Background It has been reported that acute stroke services were compromised during COVID-19 due to various pandemic-related issues. We aimed to investigate these changes by recruiting centers from different countries. Methods Eight countries participated in this cross-sectional, observational, retrospective study by providing data from their stroke data base. We compared 1 year before to 1 year during COVID-19 as regards onset to door (OTD), door to needle (DTN), door to groin (DTG), duration of hospital stay, National Institute of Health Stroke Scale (NIHSS) at baseline, 24 h, and at discharge as well as modified Rankin score (mRS) on discharge and at 3 months follow-up. Results During the pandemic year, there was a reduction in the number of patients, median age was significantly lower, admission NIHSS was higher, hemorrhagic stroke increased, and OTD and DTG showed no difference, while DTN time was longer, rtPA administration was decreased, thrombectomy was more frequent, and hospital stay was shorter. mRS was less favorable on discharge and at 3 months. Conclusion COVID-19 showed variable effects on stroke services. Some were negatively impacted as the number of patients presenting to hospitals, DTN time, and stroke outcome, while others were marginally affected as the type of management.

IntroductionThere is scarce information in Latin America about factors related to stroke patient outcomes in rural areas compared to urban ones.ObjectiveTo evaluate functional outcomes of stroke code patients from rural and urban areas and their relationship with socioeconomic disparity.MethodsProspective cohort study included patients of urban, semi-urban, and rural origin with stroke code from a high complexity hospital in southwestern Colombia between 2018 and 2019. Demographic, clinical data modified Rankin at discharge, and 3-month follow-up were analyzed. The poverty index, barriers to health access and availability of ambulances by the municipality was assessed at an ecological level.ResultsFive hundred and fifty five stroke patients were registered, 21.2% from rural areas, 432 (77.98%) had an ischemic stroke. There were no significant differences in sociodemographic factors and medical background. Urban patients had lower reperfusion therapies rates (23.25%). Favorable mRS at discharge (<3) was higher in urban areas (63.03%) and mortality was superior in rural patients (13.56%). The ambulance rate in semi-urban and rural areas was as low as 0.03 per 100.000 inhabitants, the poverty index was 11.9% in urban areas vs. 23.3% in semi urban and rural areas.ConclusionsRural patients treated in our center were more likely to present with severe strokes and unfavorable mRS at hospital discharge and 3-month follow-up compared to urban, despite having similar risk factors. There is an inverse relationship, which is not related to the poverty rate or the percentage of people with barriers to access to health. There is a need for further studies that assess barriers inherent in rural patients and establish a regional stroke network.

Resumen El Drip and Ship consiste en administrar trombolisis endovenosa en centro primario y remisión para trombectomía mecánica. Objetivo: Describir la experiencia Drip and Ship como intervención del ictus isquémico en dos regiones de Colombia. Métodos: Serie de casos retrospectiva de pacientes tratados con Drip and Ship durante 2019 y primer cuartil de 2021. Se compararon variables como puerta-imagen, puerta-aguja, puerta-ingle y desenlaces clínicos. Se calcularon medidas de tendencia central y estadísticas descriptivas. Resultados: Se registraron seis pacientes con ictus isquémico y oclusión proximal. Mediana de 60 minutos de inicio de síntomas, puerta-aguja 75 minutos, tiempo door-in door-out 167.5 minutos, tiempo de traslado 91.5 minutos para remisión desde otra ciudad. Cinco pacientes recibieron trombectomía mecánica con TICI 2c-3. 50% de los pacientes con Rankin modificado favorable al egreso y 84% a tres meses. Conclusiones: En el registro RES-Q entre 2019 y el primer cuartil de 2021, se consignaron 5954 casos de ictus isquémico en Colombia, 20 pacientes tratados con Drip and Ship (0,33%). Los tiempos de puerta- aguja y de remisión fueron mayores a lo recomendado en guías internacionales, siendo mayor en los pacientes provenientes de otras ciudades. Se requiere estructurar redes de atención para mejorar tiempos de tratamiento y número de pacientes tratados.

BackgroundBacterial meningitis (BM) is a public health challenge as it is associated with high lethality and neurological sequelae. Worldwide, most cases are registered in the African Meningitis Belt (AMB). The role of particular socioepidemiological features is essential for understanding disease dynamics and optimizing policy-making.ObjectiveTo identify socioepidemiological macro-determinants that contribute to explaining the differences in BM incidence between AMB and the rest of Africa.MethodsCountry-level ecologic study based on the cumulative incidence estimates of the Global Burden of Disease study and reports of the MenAfriNet Consortium. Data about relevant socioepidemiological features were extracted from international sources. Multivariate regression models were implemented to define variables associated with the classification of African countries within the AMB and the incidence of BM worldwide.ResultsCumulative incidences at the AMB sub-regions were 111.93 (west), 87.23 (central), 65.10 (east), and 42.47 (north) per 100,000 population. A pattern of common origin with continuous exposition and seasonality of cases was observed. Socio-epidemiological determinants contributing to differentiating the AMB from the rest of Africa were household occupancy (OR 3.17 CI 95% 1.09–9.22, p = 0.034) and malaria incidence (OR 1.01 CI 95% 1.00–1.02, p = 0.016). BM cumulative incidence worldwide was additionally associated with temperature and gross national income per capita.ConclusionSocioeconomic and climate conditions are macro-determinants associated with BM cumulative incidence. Multilevel designs are required to confirm these findings.

INTRODUCCIÓN: La fibrilación auricular aumenta 5 veces el riesgo de un ataque cerebrovascular de origen cardioembólico. La anticoagulación está indicada para prevención primaria y secundaria de embolismo cerebral. En pacientes con alto riesgo de sangrado no modificable se ha propuesto el cierre de apéndice auricular izquierdo como alternativa a la anticoagulación. MÉTODOS: Serie de casos retrospectiva de pacientes incluidos en el registro ReACTIVE entre los años 2019 y 2020 con diagnóstico de fibrilación auricular, puntaje de CHA2DS2-VASc ? 4, HAS BLED ? 3 y contraindicación de terapia anticoagulante a largo plazo. Se incluyeron variables demográficas, factores de riesgo, desenlace clínico usando la escala de Rankin modificado y se hizo seguimiento clínico a 3 meses después del procedimiento. RESULTADOS: Se incluyeron 6 pacientes, el 50 % de ellos mujeres, con mediana de edad de 80,8 ± 4,8 años. El 83,3 % presentó antecedente de sangrado mayor bajo consumo de anticoagulantes. En el seguimiento a 90 días, ningún paciente experimentó sangrado ni ataque cerebrovascular, un paciente murió por causas no cardiovasculares, en tanto que el 83,3 % de los pacientes tuvieron un Rankin modificado favorable (0-2). CONCLUSIONES: El cierre de apéndice auricular es una opción terapéutica en pacientes con fibrilación auricular y contraindicación para anticoagulación por alto riesgo de sangrado. Nuestra serie obtuvo resultados similares a los publicados a escala nacional a pesar de incluir pacientes con edad más avanzada. La conformación de equipos interdisciplinarios de corazón y cerebro es útil en la selección de pacientes para esta terapia.