There is growing body of literature on the long-term cardiac symptoms following COVID-19. We conducted a systematic review and meta analysis to synthesize and evaluate related evidence to inform clinical management and future studies. Methods We searched two preprint and seven peer reviewed article databases from January 1, 2020 to January 8, 2022 for studies investigating cardiac symptoms that persisted for at least 4 weeks among individuals who survived COVID-19. A customized Newcastle Ottawa scale was used to evaluate the quality of included studies. Random effects meta analyses were performed to estimate the proportion of symptoms with 95% confidence intervals (CI), and stratified analyses were conducted to quantify the proportion of symptoms by study characteristics and quality. Results A total of 101 studies describing 49 unique long-term cardiac symptoms met the inclusion criteria. Based on quality assessment, only 15.8% of the studies (n=16) were of high quality, and most studies scored poorly on sampling representativeness. The two most examined symptoms were chest pain and arrhythmia. Meta-analysis showed that the proportion of chest pain was 10.1% (95% CI: 6.4, 15.5) and arrhythmia was 9.8% (95% CI: 5.4, 17.2). Stratified analyses showed that studies with low-quality score, small sample size, unsystematic sampling method, and cross-sectional design were most likely to report high proportions of symptoms. For example, the proportion of chest pain was 21.3% (95% CI: 10.5, 38.5), 9.3% (95% CI: 6.0, 14.0), and 4.0% (95% CI: 1.3, 12.0) in studies with low, medium, and high-quality scores, respectively. Similar patterns were observed for other cardiac symptoms including hypertension, cardiac abnormalities, myocardial injury, thromboembolism, stroke, heart failure, coronary disease, and myocarditis. Discussion There is a wide spectrum of long-term cardiac symptoms following COVID-19. Findings of existing studies are strongly related to study quality, size and design, underscoring the need for high-quality epidemiologic studies to characterize these symptoms and understand their etiology.


Subject(s)
Chest Pain , Heart Failure , Heart Diseases , COVID-19 , Myocarditis , Hypertension , Thromboembolism , Cardiomyopathies , Coronary Disease , Stroke , Arrhythmias, Cardiac
6.
Clin Appl Thromb Hemost ; 28: 10760296221131801, 2022.
Article in English | MEDLINE | ID: covidwho-2162205

ABSTRACT

Acute ischemic stroke (AIS), characterized by high morbidity and mortality, has imposed a considerable burden on society. Despite rapid development in the treatment of AIS, there is still a high risk of recurrence. Furthermore, there is a time delay in waiting for the results of conventional coagulation tests in candidate patients for intravenous thrombolysis therapy. Heterogeneous responses to antiplatelet, intravascular thrombolysis, and endovascular therapies also worsen the situation. Thromboelastography (TEG), as a global and portable detection method for hemostasis, facilitates clinicians in disease monitoring, treatment evaluation, and prognosis prediction in AIS. In this narrative review, we provided a comprehensive summary of the clinical application of TEG in ischemic stroke and gave insights to further studies.


Subject(s)
Brain Ischemia , Ischemic Stroke , Stroke , Humans , Thrombelastography , Blood Coagulation Tests , Thrombolytic Therapy/methods , Treatment Outcome
7.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2404427.v1

ABSTRACT

Background: As part of the Covid-19-restrictions in Switzerland, a federal ban on non-urgent examinations and treatments was applied to all hospitals during six weeks in spring 2020 (“spring lockdown”). The aim of this study was to comprehensively investigate the consequences of the Covid-19 pandemic on Swiss inpatient admissions based on data of all hospitals, focusing on selected procedures of different medical urgency.  Methods: The study includes all acute care inpatient cases (including Covid-19 cases, excluding cases in psychiatry and rehabilitation) according to the Swiss Medical Statistics of Hospitals. Besides the total number of admissions, subdivided by regions, hospital types and age groups, we focused on selected procedures representing different medical urgency: elective surgeries, cancer surgeries, and emergencies. Procedures were selected based on expert interviews. We compared the number of admissions during spring lockdown and for the whole years 2020 and 2021 in absolute numbers and in percentage changes to the corresponding periods in 2019 (baseline year).  Results: During spring lockdown, the number of admissions decreased by 47,156 (32.2%) without catch-up effect by the end of 2020 (-72,817 admissions/-5.8%). With procedure-specific decreases of up to 86%, the decline in admissions was largest for elective surgery, a decline that was only fully reversed in the case of a few procedures, such as joint arthroplasty. Strikingly, admissions due to emergencies also substantially decreased during spring lockdown (stroke -14%; acute myocardial infarction STEMI: -9%, NSTEMI: -26%). Results for the selected procedures in cancer surgery showed no consistent pattern. In 2021, admission numbers for most procedures reached or even exceeded those in 2019.  Conclusions: The substantial reduction in admissions, particularly in elective procedures, may reflect the impact of the triage in favor of anticipated Covid-19-cases during spring lockdown. By the end of 2020, admissions were still at lower levels relative to the previous, pre-pandemic year. The numbers in 2021 reached the same levels as those in 2019, which suggests that the Covid-19 pandemic only temporarily impacted inpatient health care in Switzerland. Long-term consequences of the observed reduction in admissions for emergencies and cancer surgery need to be investigated at the individual level.


Subject(s)
Joint Diseases , COVID-19 , Emergencies , Myocardial Infarction , Neoplasms , Stroke
8.
Oxid Med Cell Longev ; 2022: 7692215, 2022.
Article in English | MEDLINE | ID: covidwho-2138248

ABSTRACT

Stroke is the most common cause of epilepsy and ultimately leads to a decrease in the quality of life of those affected. Ischemic and hemorrhagic strokes can both lead to poststroke epilepsy (PSE). Significant risk factors for PSE include age < 65age less than 65 years, stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), cortical involvement, and genetic factors such as TRPM6 polymorphism. The diagnosis of PSE is made by using imaging modalities, blood biomarkers, and prognostic criteria. Electroencephalography (EEG) is currently the gold standard to diagnose PSE, while new combinations of modalities are being tested to increase diagnostic specificity. This literature review uncovers a newly found mechanism for the pathology of poststroke epilepsy. The pathogenesis of early-onset and late-onset is characterized by sequelae of neuronal cellular hypoxia and disruption of the blood-brain barrier, respectively. Interleukin-6 is responsible for increasing the activity of glial cells, causing gliosis and hyperexcitability of neurons. Epinephrine, high-mobility group protein B1, downregulation of CD32, and upregulation of HLA-DR impact the pathology of poststroke epilepsy by inhibiting the normal neuronal immune response. Decreased levels of neuropeptide Y, a neurotransmitter, act through multiple unique mechanisms, such as inhibiting intracellular Ca2+ accumulation and acting as an anti-inflammatory, also implemented in the worsening progression of poststroke epilepsy. Additionally, CA1 hippocampal resonant neurons that increase theta oscillation are associated with poststroke epilepsy. Hypertensive small vessel disease may also have an implication in the temporal lobe epilepsy by causing occult microinfarctions. Furthermore, this review highlights the potential use of statins as primary prophylaxis against PSE, with multiple studies demonstrating a reduction in incidence using statins alone, statins in combination with antiepileptic drugs (AEDs), and statins with aspirin. The evidence strongly suggests that the second generation AEDs are a superior treatment method for PSE. Data from numerous studies demonstrate their relative lack of significant drug interactions, increased tolerability, and potential superiority in maintaining seizure-free status.


Subject(s)
Epilepsy , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Stroke , Humans , Aged , Incidence , Quality of Life , Epilepsy/drug therapy , Seizures/drug therapy , Anticonvulsants/therapeutic use , Stroke/complications , Stroke/drug therapy , Stroke/epidemiology , Risk Factors
9.
Acta Clin Croat ; 60(Suppl 3): 50-56, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-2145889

ABSTRACT

The most common neurological symptoms in patients with SARS-CoV-2 infection are headache, myalgia, encephalopathy, dizziness, dysgeusia and anosmia, making more than 90 percent of neurological manifestations of COVID-19. Other neurological manifestations such as stroke, movement disorder symptoms or epileptic seizures are rare but rather devastating, with possible lethal outcome. The primary aim of this study was to estimate the prevalence of acute symptomatic seizures among COVID-19 patients, while secondary aim was to determine their possible etiology. Out of 5382 patients with COVID-19 admitted to Dubrava University Hospital from November 1, 2020 until June 1, 2021, 38 (seizure rate 0.7%) of them had acute symptomatic seizures. Of these 38 patients, 29 (76.3%) had new-onset epileptic seizures and nine (23.7%) patients with previous epilepsy history had breakthrough seizures during COVID-19. Although acute symptomatic seizures are an infrequent complication of COVID-19, seizure risk must be considered in these patients, particularly in the group of patients with a severe course of the disease. Accumulation of proinflammatory cytokines may contribute to the occurrence of seizures in patients with COVID-19, but seizures may also be secondary to primary brain pathology related to COVID-19, such as stroke or encephalitis.


Subject(s)
COVID-19 , Epilepsy , Stroke , Humans , Incidence , COVID-19/complications , COVID-19/epidemiology , SARS-CoV-2 , Seizures/epidemiology , Seizures/etiology , Seizures/diagnosis , Epilepsy/epidemiology , Epilepsy/etiology , Stroke/complications , Stroke/epidemiology
10.
Zh Nevrol Psikhiatr Im S S Korsakova ; 122(11. Vyp. 2): 34-37, 2022.
Article in Russian | MEDLINE | ID: covidwho-2145658

ABSTRACT

OBJECTIVE: To analyze clinical and laboratory characteristics of patients with ischemic stroke associated with COVID-19. MATERIAL AND METHODS: A retrospective analysis of all cases of COVID-19, including those complicated with ischemic stroke, admitted to the multispecialty infectious hospital in Ufa (Russia) in 2020, was performed. Multivariate analysis was used to identify the independent predictors of the development of ischemic stroke in patients with COVID-19. RESULTS: Eleven thousand forty hundred and thirty-two patients were admitted to the multidisciplinary infectious hospital during 2020, 1226 of them also suffered from ischemic stroke. Independent predictors of ischemic stroke in COVID-19 included age and laboratory parameters: increase in number of leucocytes, erythrocytes and platelets, increase of the level of creatinine, glucose, total bilirubin and decrease of the level of total protein, and activated partial thromboplastin time. CONCLUSION: Elderly people, patients with prominent systemic inflammatory response, which presented with leukocytosis, hypercoagulation, multiorgan failure of different severity and hypoproteinemia, were at higher risk of the development of ischemic stroke in COVID-19.


Subject(s)
COVID-19 , Ischemic Stroke , Stroke , Humans , Aged , Ischemic Stroke/diagnosis , Ischemic Stroke/epidemiology , Ischemic Stroke/etiology , Stroke/diagnosis , Stroke/epidemiology , Stroke/etiology , Retrospective Studies , COVID-19/complications , Hospitalization
11.
Front Public Health ; 10: 738634, 2022.
Article in English | MEDLINE | ID: covidwho-2142305

ABSTRACT

The coronavirus disease-19 (COVID-19) pandemic may result in detrimental consequences for stroke patient's wellbeing. Family functioning and optimism could help stroke patients cope with crises leading to possible improvements in life satisfaction. This study aims to explore the protective effects of family functioning and optimism on life satisfaction among stroke patients during the COVID-19 pandemic in China. This study was designed as a cross-sectional survey. A total of 207 stroke inpatients who were receiving pharmacotherapy and rehabilitation in general public hospital of Liaoning province during the COVID-19 pandemic in China were consecutive selected and interviewed by online questionnaires via the WeChat platform effectively from April 8 to 30, 2020. The scales included: Satisfaction with Life Scale (SWLS), Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Scale and Revised Life Orientation Test (LOT-R). Hierarchical multiple regression (HMR) analysis was conducted to test the associated factors of life satisfaction. Stroke patient's life satisfaction was at a high level (Mean = 26.46, SD = 6.23) during the pandemic. Stroke patient's residence, duration of stroke, stroke type, and community shut down measures were the strong predictors of life satisfaction. Family functioning and optimism increased life satisfaction among stroke patients. This study contributes to the research on the association between family functioning and optimism on life satisfaction among stroke patients during the COVID-19 pandemic. Interventions that improve family functioning and enhance optimism should be provided in order to elevate life satisfaction for stroke patients.


Subject(s)
COVID-19 , Stroke , COVID-19/epidemiology , China/epidemiology , Cross-Sectional Studies , Humans , Pandemics , Patient Satisfaction , Personal Satisfaction , Protective Factors , Stroke/epidemiology
13.
Eur J Vasc Endovasc Surg ; 64(2-3): 150-152, 2022.
Article in English | MEDLINE | ID: covidwho-2130715
14.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2385606.v1

ABSTRACT

Ischemic stroke is a recognized neurological consequence of acute COVID-19 infection. A 61-year-old black African farmer with right-sided weakness was sent to the emergency hospital on September 19, 2022, within three hours of the onset of the impairment. He suffered a serious accident while working in the rural region fifteen years prior. Generalized body weakness, including weakness in the right upper and lower extremities while he was moving around, left facial paralysis, an inability to walk without assistance, difficulty swallowing, difficulty speaking, a two-day fever, a headache, and shortness of breath were all reasons why the patient was brought into the emergency room. An X-ray of the chest was taken, and it revealed scattered reticulations, coarse, somewhat bilateral crepitation, and diffuse bilateral infiltrates. The patient's cardiovascular checkup revealed nothing unusual. According to the Glasgow Coma Scale, the eye opening reaction was 1/4, the motor response was 3/6 (abnormal flexion), and the verbal response was 3/5 (inappropriate words). He started having trouble breathing and needed five intranasal doses of oxygen per minute to stay saturated. He began taking 81 mg of low-dose aspirin every day for a month. For ten days, he took 75 mg of clopidogrel orally once every day.


Subject(s)
COVID-19 , Coma , Facial Paralysis , Headache , Dyspnea , Fever , Stroke , Muscle Weakness
15.
Neurol India ; 70(5): 1901-1904, 2022.
Article in English | MEDLINE | ID: covidwho-2116688

ABSTRACT

Background: Coronavirus is a novel virus which has disrupted life in the past year. While it involves the lungs in the majority and this has been extensively studied, it involves other organ systems. More number of studies need to be focused on the extrapulmonary manifestations of the disease. Objective: To delineate the clinical manifestations of coronavirus disease 2019 (COVID-19) virus on the central and peripheral nervous systems and to assess the risk factors and the outcome of COVID-19 patients with neurological manifestations. Materials and Methods: All patients who were SARS-CoV-2 RNA polymerase chain reaction (PCR) positive were assessed, and detailed clinical history and laboratory findings were collected. Data was analyzed using percentage, mean, and frequency. Results: Out of 864 patients, 17 (N = 17, 1.96%) had neurological manifestations. Twelve out of 17 had comorbid conditions. Patients had diverse presentations ranging from acute cerebrovascular accident to paraplegia and encephalopathy. Ten (58.8%) patients presented with acute cerebrovascular accidents. Of the patients who developed stroke, five (50%) died. Conclusions: COVID-19 usually presents as a respiratory disease. The neurological manifestations of COVID-19 are not uncommon. One should be aware of a wide spectrum of neurological signs and symptoms of COVID-19 for early diagnosis and treatment for preventing mortality and morbidity.


Subject(s)
COVID-19 , Nervous System Diseases , Stroke , Humans , COVID-19/complications , SARS-CoV-2 , RNA, Viral , Tertiary Care Centers , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology
17.
Neurol India ; 70(5): 1942-1946, 2022.
Article in English | MEDLINE | ID: covidwho-2117614

ABSTRACT

Introduction: The unprecedented challenges during the COVID pandemic and the subsequent lockdown had resulted in a delay in treatment metrics for acute stroke. There is a rising concern that COVID-19 co-infection can adversely affect stroke outcome. We aim to investigate the impact of COVID-19 in the management of stroke patients. We also compared the differences in stroke manifestations, etiological pattern, treatment course, and outcome of acute stroke patients in COVID-19 confirmed cases. Methodology: A single-center retrospective study was done at the Stroke Unit, Government Medical College, Thiruvananthapuram. Consecutive patients of acute stroke confirmed by imaging, presenting within 24 hours of the onset of symptoms in May to July 2020 and May to July 2019, were included. The primary data variables included baseline demographics, risk factors, admission NIHSS, stroke timings, thrombolysis rate, TOAST etiology, mRS at discharge, and in-hospital mortality. Results: Strokes with higher NIHSS, arrival blood sugar and blood pressure, and delays in door-to-CT and door-to-needle time were more during the pandemic. Intravenous thrombolysis was less and mortality was higher in COVID-19 strokes during the pandemic. COVID-19-positive stroke patients had more hemorrhagic strokes, more severe strokes with low CT ASPECTS, more hemorrhagic transformation, high in-hospital mortality, and poor functional outcome at discharge and 3 months. Conclusion: Our study was a hypothesis-generating study with a limited number of patients. This study has reconfirmed the higher severity of the stroke, with a higher mRS score and mortality during the pandemic, especially among COVID-19-positive stroke patients.


Subject(s)
COVID-19 , Stroke , Humans , Tertiary Care Centers , Retrospective Studies , Time-to-Treatment , Treatment Outcome , Communicable Disease Control , Stroke/epidemiology , Stroke/etiology , Stroke/therapy , Thrombolytic Therapy/adverse effects
18.
BMJ Open ; 12(11): e055108, 2022 11 08.
Article in English | MEDLINE | ID: covidwho-2118048

ABSTRACT

INTRODUCTION: Stroke is the most common cause of neurological disability in adults worldwide. Neural stem cell (NSC) transplantation has shown promising results as a treatment for stroke in animal experiments. The pilot investigation of stem cells in stroke phase 1 and phase 2 trials showed that transplantation of the highest dose (20 million cells) was well tolerated. Preliminary clinical benefits have also been observed. However, the trials were open-label and had a small sample size. Furthermore, human NSCs (hNSCs) were intracerebrally implanted, and some serious adverse events were considered to be related to the surgical procedure. Therefore, we plan to conduct a double-blinded, randomised controlled trial to test the safety and efficacy of intranasal injection of hNSCs. METHODS AND ANALYSIS: This single-centre, randomised, double-blinded, parallel-controlled trial will be conducted in China. Sixty patients with ischaemic stroke who met the qualification criteria will be randomly divided into two groups: the NSCs and control groups. All participants will receive intranasal administration of hNSCs or placebo for 4 consecutive weeks. Patients will be followed up at baseline and at 4, 12, 24 and 48 weeks after intervention. The primary outcome is the National Institutes of Health Stroke Scale score (4, 12, 24 weeks after intervention). Secondary outcomes include the modified Rankin scale, Barthel index, Mini-Mental State Examination score (4, 12, 24 weeks after intervention) and cranial MRI changes (24 and 48 weeks after intervention). All adverse events will be recorded during the study period. ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of Ren Ji Hospital (2018-009). All subjects will provide informed consent. The results will be accessible in peer-reviewed publications and will be presented at academic conferences. TRIAL REGISTRATION: ChiCTR1900022741; Chinese Clinical Trial Registry.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Neural Stem Cells , Stroke , Adult , Humans , SARS-CoV-2 , Brain Ischemia/surgery , Stroke/surgery , Treatment Outcome , Randomized Controlled Trials as Topic
19.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.12.06.22283145

ABSTRACT

Introduction: Serious harms of the COVID-19 vaccines have been underreported in published trial reports. Methods: Systematic review of papers with data on serious adverse events (SAEs) associated with a COVID-19 vaccine. Results: We included 18 systematic reviews, 14 randomised trials, and 34 other studies with a control group. Most studies were of poor quality. The most reliable one was a systematic review of regulatory data on the two pivotal randomised trials of the mRNA vaccines. It found significantly more SAEs of special interest with the vaccines than with placebo, and the excess risk was considerably larger than the benefit, measured as the risk of hospitalisation. The adenovirus vector vaccines increased the risk of venous thrombosis and thrombocytopenia, and the mRNA-based vaccines increased the risk of myocarditis, with a mortality of about 1-2 per 200 cases. We also found evidence of serious neurological harms, including Bel's palsy, Guillain-Barre syndrome, myasthenic disorder and stroke, which are likely due to an autoimmune reaction, as has been suggested also for the HPV vaccines. Severe harms, i.e. those that prevent daily activities, were hugely underreported in the randomised trials. These harms were very common in studies of booster doses after a full vaccination and in a study of vaccination of previously infected people. Discussion: Serious and severe harms of the COVID-19 vaccines have been ignored or downplayed, and sometimes been deliberately excluded by the study sponsors in high impact medical journals. This area needs further study. Authorities have recommended virtually everyone get vaccinated and receive booster doses. They fail to consider that the balance between benefits and harms becomes negative in low-risk groups such as children and people who have already acquired natural immunity.


Subject(s)
Drug-Related Side Effects and Adverse Reactions , Venous Thrombosis , COVID-19 , Myasthenic Syndromes, Congenital , Drug Hypersensitivity , Thrombocytopenia , Guillain-Barre Syndrome , Hallucinations , Myocarditis , Stroke
20.
psyarxiv; 2022.
Preprint in English | PREPRINT-PSYARXIV | ID: ppzbmed-10.31234.osf.io.tuqzg

ABSTRACT

Purpose: Many stroke survivors adopt or return to a sedentary lifestyle after stroke. This sedentarism, in turn, impacts on quality of life, physical function, and puts survivors at a significantly greater risk of another stroke, developing dementia, or chronic illness. There is little known about the barriers and facilitators of exercise after stroke and what could be done to minimise the effects of barriers and to build on facilitators of exercise. The aim of this study was to explore the barriers and facilitators of exercise after stroke from the perspective of stroke survivors, family caregivers, physiotherapists and occupational therapists. Methods: Semi-structured phone interviews with 13 stroke survivors, 8 family caregivers and 13 therapists (one focus group consisting of 4 therapists), exploring perceived barriers and facilitators to exercise after stroke were completed. Data were analysed using thematic analysis. Demographic information including current physical activity levels, stroke impact, and physical and mental fatigue were also collected. The themes generated were subsequently mapped onto the Theoretical Domains Framework to gain a deeper understanding of the factors that influence exercise behaviour and help identify appropriate techniques to address perceived barriers. Results: TDF domains that were perceived by all three groups were: knowledge, beliefs about capabilities, beliefs about consequences, goals, memory attention and decision processes, environmental context and resources, social influences and emotion. The most reported TDF domains were environmental context and resources, social influences, emotion and beliefs about capabilities. The most common barriers that were perceived by all three groups were: covid restrictions, access to services, lack of professional support, physical capability and fatigue. The most common facilitators that were perceived by all three groups were: greater access to services and facilities, social support from others and group exercise programmes. Conclusions: Perceptions of the barriers and facilitators of exercise differ across stroke survivors, therapists and caregivers. It is vital that stroke services address the barriers to exercise after stroke and building on the facilitators to ensure that survivors receive optimal post-stroke care.


Subject(s)
Attention Deficit Disorder with Hyperactivity , Mental Fatigue , Stroke , Dementia , Fatigue
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