COVID-19 has been associated with a hypercoagulable state causing cardiovascular and neurovascular complications. To further characterize cerebrovascular disease (CVD) in COVID-19, we review the current literature of published cases and additionally report the clinical presentation, laboratory and diagnostic testing results of 12 cases with COVID-19 infection and concurrent CVD from two academic medical centers in Houston, TX, USA, between March 1 and May 10, 2020. To date, there are 12 case studies reporting 47 cases of CVD in COVID-19. However, only 4 small case series have described the clinical and laboratory findings in patients

Background Delayed cerebral ischemia is common after aneurysmal subarachnoid hemorrhage (aSAH) and is a major contributor to poor outcome. Yet, while generally attributed to arterial vasospasm, neurologic deterioration may also occur in the absence of vasospasm. Objective To determine the relationship between delayed infarction and angiographic vasospasm and compare the characteristics of infarcts related vs. those unrelated to vasospasm. Methods A retrospective review of patients with aSAH admitted from July 2007 through June 2011. Patients were included if they were admitted within 48 hours of SAH, had a CT scan both 24–48 hours following aneurysm treatment and ≥ 7 days after SAH, and had a catheter angiogram to evaluate for vasospasm. Delayed infarcts seen on late CT but not post-procedurally were attributed to vasospasm if there was moderate or severe vasospasm in the corresponding vascular territory on angiography. Infarct volume was measured by perimeter tracing. Results Of 276 aSAH survivors, 134 had all imaging requisite for inclusion. 54 (34%) had moderate or severe vasospasm, of which 17 (31%) had delayed infarcts, compared to only 3 (4%) of 80 patients without vasospasm (p<0.001). There were a total of 29 delayed infarcts in these 20 patients; 21 were in a territory with angiographic vasospasm while 8 (28%) were not. Infarct volume did not differ between vasospasm-related (18±25cc) and vasospasm-unrelated (11±12cc) infarcts (p=0.54), but infarcts in the absence of vasospasm were more likely watershed (50% vs. 10%, p=0.03). Conclusion Delayed infarcts following aSAH can occur in territories without angiographic vasospasm and are more likely watershed in distribution.

Early infarction occurs frequently after SAH and contributes as much as delayed cerebral ischemia to infarct burden and hospital outcome. Efforts to better understand and modify contributors to early infarction appear warranted.

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The ongoing COVID-19 pandemic increases the consumption of antimicrobial substances (ABS) due to the unavailability of approved vaccine(s). To assess the effect of imprudent consumption of ABS during the COVID-19 pandemic, we compare the 2020 prevalence of antidrug resistance (ADR) of Escherichia coli ( E. coli ) with a similar survey carried out in 2018 in Ahmedabad, India using SARS-CoV-2 gene detection as a marker of ABS usage. We found a significant ADR increase for in 2020 compared to 2018 in ambient water bodies, harbouring a higher incidence of ADR E.Coli towards non-fluoroquinolone drugs. Effective SARS-CoV-2 genome copies were found to be associated with the ADR prevalence. The prevalence of ADR depends on the efficiency of WWTPs (Wastewater Treatment Plants) and the catchment area in its vicinity. In year 2018 study, prevalence of ADR was discretely distributed, and the maximum ADR prevalence recorded was ~60%; against the current homogenous ADR increase, and up to 85% of maximum ADR among the incubated E.coli isolated from the river (Sabarmati) and lake (Chandola and Kankaria) samples. Furthermore, wastewater treatment plants showed less increase in comparison to the ambient waters, which eventually imply that although SARS-CoV-2 genes and faecal pollution may be diluted in the ambient waters, as indicated by low C t -value and E.coli count, the danger of related aftermath like ADR increase cannot be nullified. Also, Non-fluoroquinolone drugs exhibited overall more resistance than the quinolone drugs. Overall, this is probably the first ever study that traces the COVID-19 pandemic imprints on the prevalence of antidrug resistance (ADR) through wastewater surveillance and hints at monitoring escalation of other environmental health parameters. This study will make public and policyholders concerned about the optimum use of antibiotics during any kind of treatment.