Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia.

INTRODUCTION: The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system's bottlenecks from a territorial point of view. METHODS: Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15-May 2, 2020) and an immediate prepandemic period (January 26-March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. RESULTS: Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = -0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05-2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4-0.9], p 0.015) during the pandemic period. CONCLUSION: During the COVID-19 pandemic, Catalonia's stroke system's weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system's analysis is crucial to allocate resources appropriately.

Evolución de las consultas urgentes relacionadas con el consumo de cocaína durante el periodo 2002-2007 / Changes in emergency consultations related to cocaine abuse during the period 2002 through 2007

Objetivos: Analizar la evolución temporal de las características epidemiológicas, clínicas y toxicológicas de las consultas urgentes relacionadas con el consumo de cocaína. Método: Pacientes que consultaron al servicio de urgencias durante un período de 6años por síntomas relacionados con el consumo de cocaína en las horas previas. Se recogieron datos epidemiológicos, clínicos y toxicológicos. Resultados: Se identificaron 1.755 pacientes (292 pacientes/año, 70% varones, edad media 31 años). Las urgencias por cocaína supusieron el 0,76% del total de urgencias médicas, el 15,3% de las urgencias toxicológicas y el 28,6% de las urgencias generadas por sustancias de abuso, porcentajes que se han mantenido relativamente estables a lo largo de los 6 años. La forma de consumo más habitual fue por vía nasal (75%), con intención recreativa (91%) y asociada a otras sustancias de abuso (72%), especialmente alcohol, cannabis y derivados anfetamínicos. Los principales motivos de consulta fueron la ansiedad (27%), la agitación (20%) y las palpitaciones (12%). El 3,6% de las consulta surgentes recibieron la categoría 1 de triaje y fueron asistidas en el área de reanimación de urgencias. El 11% requirió ingreso hospitalario: un 45% en áreas médico-quirúrgicas, un 44% en psiquiatría y un 11% en cuidados intensivos. No se ha observado un incremento de las necesidades de ingreso durante el periodo estudiado. La mortalidad global de la serie fue del 0,17%.Conclusiones: El consumo de cocaína, sola o combinada con otras sustancias de abuso, genera un elevado número de consultas al servicio de urgencias, con predominio de manifestaciones neuropsiquiátricas y cardiovasculares, aunque no se objetivan cambios significativos en los últimos 6 años respecto a la incidencia ni a las necesidades de ingreso (AU)

Objective: To analyze the epidemiologic, clinical, and toxicologic characteristics of emergency consultations related to cocaine abuse. Patients and methods: The 6-year study included patients seen in the emergency department (ED) for cocaine use in the hours prior to consultation. Epidemiologic, clinical, and toxicologic data were recorded. Results: A total of 1755 patients were identified (292 patients per year, 70% male, mean age 31 years). Emergency consultations for cocaine abuse accounted for 0.76% of all medical emergencies, 15.3% of all toxic exposures, and28.6% of all emergency consultations for substance abuse; these figures remained relatively stable over the 6-year study period. The drug was most commonly taken nasally (75%), for recreational use (91%), and usually in association with other substances (72%), particularly alcohol, cannabis, and amphetamine derivatives. The main reasons for consultation were anxiety (27%), agitation (20%), and palpitations (12%). The triage classification was level I in 3.6% of cases, and these patients were attended immediately in the ED resuscitation area. Hospital admission was required in 11% of cases, of which 45% were admitted to medical-surgical specialties, 44% to psychiatry, and 11% to intensive care. There has-been no increase in the need for admission over the study period. Overall mortality was 0.17%.Conclusions: Cocaine abuse, alone or combined with other substance abuse, generates a large number of consultations to ED. The main symptoms are neuropsychiatric and cardiovascular. There have been no significant changes in incidence or in the need for admission over the past 6 years (AU)

Foot-and-Mouth Disease Virus Inactivation in Miniburgers by a Continuous Dry-Moist Heat Cooking System.

Several thermal processes were tested to inactivate foot-and-mouth disease virus in beef miniburgers using a dry oven to grill and a steam oven to finish the cooking. A satisfactory product free of foot-and-mouth disease virus was obtained by grilling the contaminated miniburgers in the dry oven for 299 s at 208°C, followed by steam cooking in the moist oven for 190 s with a minimum average exit temperature of 99.4°C. It was found that a temperature indicator device is a reliable tool to verify the thermal process.