Objective:The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods.Methods:We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases.Results:There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI, -11.7 to - 11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI, -13.8 to -12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI, -13.7 to -10.3, p=0.001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions.Conclusions:The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

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Background Due to the COVID-19 pandemic orthognathic surgery was suspended in the UK. The effect this had on patients, to date, is unknown. Aim: A multi-centre, cross-sectional survey was conducted in the UK to investigate the health-related impact for patients on the orthognathic surgery pathway, including those on the waiting list for surgery . Method : A structured questionnaire was designed to explore the impact of the pandemic on the patients whose orthognathic treatment was temporarily cancelled. Results: Ninety-five questionnaires were returned giving a response rate of 65%. When asked if the delay due to the pandemic had caused emotional distress, 63% (51/81) agreed. Respondents experienced more distress, in relation to dental appearance (60%, 51/83), self-confidence (52% 50/83), facial appearance (53%, 44/83) and ability to eat and chew (59%, 50/83) during the pandemic. One hundred percent of patients would have had appliances fitted or their appliances adjusted during the pandemic and 93% percent of patients stated that they would attend for surgery if they were offered this during the pandemic. In conclusion, patients appear to have experienced emotional distress in relation to the delay with their orthognathic treatment. The patients should be given greater priority, during the remobilisation of elective surgery. They should have access to ongoing psychological support, where delays affect their treatment. The “surgery-first” approach may be considered, for suitable patients, to minimise the duration of the treatment journey.

Fatal familial insomnia (FFI) is an extremely rare autosomal dominant prion disease. The chief clinical features include an organic sleep disorder associated with sympathetic overdrive, motor and bulbar compromise as well as progressive cognitive decline. Death ensures in 100% of cases with a mean survival duration of 18 months from time of symptom onset. Treatment strategies in the management of FFI remains largely symptomatic with greater emphasis placed on palliative care services. We report a case of a 31-year old gentleman (Mr G) who presented with insomnia, sleep behavior disturbances, diplopia, myoclonus and transient global amnesia. A family history of a paternal aunt with similar presentation who passed away raised the suspicion of probable FFI, which was subsequently confirmed by genetic testing. Mr G is the first reported definitive FFI case of Malaysian Chinese descent. Standard MRI imaging and CSF analyses are insufficient in the workup of an individual with probable FFI. PET scan, polysomnogram and genetic studies are required for cases with high index of suspicion. In view of the rapid progression of the disease with significant cognitive impairment within months of symptom onset, we advocate for early diagnosis and a biopsychosocial patient-centered treatment approach.