Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City.

Stroke is one of the leading causes of death and disability among adults worldwide. The World Health Organization (WHO) officially declared a COVID-19 pandemic on March 11, 2020. The first case in Mexico was confirmed in February 2020, subsequently becoming one of the countries most affected by the pandemic. In 2020, The National Institute of Neurology of Mexico started a Quality assurance program for stroke care, consisting of registering, monitoring and feedback of stroke quality measures through the RES-Q platform. We aim to describe changes in the demand for stroke healthcare assistance at the National Institute of Neurology and Neurosurgery during the pandemic and the behavior of stroke quality metrics during the prepandemic and the pandemic periods. For this study, we analyzed data for acute stroke patients registered in the RES-Q platform, in the prepandemic (November 2019 to February 2020) and pandemic (March-December 2020) periods in two groups, one prior to the pandemic. During the pandemic, there was an increase in the total number of assessed acute stroke patients at our hospital, from 474 to 574. The average time from the onset of symptoms to hospital arrival (Onset to Door Time-OTD) for all stroke patients (thrombolyzed and non-thrombolyzed) increased from 9 h (542 min) to 10.3 h (618.3 min) in the pandemic group. A total of 135 acute stroke patients were enrolled in this registry. We found the following results: Patients in both groups were studied with non-contrast computed tomography (NNCT), computed tomography angiography (CTA), magnetic resonance angiography (MRA), digital subtraction angiography (DSA) or more frequently in the pandemic period (early carotid imaging, Holter monitoring) as needed. Treatment for secondary prevention (antihypertensives, antiplatelets, statins) did not differ. Frequency of performing and documenting the performance of NIHSS scale at arrival and early dysphagia test improved. There was an increase in alteplase use from 21 to 42% (p = 0.03). There was a decrease in door to needle time (46 vs. 39 min p = 0.30). After the implementation of a stroke care protocol and quality monitoring system, acute stroke treatment in our institution has gradually improved, a process that was not thwarted during the COVID-19 pandemic.

Epidemiología del descontrol de la epilepsia en un servicio de urgencias neurológicas / Acute seizure epidemiology in a neurological emergency department

Introducción. El descontrol de la epilepsia representa un potencial daño neurológico, por lo que deben investigarse sus causas. Objetivo. Explorar la epidemiología de pacientes mexicanos con descontrol agudo de epilepsia en un servicio de urgencias neurológicas. Pacientes y métodos. Análisis prospectivo descriptivo de pacientes con diagnóstico previo de epilepsia que acuden a un servicio de urgencias por descontrol de las crisis. Resultados. Se analizó a 100 pacientes entre agosto de 2016 y enero de 2017. Ochenta y seis fueron crisis focales, de las cuales 76 fueron focales a bilaterales tonicoclónicas, dos fueron con alteración de la consciencia de inicio motor y tres de inicio no motor, una sin alteración de la consciencia de inicio motor y cuatro de inicio no motor. Catorce fueron generalizadas de inicio generalizado motor. Las causas de descontrol fueron: 26 pacientes por falta de adhesión al tratamiento antiepiléptico, 21 de causa desconocida, 19 por infección, 13 por privación de sueño, 10 por ajuste de tratamiento, tres por estrés, tres por menstruación, dos por uso de alcohol y tres por otras razones. En los 26 pacientes con falta de adhesión, 10 fueron por olvido de dosis, siete por negarse a tomar el medicamento, seis por causas económicas y tres por indicación de médico ajeno a la institución. Conclusiones. En México, la falta de adhesión al tratamiento representa un 25% de los casos de descontrol de la epilepsia, lo que es un área de oportunidad para incrementar la educación de higiene de crisis y disminuir la frecuencia de éstas

Introduction. Acute seizures in patients with epilepsy are a potential of source of neurological damage; their causes must be researched. Aim. To explore the epidemiology of acute seizure exacerbations in patients with epilepsy in a neurological emergency department in Mexico City. Patients and methods. Descriptive prospective study of patients with a previous diagnosis of epilepsy that receive medical care in an emergency department due to acute seizures. Results. 100 patients were analyzed between august 2016 and January 2017. 86 patients presented with focal seizures, of which 76 were focal to bilateral tonic-clonic, 2 with impaired awareness and motor onset, 3 with impaired awareness and non-motor onset, 1 without impaired awareness and motor onset, and 4 without impaired awareness and non-motor onset. 14 patients had generalized seizures with motor onset. The causes of exacerbation were as follows: 26 patients due to antiepileptic dose omission, 21 due to a unknown cause, 19 due to infection, 13 due to sleep deprivation, 3 due to stress, 3 were catamenial, 2 due to alcohol abuse and 3 due to other reasons. Of the 26 patients with dose omission, 10 were due to forgetfulness, 7 refused to comply with their prescription, 6 could not afford to buy their prescription and 3 had their prescription changed by another doctor. Conclusions. In Mexico, antiepileptic drug dose omission represents up to 25% of patients with acute seizure exacerbations; increased patient education on epilepsy hygiene measures may be an area of opportunity for reducing its frequency

WhatsApp in Stroke Systems: Current Use and Regulatory Concerns.

Smartphone use is extremely common. Applications such as WhatsApp have billions of users and physicians are no exception. Stroke Medicine is a field where instant communication among fairly large groups is essential. In developing countries, economic limitations preclude the possibility of acquiring proper communication platforms. Thus, WhatsApp has been used as an organizational tool, for sharing clinical data, and for real time guidance of clinical care decisions. It has evolved into a cheap, accessible tool for telemedicine. Nevertheless, regulatory and privacy issues must be addressed. Some countries have implemented legislation to address this issue, while others lag behind. In this article, we present an overview on the different roles WhatsApp has acquired as a clinical tool in stroke systems and the potential privacy concerns of its use.