Hospital Delay Research Articles

214. Clinical Characteristics and Outcomes of Patients Treated with Tecovirimat for Mpox Disease: A Large Cohort in New York City

Abstract Background Clinical characteristics and outcomes in patients with mpox treated with tecovirimat are not well described. Methods We requested retrospective deidentified data from healthcare systems in New York City (NYC) with >50 tecovirimat prescriptions. Patients with probable or confirmed mpox initiating tecovirimat from May–December 2022 were included. We used a survey tool to extract demographic and clinical data from medical records. Patients reporting tecovirimat initiation at a different institution or with unknown HIV status were excluded. We used multivariable Poisson regression models with robust standard errors to examine factors associated with hospitalization and treatment delays. Results Of 751 eligible records, we excluded 41, leaving 708 patients in the analysis; median age was 36 years (IQR 31–43); 694 (98%) were assigned male at birth; 566 (80%) were cisgender men who have sex with men; 399 (56%) were living with HIV; and 232 (33%), 195 (28%), and 182 (26%) identified as Hispanic, non-Hispanic (NH) white, and NH Black, respectively. Reasons for treatment included proctitis (n=376, 53%), lesion type (confluent, location) (335, 47%), HIV (237, 33%), and bacterial superinfection (58, 8%). Side effects (100, 14%) and severe adverse events (7, 1%) were rare. The most common long-term sequela was scarring (69,10%) (Table 1). Of 100 (14%) hospitalized patients, reasons for hospitalization included pain (25%), bacterial superinfection (22%), and dysphagia (13%) (Table 2). Median delay from symptom onset to treatment initiation was 8 days (IQR 6–11). NH Black patients had higher risk of initiating ≥8 days after symptom onset (adjusted relative risk [aRR]=1.4, 95%CI: 1.2–1.7) and being hospitalized (aRR=2.2, 95%CI: 1.4–3.5) compared with Hispanic patients, adjusting for HIV and insurance status (Tables 3,4). Conclusion We described common reasons for tecovirimat initiation and hospitalization. There were racial and ethnic disparities in hospitalization and treatment delays that may have been due to late presentation to care or provider-related delayed testing. More research and focused efforts to mitigate these disparities are needed. These findings may better inform decisions for treatment initiation and hospitalization for mpox. Disclosures Ofole Mgbako, MD MS, Gilead: Advisor/Consultant

Modelling the impacts of hospitalization, social dynamics and time delay from an epidemiological approach

Modelling the impacts of hospitalization, social dynamics and time delay from an epidemiological approach

Factors associated with late hospital arrival in acute stroke patients of Bangladesh

ObjectivesUnderutilisation of thrombolysis is a major problem in patients with stroke in Bangladesh as patients do not arrive within the therapeutic window due to delays in their way to emergency...

Mathematical analysis of the effects of precarious health system on COVID-19 transmission dynamics: case of Burkina Faso

n the early moments of the pandemic of coronavirus disease 2019 (COVID-19), the level of effectiveness in treatment and management of patients was limited due to the lack of effective medications and adapted infrastructures in several countries especially in most developing countries. In this study, we propose an SIR-pattern model to investigate the epidemiological effect of delay in hospitalization and case managements. After computing the basic reproduction number thanks to the Next Generation Matrix method, we proved that the model has a locally asymptotically stable disease-free equilibrium whenever the basic reproduction number is less than one, and condition which ensure the appearance of two endemic equilibria indicating the possibility of having backward bifurcation is determined. When the basic reproduction number exceeds one, Lyapunov functional technique is used to establish the global stability of the unique endemic equilibrium point. Also, we presented a local sensitivity analysis that gives better understanding of the role of each model parameter appearing in the basic reproduction number. Numerical simulation of the model is also performed to corroborate the analytical results. Finally, we fitted our model by using reported data for Burkina Faso, and the results showed that it can be used for predicting the disease outcomes.

Delays in Presentation, Diagnosis, and Treatment Among Patients With GI Cancer in Southwest Nigeria.

The incidence of GI cancers is increasing in sub-Saharan African countries. We described the oncological care pathway and assessed presentation, diagnosis, and treatment intervals and delays among patients with GI cancer who presented to the Obafemi Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria. We analyzed data from 545 patients with GI cancer in the African Research Group for Oncology (ARGO) database. We defined presentation interval as the interval between symptom onset and presentation to tertiary hospital, diagnostic interval as between presentation and diagnosis, and treatment interval as between diagnosis and initiation of treatment. We considered >3 months, >1 month, and >1 month to be presentation, diagnosis, and treatment delays, respectively. We compared lengths of intervals using Mann-Whitney U tests and logistic regression. The most frequent cancer types were pancreatic (32%) and colorectal (28%). Most patients presented at stages III (38%) and IV (30%). The median presentation interval was 84 days (IQR, 56-191), and 49% presented after 3 months or longer. The median diagnosis and treatment intervals were 0 (IQR, 0-8) and 7 (IQR, 0-23) days, respectively. There was no relationship between age, sex, education, or distance to tertiary hospital and presentation delay, but patients with stage III to IV versus I to II had higher odds of presentation delay (odds ratio [OR], 1.68 [95% CI, 1.13 to 2.50]). Among patients with pancreatic cancer, older patients were less likely to have a diagnosis delay (OR, 0.50 [95% CI, 0.25 to 0.98]). About half of patients with GI cancer in Ile-Ife, Nigeria, did not present to tertiary hospitals until more than 90 days after noticing symptoms. Efforts are warranted to improve public knowledge of GI cancer symptoms and to strengthen health systems for prompt diagnosis and referral to specialty care.

A Social Survey on the COVID-19 Mortality Related to the First 48 Hours of Hospitalization

Background: COVID-19, caused by severe acute respiratory syndrome (SARS), is known for high mortality rates across the globe. Nonetheless, early diagnosis and treatment of this infectious disease are critical for increasing the recovery and survival of patients. The present study aimed to investigate the causes of delays in referring to hospitals regarding COVID-19 deaths in the first 48 hours of hospitalization to reduce mortality. Methods: In this cross-sectional study, we extracted data from the families of 213 patients who died of COVID-19 between February 2020 and February 2021 in Mashhad, Iran. The data were collected via phone using an 18-item checklist designed by a panel of experts and related to the causes of hospitalization delays. Results: Out of the 213 patients who died of COVID-19 in hospitals, 62.5% (133) were male, older (64±12 years), illiterate (42%), and with one or more comorbidities (92.4%). Regarding the effect of 10 delay causes in the checklist related to hospitalization, it was reported that the highest score pertained to the fear of hospitalization (55.8%), following physicians’ advice about not referring to hospitals (44.1%), and taking herbal medicines (32.3%), respectively. Conclusion: Certain groups at higher risk of COVID-19 mortality included males, older individuals, and those with comorbidities. Fear of hospitalization was the main reason for delays in referring to hospitals, suggesting the role of demographic characteristics, socioeconomic status, and, most importantly, the role of social factors in increasing premature mortality.

Cochlear implantation in pediatrics: Impact of newborn hearing screening on intervention time

ObjectivesThe newborn hearing screening (NHS) program was globally established for early hearing loss (HL) identification and intervention. Early intervention is essential to minimize or prevent the negative consequences of HL. In Saudi Arabia, the NHS was officially implemented in 2016. Currently, its impact on the timing of cochlear implantations (CIs) in Saudi Arabia remains unclear, and information on potential hospital-related delays affecting early implantation is lacking. Thus, this study aimed to evaluate the effect of implementing the NHS on age at CI in children with prelingual deafness in a CI center in Saudi Arabia, and to evaluate the hospital timing in the CI process. MethodsAll pediatric CI users who presented for the first time to the CI committee (CIC) at a tertiary center and received their implants between 2015 and 2022 were enrolled in this study. Date of birth (DOB), date of presentation to the CI committee (DOCIC), and date of CI surgery (DOCIS) were retrospectively reviewed. ResultsIn total, 304 CI children were included in the analysis. Approximately 55 % of the children (n = 167) were screened for HL through the NHS, whereas 45 % of the children (n = 137) were born before the launch of the NHS. Both age at the presentation to the CIC (i.e. difference between DOCIC and DOB) and age at implantation (i.e. difference between DOCIS and DOB) were significantly earlier in children who were screened for HL through the NHS than those who were not screened (P < 0.0001). The time difference between the DOCIC and DOCIS was not significantly different between the screened and unscreened children (P > 0.05). ConclusionThe implementation of the NHS in the tertiary center has a significant positive effect on age at presentation to the CIC and age at implantation, but not on the actual CI surgery. Further research is needed to reduce the hospital delays before the actual surgery in order to increase the likelihood of children receiving implantation early in their life.

VERY MOBILE LEFT VENTRICULAR PAPILLARY FIBROELASTOMA PRESENTING WITH ISCHEMIC STROKE

Abstract Papillary fibroelastomas are small and pedunculated left side valves associated mass, that frequently causing cerebral embolization; they are composed of collagen and elastic fibers and are usually connected with a pedicle to the endocardial layer. Differential diagnosis with endocarditis can rely on the side of attachement: Papillary fibroelastomas are more frequently found downstream the valves, instead, endocarditis are mostly found upstream the valves. They are mostly located (&amp;gt;80%) on valvular surfaces, more commonly on left side cardiac valves (44% on the aortic valve and 35% on the mitral valve); therefore, in the present knowledge, papillary fibroelastomas arising from left ventricular myiocardial wall are rare and mostly anecdotally descripted. We present the case of a 78–year–old man, diabetic, with no cardiac history, hospitalized with a right capsulo–lenticular stroke. Symptomatic due to left hemiparesis, he did not undergo thrombolysis due to a delay in hospitalization of almost 24 hours. The transthoracic and then transesophageal echocardiogram showed the presence of a hyperechogenic, floating mass of approximately 3 cm at the level of the left ventricle, separate from the mitral valve and attached to the mid–distal anterior septum and the ventricular apex (Figure 1). Cardiac MRI confirmed the presence of a peduncolate left ventricular mass, isointense on cine sequences, without myocardial infiltration, isointense on T1–weighted images and mildy hyperintense on T2–weighted images, with mild uniform late–gadolinium enhancement (Figure 2). The patient underwent surgical removal of the mass: histological analysis showed multiple, branching fronds of paucicellular, avascular fibroelastic tissue lined by a single layer of endocardium, with positive stains at Weigert coloration for elastic fibers (Figure 3). Histomorphological analysis was compatible with papillary fibroelastoma. This is a very atypical case of papillary fibroelastoma, due to the large size of the mass and the intraventricular and not–valvular location, which determined its emboligenicity and which, if not removed, would have exposed the patient to an enormous risk of recurrence of stroke.

Reasons and extent of delay in the diagnosis of pulmonary tuberculosis after the appearance of symptoms.

Delay in the diagnosis of tuberculosis (TB) is a significant problem at both individual and community levels. Delayed diagnosis of TB contributes to more severe disease manifestations, higher risk of death, and higher disease transmission in the community. We conducted this study to assess the extent and associated reasons for delay in diagnosis of pulmonary TB. This study was conducted in the Department of TB and Respiratory Diseases, J. N. Medical College, Aligarh, from June 2020 to May 2022. A total of 2053 new pulmonary TB patients, who first consulted any private healthcare provider (HCP) for treatment, were enrolled in the study. The required information was collected by interview technique using a predesigned questionnaire. A total of 2053 patients were enrolled in the study. There was a significant delay of more than 2 weeks in the diagnosis of pulmonary TB after the onset of symptoms in 94% of patients. The extent of delay ranged from 8 days to 240 days with a mean of 36.33 days. The delay in visiting the HCPs by the patient was not significant. Only 5.85% of patients had a significant delay of more than 2 weeks in seeking any health care after the appearance of symptoms. A delay by HCP contributed to a greater portion of the total delay, with a mean of 31.77 days. The main reason for the delay by HCPs was not investigating TB. The hospital delay was not significant. The mean hospital delay was 5.82 days. The delay in the diagnosis of TB in India is very high. A delay by HCPs contributes to a greater portion of the total delay. Information, Education and Communication (IEC) activities will play an important role in reducing the delay. All HCPs should be actively involved in subjecting the suspects to TB diagnosis at the earliest possible as per National Tuberculosis Elimination Programme (NTEP) guidelines.

Time to scale-up point-of-care ultrasound (POCUS) in obstetrics and gynaecology in Nigeria

The availability, affordability and portability of high-resolution-ultrasound machine in recent years have made ultrasound an indispensable point-of-care diagnostic and procedural tool in current practice of Obstetrics and Gynaecology. POCUS is a goal-directed (focused/emergency) ultrasound examination performed by the healthcare provider in the consulting office or patient’s bedside to make a specific diagnosis that will direct timely and definitive treatment of the patient. It improves clinical outcomes, prevents hospital delays, promotes swift definitive treatment, reduces cost and enhances patient satisfaction without exposure to ionizing radiation. It is a readily available care in Obstetrics and Gynaecology. Skills acquisition in POCUS should be incorporated in teaching programs for midwives, medical students, resident doctors and consultants. This review aims to summarize the literature on the advances in ultrasound technology, indications and practice guidelines for clinicians’ POCUS examinations in Obstetrics and Gynaecology. Recommendations to fill the gaps in the current training and skills acquisition in Nigeria are proposed.

Clinical, Demographic, and Angiographic Profiles of Amarnath Pilgrims Presenting With Acute Coronary Syndrome.

The challenges posed by high altitude are particularly significant in terms of cardiovascular health. There are currently no data available on acute coronary syndrome (ACS) among Amarnath pilgrims. The objective of this study was to investigate the clinical and angiographic profiles of ACS among Amarnath pilgrims, focusing on demographic characteristics, risk factors, types of ACS, clinical presentation, angiographic findings, and in-hospital outcomes. By examining these aspects, we aimed to provide insights into the unique challenges faced by pilgrims during their spiritual journey and to identify potential strategies for improving the prevention and management of ACS in this population. Methods: This was a hospital-based, prospective, observational study that included patients who had participated in the pilgrimage and presented with ACS between 2022 and 2023. Results: Sixty patients were recruited for the study, with a mean age of 51.19 ± 11.17 years. Of these, 43 (71.7%) were male. Risk factors identified in the study included hypertension in 35 (58.3%), smoking in 23 (38.3%), diabetes mellitus in 18 (30%), and dyslipidemia in 25 (41.6%) patients. ST-elevation myocardial infarction (STEMI) was present in 46 (76.66%) patients, Anterior wall myocardial infarction (AWMI) occurred in 29 (48.3%), inferior wall myocardial infarction (IWMI) in 15 (25%), and high lateral wall myocardial infarction (HLWMI) in two (3.3%) patients. Of the 60 patients, 19 (31.6%) were in Killip class I, 16 (26.6%) were in class II, and 25 (41.6%) were in classes III or IV. The average time from the onset of symptoms to hospitalization was 7.6 ± 3.1 hours, significantly higher in those with Killip class III or IV (9.3 ± 3.6 vs. 5.4 ± 2.7 hours, p = 0.01). There were nine (15%) in-hospital deaths, and in the multivariate analysis, advanced Killip class (p = 0.04) and delays in hospitalization of more than six hours (p = 0.03) were found to be significant predictors of mortality. In conclusion, 40% of patients presented in the advanced Killip class, and 15% experienced in-hospital mortality. The average time from the onset of symptoms to hospitalization was significantly higher for those categorized in the advanced Killip classes. Our study highlights a significant association between advanced Killip class, delay in hospitalization, and in-hospital mortality among Amarnath pilgrims with ACS, underscoring the importance of timely intervention. It is recommended that appropriate measures be taken to improve patient outcomes in these cases.

Safety incident reporting and barriers (SIRaB) study: Strategies and approaches for investigating patient safety events in a hospital set-up.

Unsafe patient events not only entail a clinical impact but also lead to economic burden in terms of prolonged hospitalization or unintended harm and delay in care delivery. Monitoring and time-bound investigation of patient safety events (PSEs) is of paramount importance in a healthcare set-up. To explore the safety incident reporting behaviour and the barriers in a hospital set-up. The study had two sections: (a) Retrospective assessment of all safety incidents in the past 1 year, and (b) Understanding the barriers of safety reporting by interviewing the major stakeholders in patient safety reporting framework. Further root cause analysis and failure mode effect analysis were performed for the situation observed. Results were statistically analyzed. Of the total of 106 PSEs reported voluntarily to the system, the highest reporting functional group was that of nurses (40.57%), followed by physicians (18.87%) and pharmacists (17.92%). Among the various factors identified as barriers in safety incident reporting, fear of litigation was the most observed component. The most commonly observed event was those pertaining to medication management, followed by diagnostic delay. Glitches in healthcare delivery accounted for 8.73% of the total reported PSEs, followed by 5.72% of events occurring due to inter-stakeholder communication errors. 4.22% of the PSEs were attributed to organizational managerial dysfunctionalities. Majority of medication-related PSE has moderate risk prioritization gradation. Effective training and sensitization regarding the need to report the patient unsafe incidents or near misses to the healthcare system can help avert many untoward experiences. The notion of 'No Blame No Shame' should be well inculcated within the minds of each hospital unit such that even if an error occurs, its prompt reporting does not get harmed.

The changing pattern of pediatric burns in a territory burn center before and during the COVID-19 pandemic in China: A retrospective study

BackgroundPediatric burn patients are an essential part of burn populations. However, there is limited publicly available data on the epidemiological impact of COVID-19 on pediatric burns in China. ObjectiveIn this paper, pediatric burn patients admitted to the Department of Burn Surgery of the First Hospital of Jilin University before and during COVID-19 were retrospectively investigated to determine the impact of COVID-19 on pediatric burn inpatients. MethodsThe information of inpatients from July 2017 to December 2019 (pre-COVID-19 group) and from January 2020 to June 2022 (COVID-19 group) in the Department of Burn Surgery at the First Hospital of Jilin University was retrospectively investigated. Demographic information of patients, length of hospital stay, total body surface area (TBSA) of burn injury, post-injury visit time, comorbidity, surgical methods, etc., were statistically analyzed. ResultsThe COVID-19 group included 154 (10.2%) patients, and the pre-COVID-19 group included 335 (19.4%) patients (P＜0.001). There were no differences in gender, age, length of hospital stay, or etiology of burns between the two groups. Compared to the pre-COVID-19 group, patients in the pre-COVID-19 group experienced a significant delay in presentation (P＜0.001), had a larger TBSA of burn wound (P ＜ 0.001), were more prone to sustaining major burns (P ＜ 0.001), a higher likelihood of undergoing operations (P = 0.03), higher cost (P＜0.001) and more complications (P＜0.001). Additionally, upper extremities were the most commonly part involved in both groups (P = 0.004), with the lower extremities showed a significant increase to be involved in burn injury during COVID-19 pandemic (P = 0.007). Furthermore, the majority of guardians did not take first aid measures in both groups following burn injury (P = 0.102). ConclusionsDuring the COVID-19 pandemic period, scalds remained the main reason for hospitalization. The number of hospitalized patients has decreased dramatically, while the severity of burns has significantly increased, with a notable delay in hospital visits and an increased occurrence of complications.

How SWAT Changed the Conversation: Implementation of a Discharge SWAT Team Improves Morale and Facilitates Communication During the COVID-19 Pandemic.

Hospital overcrowding and delays in discharge are serious issues in the modern health care landscape and can lead to poor patient outcomes and health care personnel (HCP) burnout. The goal of this project was to develop a collaborative forum where HCP representing the entire spectrum of the inpatient care team, including case management team members, could connect to discuss challenges and barriers to patient discharge. The following describes the development, implementation, and outcomes of the discharge SWAT (Solutions, Wins, Actions, and Tactics) team, which is a 30-min virtual daily meeting where discussion is primarily centered around challenges in discharging individual patients and addressing case manager needs. The primary aim of SWAT meetings is fostering a positive atmosphere to address barriers to discharge while prioritizing patient care and outcomes. This study was conducted in a 40-hospital academic health system in the United States. SWAT meetings were first implemented at a representative flagship facility in a health system. HCP at this first facility were surveyed to assess satisfaction with SWAT meetings. SWAT meetings then were implemented at the majority of facilities in a 40-hospital academic health system. During SWAT implementation, average inpatient length of stay (LOS) and patient care transitions were monitored for participating and nonparticipating service lines. Among surveyed HCP, the majority view SWAT meetings favorably and reported that it was a valuable use of their time and positively impacted their work in the patient discharge space. Nonprovider and case management staff in particular valued the SWAT meetings and found them beneficial. LOS remained stable for patients under the care of participating providers, despite the upheaval of the ongoing COVID-19 pandemic, and the research team also observed a positive impact of SWAT meetings on appropriate inpatient care transitions.

Abstract WP44: Assessing Timely Care of WI's Critical Access Hospitals Acute Stroke Patients With a Speed and Efficiency Task Force

Introduction: Data indicates that rural residents are at 30% higher risk of stroke. 2 Thirty percent of Wisconsin’s (WI) residents live in a rural area and are more often served by smaller, critical access hospitals (CAH). WI Coverdell Stroke Program (Coverdell) data entry into Get With The Guidelines-Stroke® (GWTG) for 2022 shows 22.3% of stroke patient’s transfer from a spoke, often CAH, to a larger tertiary or hub hospital. To assist Coverdell participating (CAH) in timely care of acute stroke patients, Coverdell, American Heart Association® (AHA), and 32 CAH’s partnered to form a Speed and Efficiency Taskforce (TF). Methods: An agreed upon charter, framework and data goals were established in May 2022. Metrics of EMS pre-notification, arrival to CT, and door to needle (DTN) times were regularly reviewed. Evaluation of patients arriving within 4.5 hours of last known well (LKW), median DTN, and percent DTN &lt; 60 minutes were analyzed in two arrival windows. Hypothesized differences when comparing arrival windows of 0700-1900 and 1901-0659 were that the 1901-0659 window would have extended treatment times due to lack of 24/7 CT coverage and LKW not validated from others. Results: Data analysis for 2022. N=179 • Arrival to CT: 10 minutes faster in 1901-0659 window • Median DTN: 3 minutes faster in 0700-1900 window (71 vs 74 minutes respectively) • % DTN within 60 minutes: 12% higher compliance in 0700-1900 window Conclusions: Coverdell CAH’s are initiating the CT in a timely manner. Times are lower for arrivals between 1901-0659, ruling out delays due to CT tech non-availability. Delays in DTN treatment times within 60 minutes of arrival are more significant in the 1901-0659 arrival timeframe. The potential causes are a delay in telestroke consult with decision to treat, internal hospital delays in mixing and delivering thrombolytics, CT availability, and family/significant others present. Further research regarding arrival time affecting treatment need to be considered.

Where are the inequalities in colorectal cancer care in a country with universal healthcare? A systematic review and narrative synthesis

ObjectivePatients diagnosed with colorectal cancer living in more deprived areas experience worse survival than those in more affluent areas. Those living in more deprived areas face barriers to accessing timely,...

Psychosocial markers of pre-hospital delay in patients with diabetic foot: A cross-sectional survey.

This study aimed to determine the psychosocial markers associated with pre-hospital delay among patients with diabetic foot (DF). This study has a cross-sectional design. The participants completed a questionnaire including pre-hospital time, demographic characteristics, Social Support Rate Scale, Brief Illness Perception Questionnaire and Type D Personality Scale-14. Bivariate and multivariate analyses were conducted to explore independent associations with pre-hospital delay. Only 1.8% (3/164) of participants arrived at the hospital for medical care in 24 h of symptom onset. Patients with low utilization of social support (p = 0.029), low negative illness perceptions (p = 0.014) and high levels of negative affectivity (p = 0.009) are likely to arrive late at the clinic. Medical staff should pay attention to identifying diabetic patients' Type D personalities and take actions to improve their social support as well as illness perception, so as to reduce the occurrence of hospital delay. Psychosocial factors play a vital role in the delay in seeking medical treatment for patients with DF. Medical staff need to improve patients' illness perception as well as self-management ability through health education. Importantly, key family members provide an emotional and psychological support system for diabetic patients. Therefore, nurses need to work with family members together to give information and psychological support during family visits. Additionally, building and maintaining trust with patients is crucial to encouraging individuals to express their concerns and worries. In this case, nurses may identify patients' negative emotions and conduct timely intervention, so as to achieve favourable outcomes. This study used a convenience sample of 164 participants with DF recruited from the wound clinic of Northern Jiangsu People's Hospital and Yangzhou Hospital of TCM in China.

Abstract 12134: The Utilization Rate of Intravenous Thrombolysis in Asian Countries: A Systematic Review and Meta-Analysis

Introduction: Even though IV thrombolysis has been used for more than two decades, coverage remains inadequate. Asia, the region with the highest age-standardized incidence of ischemic stroke, has no regional data on IVT utilization at present. Objective: This study aimed to provide more accurate estimates of IVT usage for AIS in Asia. Methods: We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 15th March 2023. Results: A total of 67 observational studies with a total of 778,046 patients with ischemic stroke were included in the final analysis. In terms of regional distribution of studies, East Asia was the most common (n=12), followed closely by Arab (n=18), Southeast Asia (n=15), South Asia (n=12) and lastly Central and North Asia (n=2). In terms of the income level stratified by GDP of these countries, 35.8 % of them were classified as high-income countries, 40.3% were of lower-middle income countries and the rest (23.9%) being upper-middle-income countries. Our pooled analysis of 67 Asian studies revealed an IV thrombolysis rate of 9.1%. We discovered substantial variation in the thrombolysis rate across Asia, with 11.3% receiving thrombolysis in HIC countries and only 8.1% in LMICs; far below the American Stroke Association's target rate of 50%. Conclusion: Patients with ischemic stroke in HIC countries, countries/hospitals with their own guidelines/protocols, living in urban areas, and receiving care in hospitals with a public-private partnership are more likely to receive thrombolysis, according to our findings. Improving thrombolysis rates throughout Asia would be greatly aided by reducing prehospital and hospital delays, enhancing local infrastructure and human resources, and educating the public about stroke.

Prevalence and factors associated with pre-hospital delay among acute stroke patients at Mulago and Kiruddu national referral hospitals, Kampala: a cross-sectional study

BackgroundDespite advancements in acute stroke care, acute stroke patients present late for care resulting in high mortality and poor functional outcomes. This study determined the prevalence of pre-hospital delay and associated factors among adult acute stroke patients in Uganda.MethodsIn a hospital based, cross-sectional study, one hundred and forty-three study participants with confirmed acute stroke presenting to the emergency units of Mulago and Kiruddu national referral hospitals were enrolled. Using an interviewer-administered questionnaire, details on sociodemographics, onset of stroke, arrival at the tertiary facility, health system and clinical factors were collected. Descriptive statistics and modified Poisson regression analyses were performed to determine factors associated with prehospital delay.ResultsAmong the 143 study participants, nearly two-thirds (79/146) had ischemic stroke while a third (59/143) had haemorrhagic stroke. The mean age was 59 years (SD 16) and 51.7% of acute stroke patients were males. Ninety one percent (130/143) presented to the emergency unit after 3 hours. The majority (124/143) reported visiting lower-level facilities prior to referral to the tertiary facility. Staying outside Kampala district (PR: 1.28 (1.22–1.34), p < 0.001), and using hired or government ambulance for transport to tertiary facility (PR: 1.17 (1.13–1.20), p < 0.001) were associated with pre-hospital delay.ConclusionsPrevalence of pre-hospital delay among acute stroke patients presenting to public tertiary hospitals in Uganda is very high. The causes of pre hospital delay should be further explored qualitatively. Efforts to reduce prehospital delay should include improving pre-hospital transport systems for stroke patients.

Potential role of IgM-enriched immunoglobulin as adjuvant treatment in severe SARS-CoV-2 infection.

Severe COVID-19 patients are characterized by a dysregulated host response to an infection, with uncontrolled pro- and anti- inflammatory pathway activation. Consistent proportion of patients require admission in intensive care units and are at risk of progression to severe forms of disease. These patients are generally admitted during later stages of the disease, when effective antiviral and monoclonal antibody are not indicated. We aimed to assess the potential role of IgM-enriched intra venous immunoglobulins (IGAM) preparations in this setting. This retrospective, observational case-controlled study was conducted at a single-center University Hospital of Udine in the Friuli Venezia Giulia Region of Italy. Patients referring to the center between March 2020 and April 2021 was included. During the study period, patient who received Pentaglobin® IGAM treatment (N.=56), administered as compassionate use, was compared with a control group (N.=169) to assess, by propensity score analysis, clinical outcome. Untreated controls required, respect to patient treated with IGAM therapy, longer time to hospitalization with no significant differences in death and orotracheal intubation requirement. Significant differences in the two cohort were in: SOFA was higher in treated, while D-dimer and P/F ratio was better in the treatment cohort. Multivariate logistic regression analysis performed on the "matched sample," obtained by a weighting propensity score approach, identify, as significant protective factor for death outcome, the Pentaglobin® treatment (0.820 [0.698-0.963], P=0.016) and low C-reactive protein (1.001 [1.000-1.002], P=0.031) value while the delay of onset hospitalization is associate with a worst outcome (0.983 [0.967-0.999], P=0.041). The present study offers a significant insight concerning the use of IgM-enriched immunoglobulin preparations in patients with SARS-CoV-2 severe infection and also could identifying the specific immunological and biochemical profile of the patient who can more benefit from this therapeutic option.