IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India.

BACKGROUND: India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India's public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges. AIM: This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study. METHODS: A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken. RESULTS: In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal. CONCLUSION: This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country.

Impact of sepsis in patients admitted with covid-19 infection in a tertiary care center in Delhi. A retrospective cross-sectional study.

Background: COVID-19 pandemic has emerged as one of the worst humanitarian crises in human history. Viral sepsis is implicated as a major source of morbidity and mortality in COVID-19 infection. The study provides an insight into impact of COVID -19 associated sepsis on the patient's clinical course and mortality. Materials and Methods: The study was conducted on 112 participants admitted with symptomatic COVID -19 infection in a COVID -19 designated center in New Delhi, India between July and October 2020. Result: 41.1% (n=46) of the participants had critical disease which includes sepsis. Out of 46 Critical patients 19 (41.3%) had sepsis, 21(45.7%) had septic shock and 6 (18.8%) had Sepsis with ARDS. Sepsis and septic shock at time of presentation was associated with higher mortality. Conclusion: Severe and critical illness was marked by advance age, comorbidities like Diabetes mellitus, high total leucocyte count and deranged renal and hepatic function in the study. Thus COVID-19 induced sepsis is an important determinant of disease severity precipitating multiorgan dysfunction and adverse outcome in patients.

Résumé Contexte: La pandémie de COVID-19 est devenue l'une des pires crises humanitaires de l'histoire de l'humanité. La septicémie virale est impliquée comme une source majeure de morbidité et de mortalité dans l'infection au COVID-19. L'étude donne un aperçu de l'impact de la septicémie associée au COVID -19 sur l'évolution clinique et la mortalité du patient. Matériels et méthodes: L'étude a été menée sur 112 participants admis avec une infection COVID -19 symptomatique dans un centre désigné COVID -19 à New Delhi, en Inde, entre juillet et octobre 2020. Résultat: 41,1 % (n = 46) des participants avaient un état critique maladie qui comprend la septicémie. Sur 46 patients critiques, 19 (41,3 %) avaient une septicémie, 21 (45,7 %) avaient un choc septique et 6 (18,8 %) avaient une septicémie avec SDRA. La septicémie et le choc septique au moment de la présentation étaient associés à une mortalité plus élevée. Conclusion: La maladie grave et critique était marquée par un âge avancé, des comorbidités comme le diabète sucré, un nombre total élevé de leucocytes et une fonction rénale et hépatique dérangée dans l'étude. Ainsi, la septicémie induite par le COVID-19 est un déterminant important de la gravité de la maladie, précipitant un dysfonctionnement multiorganique et des résultats indésirables chez les patients. Mots-clés: COVID-19, réponse immunitaire, maladie respiratoire aiguë sévère coronavirus-2, septicémie virale.