RESUMEN
The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p = 0.004, 95% CI 6.513 to - 2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable (p = 0.519, 95% CI - 1.605 to 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 h (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.
Asunto(s)
Atención Integral de Salud/organización & administración , Infecciones por Coronavirus/terapia , Prestación Integrada de Atención de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Neumonía Viral/terapia , Accidente Cerebrovascular/terapia , Anciano , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Grupo de Atención al Paciente/organización & administración , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Recuperación de la Función , Derivación y Consulta/organización & administración , Singapur/epidemiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Factores de Tiempo , Tiempo de Tratamiento/organización & administración , Resultado del Tratamiento , Flujo de TrabajoRESUMEN
This report describes the clinical features of H1N1 2009 influenza infection in 10 young renal patients receiving chronic dialysis or immunosuppressants, and to compare their durations of viral shedding with 20 healthy controls. Although patients shed the virus for longer periods compared with controls, all had a self-limited clinical course. Studies on indications, dosages and durations of antiviral therapy in renal and immunocompromised patients are warranted.