Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction

Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient

Mucormycosis is an opportunistic fungal disease that commonly presents as cutaneous or rhinocerebral infections associated with immunocompromised states. It may exceptionally present as isolated involvement of the brain with a varied clinical presentation, which may be difficult to diagnose early, leading to increased mortality. Herein, we report the case of a 42-yearold immunocompetent female with left-sided limb weakness and a history of recurrent vomiting and headache for the last two years. Clinically, glioma was suspected, but histopathological examination revealed a few broad aseptate fungal hyphae. As no other organ was involved, the diagnosis of isolated cerebral mucormycosis was rendered. Reporting this case, we show an unusual presentation of a central nervous system mucormycosis masquerading a tumor in an immunocompetent patient. The case also highlights the importance of a careful histopathological examination to avoid missing the presence of occasional fungal hyphae. Ideally, recognition of fungal hyphae in the brain, during intraoperative consultation, can prompt brain tissue culture for definitive diagnosis and early empirical antifungal therapy, Mucormycosismay prove life-saving

The effectiveness of a dose based reporting tool in reducing vaccine wastage at primary care clinics in Delhi, India: an operational research study

Minimizing vaccine wastage and associated costs is considered a key target for appropriate vaccine management. In India, the Rotavirus Vaccine (RVV) (2019) and the fractionated injectable polio vaccine (f-IPV) (2016) are more prone to wastage with high procurement costs. In this operational research study, we determined the effectiveness of a (self-designed) dose based reporting tool (DBRT) in reducing vaccine (f-IPV and RVV) wastage at primary care facilities in India during December 2019 to March’ 2020. Data reports of all the immunization sessions conducted at three primary care facilities were analyzed to calculate the wastage rates of the RVV and the f-IPV for the following periods: (1). Period of initiation (August-November’ 2019) (2). Pre-intervention with sensitization of healthcare providers (December’ 2019-January’ 2020) (3). Post-intervention after application of the DBRT. Intervention: The DBRT is a paper-based reporting format that assigns a unique code to each RVV and IPV vial. The health facility is required to report the total doses administered from each coded vial during every immunization session by updating it on the assigned reporting format. Pre-intervention, the average monthly wastage of f-IPV was 23.5% and of the RVV ranged from 18%-31%. Post-intervention, on using the DBRT, the monthly wastage of both RVV and f-IPV dropped significantly to 8.6% and 11.4%, respectively. During the subsequent month, the IPV wastage further decreased to only 4.7%. In conclusion, the DBRT reduces vaccine wastage in government primary care facilities by enabling a paper audit trail that promotes responsiveness and accountability among healthcare workers directly involved in vaccine administration

Transition Based Discount Factor for Model Free Algorithms in Reinforcement Learning

Reinforcement Learning (RL) enables an agent to learn control policies for achieving its long-term goals. One key parameter of RL algorithms is a discount factor that scales down future cost in the state’s current value estimate. This study introduces and analyses a transition-based discount factor in two model-free reinforcement learning algorithms: Q-learning and SARSA, and shows their convergence using the theory of stochastic approximation for finite state and action spaces. This causes an asymmetric discounting, favouring some transitions over others, which allows (1) faster convergence than constant discount factor variant of these algorithms, which is demonstrated by experiments on the Taxi domain and MountainCar environments; (2) provides better control over the RL agents to learn risk-averse or risk-taking policy, as demonstrated in a Cliff Walking experiment

Partial siamese twin as potential organ donor

During evaluation of a partial Siamese twin for removal of nonviable parasitic part in an 8-year-old male child, a fully functional kidney was found. The functional status of the extra kidney was found to be within acceptable limits for the purpose of transplant, which was subsequently done in a 24-year-old patient with end-stage renal disease. The recipient is healthy 19 months after the surgery. The possibility of using organs from a partial Siamese twin makes this a unique case report

A Grusome trend in Homicidal Crimes, Cut Throat- A case series Medical Science The International Weekly Journal for Medicine The International Weekly Journal for Medicine

Globally, cut throat injuries account for approximately 5 % to 10 % of all traumatic injuries. The distinction between homicidal, suicidal and accidental wounding is a central issue for forensic experts. Cut-throat wounds are “effective ” in homicidal attacks with sharp & heavy sharp weapons. While accidental injuries in this topographic region caused by sharp objects are rarely seen and most often caused by broken glass. Suicidal incised neck wounds are typically multiple, being characterized by a number of hesitation cuts parallel to the wound. In these cases, presence or absence of particular features (e.g., hesitation marks, defensive wounds) can allow distinction between suicide and homicide, especially if further circumstances, i.e. atypical crime scene scenarios or missing suicide notes, need the forensic pathologist to have an incredulous approach regarding the manner of death. The present article describes five cases of homicidal cut throat injuries- history and autopsy findings are discussed. Key Words: sharp weapon injuries, cut-throat, homicide, autopsy. 1