hsCRP level and cognitive function in ischemic stroke patients: systematic review

Increased level of High sensitivity C-reactive protein (hsCRP) is associated with poor ischemic stroke functional outcomes according to several previous studies. However, there are no studies that specifically evaluate cognitive function. This systematic study aims to perform a narrative analysis of hsCRP levels with cognitive function in ischemic stroke patients. A systematic search of research articles was carried out on electronic databases using the PRISMA guidelines and on the bibliography on the references of the relevant articles. The electronic databases used are PubMed/Medline, Cochrane, Wiley Online Library, Scopus, Science Direct, and Google Scholar. The included study designs were cross-sectional, case-control, and prospective cohort studies. The risk of bias was analyzed by using ROBINS-1 and the quality of research by using GRADE. From eight studies, there were four studies that in addition to examining hsCRP also examined other inflammatory markers i.e.; fibrinogen (1 study) and homocysteine (3 studies). The risk of bias assessment tool for ROBINS-I indicated a high risk of outcome assessment blinding for eight studies. The quality of studies was assessed by GRADE showed low quality. Results indicated an association between elevated hsCRP and poor cognitive outcome in ischemic stroke patients. The hsCRP examination can be considered in ischemic stroke patients to predict cognitive function. However, as a routine examination, further studies are still needed

NEUROLOGICAL ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI) ON HEALTH WORKFORCE OF A SECONDARY REFERRAL HOSPITAL IN SOUTH SULAWESI WHO RECEIVED THE

Background: The COVID-19 vaccination can relate to the occurrence of neurological adverse events following immunization (AEFI) that could impact work and daily activities. This problem is particularly important in the health workforce. However, little is known about neurological AEFI among the health workforce working in peripheral facilities. Objective: To study the neurological AEFIs and their impact among the health workforce who received the COVID-19 vaccination in a secondary referral hospital in South Sulawesi, the Andi Makassau Hospital (Rumah Sakit Umum Daerah Andi Makassau/RSAM). Methods: The COVID-19 pandemic, we created a questionnaire about neurological AEFIs and their effects which were distributed online using the Google Form application to the health workforce at the RSAM who had received at least one dose of COVID-19 vaccination. Results: We obtained 97 subjects. There were 78.5% neurological AEFIs with the most reported type being muscle pain (16%). Most neurological AEFIs were experienced by women (84.9%), age group 21-35 years (53.8%), and non-doctors/nurses (60.8%). The significant influencing factors in multivariate analysis were age group 36-45 years (p = 0.04), nursing proffesion (p = 0.005), and non- viral-based baccine type (p = < 0.0001). Conclusion: Neurological AEFI is commonly found among the health workforce who received the COVID-19 vaccination. However, it only has a little impact on their work and attitudes towards vaccination. This may be because all subjects experienced mild neurological AEFI

Lower GCS is Related to Poor Outcome among Acute Stroke Patients with COVID-19 in A Tertiary Referral Hospital in Indonesia

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has forced the health workforce to take mitigative measures such as physical distancing, screening, personal protective equipment donning, and confinement on patient care. We aimed to study the outcome of acute stroke patients with suspected, probable, or confirmed COVID-19 in a tertiary referral hospital in Indonesia during the first year of COVID-19 pandemic.METHODS: This was a retrospective study examining all medical records of adult patients suffering from acute stroke with suspected or confirmed COVID-19 who were admitted to R.D. Kandou Hospital, Manado, Indonesia, between March 2020 to March 2021. Clinical and laboratory parameters were compared between subjects with poor and good outcomes based on Glasgow Outcome Scale (GOS), divided into poor outcome (GOS 1-3) and good outcome (GOS 4-5).RESULTS: Fourty-six eligible subjects were enrolled in the study. Based on the GOS, 36 subjects (78.3%) were admitted to the hospital with poor prognosis. On admission, the median Glasgow Coma Scale (GCS) was 11, breathlessness was found in 54.3% of subjects, fever was found in only 15 subjects (32.6%), and the lowest oxygen saturation on admission 95%. We found that GCS significantly related to outcome after controlled for other factors using the logistic regression method (p=0.03; 95% CI=1.08-4.78).CONCLUSION: Lower GCS can be used to predict poor outcome in acute stroke patients with COVID-19.KEYWORDS: COVID-19, acute stroke, Glasgow Coma Scale, outcome, Indonesi