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1.
PLoS One ; 16(12): e0258450, 2021.
Article in English | MEDLINE | ID: covidwho-1581814

ABSTRACT

BACKGROUND AND AIMS: Patients with liver cirrhosis (LC) are considered to be at increased risk for mortality when acquiring SARS-CoV-2 infection and subsequently developing Corona Virus Disease 2019 (COVID-19). During the COVID-19 pandemic, hospitals are regarded as sites with increased risk of infection. Therefore, patient contacts are often limited to urgent indications, which could negatively affect disease monitoring. However, data regarding actual infection rates in cirrhotic patients is limited. The aim of this prospective study was to assess the incidence of COVID-19 in patients with LC with/without hepatocellular carcinoma (HCC) with physical presentation at our University Medical Center. METHODS: Patients were enrolled between 1st April and 30th June 2020 at the University Medical Center Hamburg-Eppendorf, Germany. Symptoms of upper airway infection at baseline and presence of SARS-CoV-2 antibodies (IgG/IgM/IgA) were assessed at baseline and follow-up (FU) using an Electro-chemiluminescence immunoassay (Roche Elecsys). FU visits, including liver function test, clinical assessment and symptom questionnaire, were conducted after 6-8 weeks (FU-1) and 6 months (FU-2). Prior to inclusion of the first patient, obligatory face masks and personal distance were implemented as protective measures. RESULTS: A total of 150 patients were enrolled, 23% (n = 35) also had diagnosis of HCC (median age: 64 years, range: 19-86), 69% were male. Liver function according to Child-Pugh score (CPS) was: CPS A: 46% (n = 62); CPS B: 37% (n = 50); CPS C: 17% (n = 23). Clinical symptoms indicating upper airway infection were present in 53% (n = 77): shortness of breath (n = 40) and coughing (n = 28) were the most frequent. For the 150 patients enrolled, 284 outpatient visits were registered and 33 patients were admitted to the University Medical Center during the follow-up period. After a median of 52 days, n = 110 patients completed FU-1 and n = 72 completed FU-2 after a median of 6.1 months. Only in one patient, an 80-year-old man with stable liver function (CPS A) and advanced HCC, SARS-CoV-2 antibodies were detected at baseline and FU-1, while antibody testing was negative in the remaining patients at baseline, FU-1 and FU-2. CONCLUSION: The incidence of COVID-19 at our tertiary medical center during the pandemic was low in LC and HCC patients, when simple protective measures were implemented. Therefore, a routine care for patients with chronic liver diseases does not increase the risk of SARS-CoV-2 infection and should be maintained with protective measures.


Subject(s)
COVID-19/epidemiology , Carcinoma, Hepatocellular/virology , Liver Cirrhosis/virology , Adult , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/complications , Cohort Studies , Female , Germany/epidemiology , Humans , Incidence , Liver Cirrhosis/complications , Liver Neoplasms/complications , Liver Neoplasms/virology , Male , Middle Aged , Pandemics , Prospective Studies , SARS-CoV-2/pathogenicity , Tertiary Care Centers/trends
2.
Biomed Res Int ; 2021: 6995096, 2021.
Article in English | MEDLINE | ID: covidwho-1573872

ABSTRACT

At the beginning of the COVID-19 pandemic, early modelling studies estimated a reduction in childhood vaccinations in low- and middle-income countries. Regular provision of both curative and preventive services such as antenatal care and childhood immunizations has been negatively affected since the onset of the pandemic. Our study was aimed at examining the impact that the pandemic had on childhood vaccination services at the Tamale Teaching Hospital (TTH). A mixed methods study design was employed for the study, which was conducted at the Child Welfare Clinic (CWC) of the TTH. With quantitative approach, we retrospectively looked at the uptake of the various vaccines during the pandemic era, defined as the period between 1st March 2020 and 28th February, 2021, and the prepandemic era defined as the period 1st March 2019 to 29th February, 2020. The qualitative approach was used to understand the perspective of five healthcare providers at the CWC and the four caregivers of children who have missed a vaccine or delayed in coming, on the factors accounting for any observed change. Data analysis was done using Microsoft Excel 2016 and thematic content analysis. Quantitative data were presented in frequencies, percentages, and line graphs. With the exception of the Measles Rubella (MR) 2 vaccine, we observed a decline ranging from 47% (2298) to 10.5% (116), with the greatest decline seen in the BCG and the least decline seen in the MR1 vaccine. The month of May 2020 saw the greatest decline, that is, 70.6% (813). A decline of 38.3% (4473) was noted when comparison was made between the designated prepandemic and pandemic eras, for all the vaccines in our study. Fear of COVID-19 infection and misinformation were commonly given as reasons for the decline. Catch-up immunization schedule should be instituted to curtail possible future outbreaks of vaccine-preventable diseases.


Subject(s)
Immunization Programs/trends , Vaccination/trends , BCG Vaccine , COVID-19/complications , COVID-19/psychology , Female , Ghana/epidemiology , Humans , Infant , Infant, Newborn , Male , Measles Vaccine , Pandemics , Pregnancy , Retrospective Studies , Tertiary Care Centers/trends
3.
J Orthop Surg Res ; 16(1): 601, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1468072

ABSTRACT

BACKGROUND: The COVID-19 pandemic represents one of the most massive health emergencies in the last century and has caused millions of deaths worldwide and a massive economic and social burden. The aim of this study was to evaluate how the COVID-19 pandemic-during the Italian lockdown period between 8 March and 4 May 2020-influenced orthopaedic access for traumatic events to the Emergency Department (ER). METHODS: A retrospective review of the admission to the emergency room and the discharge of the trauma patients' records was performed during the period between 8 March and 4 May 2020 (block in Italy), compared to the same period of the previous year (2019). Patients accesses, admissions, days of hospitalisation, frequency, fracture site, number and type of surgery, the time between admission and surgery, days of hospitalisation, and treatment cost according to the diagnosis-related group were collected. Chi-Square and ANOVA test were used to compare the groups. RESULTS: No significant statistical difference was found for the number of emergency room visits and orthopaedic hospitalisations (p < 0.53) between the year 2019 (9.5%) and 2020 (10.81%). The total number of surgeries in 2019 was 119, while in 2020, this was just 48 (p < 0.48). A significant decrease in the mean cost of orthopaedic hospitalisations was detected in 2020 compared (261.431 euros, equal to - 52.07%) relative to the same period in 2019 (p = 0.005). Although all the surgical performances have suffered a major decline, the most frequent surgery in 2020 was intramedullary femoral nailing. CONCLUSION: We detected a decrease in traumatic occasions during the lockdown period, with a decrease in fractures in each district and a consequent decrease in the diagnosis-related group (DRG).


Subject(s)
COVID-19/economics , COVID-19/epidemiology , Orthopedic Procedures/economics , Patient Admission/economics , Tertiary Care Centers/economics , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/prevention & control , Child , Child, Preschool , Costs and Cost Analysis/trends , Female , Humans , Infant , Infant, Newborn , Italy/epidemiology , Male , Middle Aged , Orthopedic Procedures/trends , Pandemics/economics , Patient Admission/trends , Retrospective Studies , Tertiary Care Centers/trends , Young Adult
5.
World Neurosurg ; 155: e34-e40, 2021 11.
Article in English | MEDLINE | ID: covidwho-1331291

ABSTRACT

BACKGROUND: As the COVID-19 pandemic surpasses 1 year, it is prudent to reflect on the challenges faced and the management strategies employed to tackle this overwhelming health care crisis. We undertook this study to validate our institutional protocols, which were formulated to cater to the change in volume and pattern of neurosurgical cases during the raging pandemic. METHODS: All admitted patients scheduled to undergo major neurosurgical intervention during the lockdown period (15 March 2020 to 15 September 2020) were included in the study. The data involving surgery outcomes, disease pattern, anesthesia techniques, patient demographics, as well as COVID-19 status, were analyzed and compared with similar retrospective data of neurosurgical patients operated during the same time period in the previous year (15 March 2019 to 15 September 2019). RESULTS: Barring significant increase in surgery for stroke (P = 0.008) and hydrocephalus (P <0.001), the overall case load of neurosurgery during the study period in 2020 was 42.75% of that in 2019 (P < 0.001), attributable to a significant reduction in elective spine surgeries (P < 0.001). However, no significant difference was observed in the overall incidence of emergency and essential surgeries undertaken during the 2 time periods (P = 0.482). There was an increased incidence in the use of monitored anesthesia care techniques during emergency and essential neurosurgical procedures by the anesthesia team in 2020 (P < 0.001). COVID-19 patients had overall poor outcomes (P = 0.003), with significant increase in mortality among those subjected to general anesthesia vis-a-vis monitored anesthesia care (P = 0.014). CONCLUSIONS: Despite a significant decrease in neurosurgical workload during the COVID-19 lockdown period in 2020, the volume of emergency and essential surgeries did not change much compared with the previous year. Surgery in COVID-19 patients is best avoided, unless critical, as the outcome in these patients is not favorable. The employment of monitored anesthesia care techniques like awake craniotomy and regional anesthesia facilitate a better outcome in the ongoing COVID-19 era.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Communicable Disease Control/trends , Health Resources/trends , Neurosurgical Procedures/trends , Tertiary Care Centers/trends , COVID-19/prevention & control , COVID-19 Testing/methods , COVID-19 Testing/trends , Clinical Protocols , Communicable Disease Control/methods , Female , Humans , India/epidemiology , Male , Neurosurgical Procedures/methods , Retrospective Studies , Treatment Outcome
7.
Plast Reconstr Surg ; 148(1): 168e-169e, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1263729

Subject(s)
COVID-19/prevention & control , Infection Control/organization & administration , Pandemics/prevention & control , Surgery Department, Hospital/organization & administration , Surgery, Plastic/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/standards , COVID-19 Testing/statistics & numerical data , COVID-19 Testing/trends , Egypt/epidemiology , Elective Surgical Procedures/standards , Elective Surgical Procedures/statistics & numerical data , Elective Surgical Procedures/trends , Health Policy , Humans , Infection Control/standards , Infection Control/statistics & numerical data , Infection Control/trends , Reconstructive Surgical Procedures/standards , Reconstructive Surgical Procedures/statistics & numerical data , Reconstructive Surgical Procedures/trends , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data , Surgery Department, Hospital/trends , Surgery, Plastic/standards , Surgery, Plastic/statistics & numerical data , Surgery, Plastic/trends , Telemedicine/organization & administration , Telemedicine/standards , Telemedicine/statistics & numerical data , Tertiary Care Centers/organization & administration , Tertiary Care Centers/standards , Tertiary Care Centers/statistics & numerical data , Tertiary Care Centers/trends , Triage/organization & administration , Triage/standards , Triage/statistics & numerical data , Triage/trends
8.
BMC Pregnancy Childbirth ; 21(1): 416, 2021 Jun 04.
Article in English | MEDLINE | ID: covidwho-1259189

ABSTRACT

BACKGROUND: On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a 'national disaster'. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. METHODS: This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. RESULTS: Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. CONCLUSIONS: Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women's experiences and understand how bookings and deliveries at local clinics changed during this time.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Maternal Health Services/statistics & numerical data , Tertiary Care Centers/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Maternal Health Services/trends , Maternal Mortality , Morbidity , Perinatal Mortality , Pregnancy , Pregnancy Outcome , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers/trends , Workload/statistics & numerical data , Zimbabwe/epidemiology
9.
J Orthop Surg Res ; 16(1): 356, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1255944

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic has had a massive impact on individuals globally. The Chinese government has formulated effective response measures, and medical personnel have been actively responding to challenges associated with the epidemic prevention and control strategies. This study aimed to evaluate the effect of the implementation of a care transition pathway on patients that underwent joint replacement during the COVID-19 pandemic. METHODS: A quasi-experimental study was designed to evaluate the effect of implementing a care transition pathway for patients who underwent joint replacement during the COVID-19 pandemic in the orthopedic department of a tertiary care hospital in Beijing, China. Using a convenient sampling method, a total of 96 patients were selected. Of these, 51 patients who had undergone joint replacement in 2019 and received treatment via the routine nursing path were included in the control group. The remaining 45 patients who underwent joint replacement during the COVID-19 epidemic in 2020 and received therapy via the care transition pathway due to the implementation of epidemic prevention and control measures were included in the observation group. The quality of care transition was assessed by the Care Transition Measure (CTM), and patients were followed up 1 week after discharge. RESULTS: The observation group was determined to have better general self-care preparation, written planning materials, doctor-patient communication, health monitoring, and quality of care transition than the control group. CONCLUSIONS: A care transition pathway was developed to provide patients with care while transitioning through periods of treatment. It improved the patient perceptions of nursing quality. The COVID-19 pandemic is a huge challenge for health professionals, but we have the ability to improve features of workflows to provide the best possible patient care.


Subject(s)
Arthroplasty, Replacement/trends , COVID-19/epidemiology , Non-Randomized Controlled Trials as Topic/trends , Orthopedic Procedures/trends , Tertiary Care Centers/trends , Transitional Care/trends , Aged , Arthroplasty, Replacement/methods , Arthroplasty, Replacement/rehabilitation , Beijing/epidemiology , COVID-19/prevention & control , China/epidemiology , Female , Humans , Male , Middle Aged , Non-Randomized Controlled Trials as Topic/methods , Orthopedic Procedures/methods , Orthopedic Procedures/rehabilitation , Pandemics , Treatment Outcome
10.
Clin Biochem ; 95: 41-48, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1233389

ABSTRACT

BACKGROUND: Coronavirus Disease 2019 (COVID-19) has variable clinical presentation, from asymptomatic to severe disease leading to death. Biochemical markers may help with management and prognostication of COVID-19 patients; however, their utility is still under investigation. METHODS: A retrospective study was conducted to evaluate alanine aminotransferase, C-reactive protein (CRP), ferritin, lactate, and high sensitivity troponin T (TnT) levels in 67 patients who were admitted to a Canadian tertiary care centre for management of COVID-19. Logistic, cause-specific Cox proportional-hazards, and accelerated failure time regression modelling were performed to assess the associations of initial analyte concentrations with in-hospital death and length of stay in hospital; joint modelling was performed to assess the associations of the concentrations over the course of the hospital stay with in-hospital death. RESULTS: Initial TnT and CRP concentrations were associated with length of stay in hospital. Eighteen patients died (27%), and the median initial TnT concentration was higher in patients who died (55 ng/L) than those who lived (16 ng/L; P < 0.0001). There were no survivors with an initial TnT concentration > 64 ng/L. While the initial TnT concentration was predictive of death, later measurements were not. Only CRP had prognostic value with both the initial and subsequent measurements: a 20% increase in the initial CRP concentration was associated with a 14% (95% confidence interval (CI): 1-29%) increase in the odds of death, and the hazard of death increased 14% (95% CI: 5-25%) for each 20% increase in the current CRP value. While the initial lactate concentration was not predictive of death, subsequent measurements were. CONCLUSION: CRP, lactate and TnT were associated with poorer outcomes and appear to be useful biochemical markers for monitoring COVID-19 patients.


Subject(s)
C-Reactive Protein/metabolism , COVID-19/blood , Hospitalization/trends , Lactic Acid/blood , Tertiary Care Centers/trends , Troponin T/blood , Adult , Aged , Aged, 80 and over , Biochemical Phenomena/physiology , Biomarkers/blood , Blood Gas Analysis/methods , Blood Gas Analysis/trends , COVID-19/diagnosis , COVID-19/epidemiology , Canada/epidemiology , Female , Humans , Inflammation Mediators/blood , Length of Stay/trends , Male , Middle Aged , Retrospective Studies
11.
Neurosci Lett ; 749: 135692, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1196745

ABSTRACT

BACKGROUND: India has the second largest COVID-19 epidemic in the world as per current estimates. Central and peripheral nervous system involvement in COVID-19 (Neuro COVID-19) has been increasingly identified and reported. This letter is the first report of the spectrum of neurological disorders observed in patients with severe COVID-19 from a resource limited setting like India. Till October 30th 2020, Noble hospital and research center, Pune, India has admitted 2631 patients of COVID-19. Out of these, 423 patients had severe COVID-19. NEUROLOGIC COMPLICATIONS IN SEVERE COVID-19 IN PUNE, INDIA: Of the 423 patients with severe COVID-19, 20 (4.7%) had pre-existing neurologic co-morbidities, with cerebrovascular disease (8 patients) being the most common. Poliomyelitis (4 patients) was also an important co-morbidity associated with severe COVID-19. Bodyache or myalgia (207/423, 49 %) and headache (59/423, 13.9 %) were the most common neurologic symptoms observed in patients. Encephalopathy (22/423, 5.2 %) and new onset large vessel ischemic stroke secondary to cerebral artery thrombosis (5/423, 1.1%) were the most common secondary neurologic complications noted in our cohort. Two cases of COVID-19/central nervous system tuberculosis co-infection were also identified. CHALLENGES IN MANAGEMENT OF NEURO COVID-19 IN INDIA: Various challenges like an overwhelmed health care system, inadequate workforce, lack of exhaustive reporting of symptoms and poor availability of neuroimaging in ventilated COVID-19 patients leads to underestimation of Neuro COVID-19 in resource limited settings like India.


Subject(s)
COVID-19/diagnostic imaging , Nervous System Diseases/diagnostic imaging , Severity of Illness Index , Tertiary Care Centers/trends , Tuberculosis, Central Nervous System/diagnostic imaging , COVID-19/epidemiology , COVID-19/therapy , Humans , India/epidemiology , Nervous System Diseases/epidemiology , Tuberculosis, Central Nervous System/epidemiology , Tuberculosis, Central Nervous System/therapy
12.
Dermatol Ther ; 33(6): e14136, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1140163

ABSTRACT

The aim of this study was to evaluate the changing trends in dermatology clinical practice at a tertiary center during the coronavirus disease 2019 (COVID-19) pandemic. This retrospective cohort study was conducted on patients who were admitted to Ufuk University Hospital with dermatologic complaints/diseases before and during the pandemic. The patients were divided into two groups: (a) the pre-pandemic period (March-May 2019) and (b) the Pandemic period (March-May 2020). Demographic features, clinical characteristics, dermatologic diseases/complaints, dermatologic procedures/interventions, hospitalization rate, and use of biologic agents were compared between the two groups. Total number of hospital admissions have decreased from 1165 to 717. Admission rates for acne, dermatophytosis, and benign neoplasm of the skin significantly lower during the pandemic period (P values were .02, .04, and .006, respectively). Contact dermatitis, acne accompanying dermatitis, cicatricial hair loss, lichen planus, and zona zoster infection rates were significantly higher (P values were .007, <.001, .009, .04, and .03, respectively). Rates of biopsy and electrocautery procedures were decreased significantly (P values were <.001 and .002, respectively). The hospitalization rate was similar between the groups (P = .51). However, the use of biologic agents significantly decreased during the pandemic period (P = .01). Updated clinical protocols should be established for the new normal period in accordance with these findings.


Subject(s)
COVID-19 , Dermatologists/trends , Dermatology/trends , Practice Patterns, Physicians'/trends , Skin Diseases/therapy , Tertiary Care Centers/trends , Adult , Aged , Biological Products/therapeutic use , Biopsy/trends , Electrocoagulation/trends , Female , Humans , Male , Middle Aged , Patient Admission/trends , Retrospective Studies , Skin Diseases/diagnosis , Skin Diseases/etiology , Time Factors , Turkey/epidemiology , Young Adult
13.
J Clin Neurosci ; 87: 50-54, 2021 May.
Article in English | MEDLINE | ID: covidwho-1116967

ABSTRACT

BACKGROUND: COVID-19 has greatly impacted surgical specialities throughout the globe leading to a decrease in hospital admissions and referrals. Neurosurgery has seen a great decline in cases including head trauma leading to a negative impact on the development of neurosurgical trainees. The main objective of this study is to the identify changes in neurosurgical referrals, admissions and management during the COVID-19 pandemic. We also aim to assess how current practise could be adapted to help manage future pandemic peaks. METHODS: Data was collected for the first 31 days of lockdown during 2020 (23rd March - 22nd April) and compared to the same time period in the years 2016-2019. We assessed the number of referrals, admissions and clinical information of patients during this period with a key emphasis on head trauma. RESULTS: Neurosurgical head injury referrals and admissions reduced by 57.5% and 48.3% respectively during the first 31 days of lockdown when compared to the mean figures for the same period in the previous 4 years. This was also seen with head trauma with a 21.9% decline in referrals and 39.1% reduction in admissions for the period of interest. A significant decrease in length of stay (P < 0.001) was seen between 2020 and the years 2017-19. CONCLUSION: The impact of COVID-19 makes it imperative that we plan for future pandemics to lessen the impact on neurosurgery. Special considerations need to be taken so that trainees are sufficiently prepared for completion of training whilst still priotising patient safety and providing high quality care.


Subject(s)
COVID-19/epidemiology , Craniocerebral Trauma/epidemiology , Neurosurgical Procedures/trends , Patient Admission/trends , Referral and Consultation/trends , Tertiary Care Centers/trends , Adult , COVID-19/prevention & control , Communicable Disease Control/trends , Craniocerebral Trauma/surgery , Female , Humans , Male , Middle Aged
14.
Acta Neurol Scand ; 143(5): 569-574, 2021 May.
Article in English | MEDLINE | ID: covidwho-1072543

ABSTRACT

OBJECTIVE: To characterize patients with coronavirus disease 2019 (COVID-19) who presented primarily with neurologic symptoms without typical COVID-19 symptoms of fever, cough, and dyspnea. METHODS: We retrospectively identified COVID-19-positive patients 18 years and older that had neurology symptoms on presentation requiring neurology consultation between March 14, 2020 and May 18, 2020. The patients were then classified into those with typical COVID-19 symptoms and those without. Demographic, clinical symptoms, laboratory result, and clinical outcomes were collected. RESULTS: Out of 282 patients who had neurology consult during this period, we identified 56 (mean age 69.2 years, 57% women) who tested COVID-19-positive and had neurologic symptoms on initial presentation. Of these, 23 patients (mean age 65.2 years, 52% women) had no typical COVID-19 symptoms while 33 did (mean age 72.2 years, 60% woman). In both groups, impaired consciousness was the most common initial neurologic symptom, followed by stroke, unsteady gait, headache, seizure, syncopal event, acute vision changes, and intracranial hemorrhage. Out of the 23 patients without typical COVID-19 symptoms on presentation, 10 went on to develop typical symptoms with 8 needing supplemental oxygen and one requiring mechanical ventilation. CONCLUSION: Patients who have COVID-19 can present with serious neurologic symptoms such as impaired consciousness and stroke even without typical COVID-19 symptoms. Those without typical COVID-19 symptoms can later develop typical symptoms severe enough to need respiratory support.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Hospitalization/trends , Nervous System Diseases/diagnosis , Nervous System Diseases/epidemiology , Adult , Aged , Aged, 80 and over , Female , Headache/diagnosis , Headache/epidemiology , Humans , Male , Middle Aged , Retrospective Studies , Stroke/diagnosis , Stroke/epidemiology , Tertiary Care Centers/trends
15.
Neurol Sci ; 42(1): 15-20, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1064519

ABSTRACT

INTRODUCTION: The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. METHODS: This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). RESULTS: There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. CONCLUSIONS: During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.


Subject(s)
COVID-19 , Ischemic Attack, Transient/therapy , Mechanical Thrombolysis/statistics & numerical data , Patient Admission/statistics & numerical data , Stroke/therapy , Tertiary Care Centers/statistics & numerical data , Thrombolytic Therapy/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Ischemic Attack, Transient/drug therapy , Male , Mechanical Thrombolysis/trends , Middle Aged , Patient Admission/trends , Retrospective Studies , Severity of Illness Index , Stroke/drug therapy , Tertiary Care Centers/trends , Thrombolytic Therapy/trends , United Kingdom
17.
Diabetes Metab Syndr ; 15(1): 215-220, 2021.
Article in English | MEDLINE | ID: covidwho-1065021

ABSTRACT

BACKGROUND AND AIMS: It is not known if new onset diabetes during Coronavirus-19 disease (COVID-19; NOD COVID) is phenotypically or biochemically different than new onset diabetes before COVID-19 (NOD). METHODS: All adults diagnosed with new onset diabetes from during the time of COVID-19 were compared with new onset diabetes prior to COVID-19 from two tertiary care hospitals in Chennai and Delhi. RTPCR test for SARS-CoV-2 virus was done as appropriate, and COVID-19 antibody test was done in all other NOD COVID patients. RESULT: A total of 555 patients with new onset diabetes were included in the study (282 NOD and 273 NOD COVID patients). Patients with NOD COVID had higher fasting and post prandial blood glucose and glycated hemoglobin levels vs. NOD patients. Both the groups had high average body mass index; ∼28 kg/m2. Interestingly, fasting C-peptide levels were significantly higher in the NOD COVID group vs. NOD group. There was no difference in C-peptide levels or glycemic parameters between the COVID-19 antibody positive and negative NOD COVID cases. CONCLUSION: Individuals who were diagnosed with diabetes during COVID-19 epidemic (NOD COVID) do not significantly differ from those diagnosed before COVID-19 in symptomatology, phenotype, and C-peptide levels but they had more severe glycemia.


Subject(s)
Blood Glucose/metabolism , COVID-19/blood , COVID-19/epidemiology , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/epidemiology , Glycemic Index/physiology , Adult , COVID-19/diagnosis , Diabetes Mellitus, Type 2/diagnosis , Female , Humans , India/epidemiology , Male , Middle Aged , Pandemics , Tertiary Care Centers/trends
18.
Diabetes Metab Syndr ; 14(6): 1967-1972, 2020.
Article in English | MEDLINE | ID: covidwho-1059518

ABSTRACT

BACKGROUND AND AIMS: COVID-19 pandemic and lockdown measures to contain it have affected health care services globally. This study aims to assess the effect and urban-rural differences of COVID19 pandemic on diabetes care. METHODS: This cross-sectional study was conducted among persons with diabetes (PWDs) registered for care at a diabetes clinic of a tertiary care center in Southern India. We collected following information by telephonic interviews: physician consultations, access to diabetes medications and blood sugar tests, use of telemedicine services, out of pocket expenditure and psychological morbidity. RESULTS: A total of 350 PWDs were interviewed. Majority were male (78%) and from rural areas (79%). One fourth (24%) met any physician for diabetes care at least once during lockdown. PWDs from rural areas mainly consulted a physician in a private clinic (55%) compared to urban areas (26%). Two third (65%) availed medications from private medical shops. Almost half (46%) got their blood sugar tested during and majority of them (81%) reported unsatisfactory glycemic control. Only few (5%) was aware and three utilized telemedicine services. Almost all (99%) spent money (US $ 8.3) for diabetes care. One third (33%) had moderate or high psychological distress. CONCLUSIONS: Majority of PWDs did not consult a physician during lockdown. Cost of care was high. Measures to improve utilisation of telemedicine services and peripheral health facilities are needed.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Glycemic Index/physiology , Quarantine/trends , Rural Population/trends , Tertiary Care Centers/trends , Adult , Aged , COVID-19/blood , COVID-19/therapy , Cross-Sectional Studies , Diabetes Mellitus/blood , Diabetes Mellitus/therapy , Female , Humans , India/epidemiology , Male , Middle Aged , Pandemics , Quarantine/methods , Risk Reduction Behavior , Telemedicine/methods , Telemedicine/trends
20.
World Neurosurg ; 146: e1191-e1201, 2021 02.
Article in English | MEDLINE | ID: covidwho-1026721

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) continues to affect all aspects of health care delivery, and neurosurgical practices are not immune to its impact. We aimed to evaluate neurosurgical practice patterns as well as the perioperative incidence of COVID-19 in neurosurgical patients and their outcomes. METHODS: A retrospective review of neurosurgical and neurointerventional cases at 2 tertiary centers during the first 3 months of the first peak of COVID-19 pandemic (March 8 to June 8) as well as following 3 months (post-peak pandemic; June 9 to September 9) was performed. Baseline characteristics, perioperative COVID-19 test results, modified Medically Necessary, Time-Sensitive (mMeNTS) score, and outcome measures were compared between COVID-19-positive and-negative patients through bivariate and multivariate analysis. RESULTS: In total, 652 neurosurgical and 217 neurointerventional cases were performed during post-peak pandemic period. Cervical spine, lumbar spine, functional/pain, cranioplasty, and cerebral angiogram cases were significantly increased in the postpandemic period. There was a 2.9% (35/1197) positivity rate for COVID-19 testing overall and 3.6% (13/363) positivity rate postoperatively. Age, mMeNTS score, complications, length of stay, case acuity, American Society of Anesthesiologists status, and disposition were significantly different between COVID-19-positive and-negative patients. CONCLUSIONS: A significant increase in elective case volume during the post-peak pandemic period is feasible with low and acceptable incidence of COVID-19 in neurosurgical patients. COVID-19-positive patients were younger, less likely to undergo elective procedures, had increased length of stay, had more complications, and were discharged to a location other than home. The mMeNTS score plays a role in decision-making for scheduling elective cases.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Neurosurgical Procedures/trends , Perioperative Care/trends , Tertiary Care Centers/trends , Adult , Aged , COVID-19/diagnosis , District of Columbia/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Neurosurgical Procedures/methods , Pandemics/prevention & control , Perioperative Care/methods , Retrospective Studies , Time Factors , Treatment Outcome
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