Background Coronavirus disease-2019 (COVID-19), a pandemic that brought the whole world to a standstill, has led to financial and health care burden. We aimed to evaluate epidemiological characteristics, needs of resources, outcomes, and global burden of the disease. Methods Systematic review was performed searching PubMed from December 1, 2019, to March 25, 2020, for full-text observational studies that described epidemiological characteristics, following MOOSE protocol. Global data were collected from the JHU-Corona Virus Resource Center, WHO-COVID-2019 situation reports, KFF.org, and Worldometers.info until March 31, 2020. The prevalence percentages were calculated. The global data were plotted in excel to calculate case fatality rate (CFR), predicted CFR, COVID-19 specific mortality rate, and doubling time for cases and deaths. CFR was predicted using Pearson correlation, regression models, and coefficient of determination. Results From 21 studies of 2747 patients, 8.4% of patients died, 20.4% recovered, 15.4% were admitted to ICU and 14.9% required ventilation. COVID-19 was more prevalent in patients with hypertension (19.3%), smoking (11.3%), diabetes mellitus (10%), and cardiovascular diseases (7.4%). Common complications were pneumonia (82%), cardiac complications (26.4%), acute respiratory distress syndrome (15.7%), secondary infection (11.2%), and septic shock (4.3%). Though CFR and COVID-19 specific death rates are dynamic, they were consistently high for Italy, Spain, and Iran. Polynomial growth models were best fit for all countries for predicting CFR. Though many interventions have been implemented, stern measures like nationwide lockdown and school closure occurred after very high infection rates (>10cases per 100 000population) prevailed. Given the trend of government measures and decline of new cases in China and South Korea, most countries will reach the peak between April 1-20, if interventions are followed. Conclusions A collective approach undertaken by a responsible government, wise strategy implementation and a receptive population may help contain the spread of COVID-19 outbreak. Close monitoring of predictive models of such indicators in the highly affected countries would help to evaluate the potential fatality if the second wave of pandemic occurs. The future studies should be focused on identifying accurate indicators to mitigate the effect of underestimation or overestimation of COVID-19 burden.

Background Due to pro-inflammatory and hypercoagulation states, COVID-19 infection is believed to increase the risk of stroke and worsen the outcomes of the patients having pre-existing cerebrovascular diseases (CeVD). There is limited literature on prevalence of pre-existing CeVD in COVID-19 patients, and outcomes are unknown. The objective of this meta-analysis is to evaluate the outcomes of COVID-19 patients with pre-existing CeVD. Methods English full-text-observational studies having data on epidemiological characteristics of COVID-19 patients were identified searching PubMed, Web of Science, and Scopus using MeSH-terms COVID-19 OR coronavirus OR SARS-CoV-2 OR 2019-nCoV from December 1, 2019 to April 30, 2020. Studies having CeVD or stroke as one of the pre-existing comorbidities and described outcomes including intensive care unit (ICU) admission, mechanical ventilation utilization, and mortality were selected with consensus of three reviewers. Following MOOSE protocol, 11 studies were included. The pooled prevalence of CeVD and outcomes were calculated. Meta-regression was performed, and correlation coefficient (r) and odds ratio (OR) were estimated to evaluate the effects of pre-existing CeVD on outcomes of COVID-19 patients. Meta-analysis with random-effects model was used to calculate OR along with its 95% CI from the studies containing data on composite poor outcome. Results Out of 8/11 studies showing data on mortality and mechanical ventilation, and 7/11 on ICU admission, pooled prevalence of pre-existing CeVD was 4.4% (244/4987). In age-adjusted meta-regression analysis, pre-existing CeVD was

Introduction: Migraine is a chronic disabling neurological disease, with an estimated expense of $15-20 million/year. Several studies with a small number of patients have studied risk factors for migraine such as cardiovascular disorders, stroke, smoking, demographic, and genetic factors but this is the first comprehensive study for evaluation of vascular and nonvascular risk factors. It is important to evaluate all the risk factors that help to prevent the healthcare burden related to migraine. Methodology: We performed a retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) (years 2013-2014) in adult (>18-years old) hospitalizations in the United States. Migraine patients were identified using ICD-9-CM code to determine the demographic characteristics, vascular, and nonvascular risk factors. Univariate analysis was performed using the chi-square test and a multivariate survey logistic regression analysis was performed to identify the prevalence of the risk factors and evaluate the odds of prevalence of risk factors amongst migraine patients compared to nonmigraine patients, respectively. Results: On weighted analysis, after removing missing data of age, gender and race, from years 2013 to 2014, of the total 983,065 (1.74%) migraine patients were identified. We found that younger (median age 48-years vs. 60-years), female (82.1% vs. 58.5%; p<0.0001), white population (76.8% vs. 70.5%; p<0.0001), and privately insured (41.1% vs. 27.4%; p<0.0001) patients were more likely to have migraine than others. Cerebral atherosclerosis, diabetes mellitus, ischemic heart disease, atrial fibrillation, and alcohol abuse were not significantly associated with migraine. Migraineurs had higher odds of having hypertension [odds ratio (OR):

The opioid epidemic has been linked to several other health problems, but its impact on headache disorders has not been well studied. We performed a population-based study looking at the prevalence of opioid use in headache disorders and its impact on outcomes compared to non-abusers with headaches. Methodology We performed a cross-sectional analysis of the Nationwide Inpatient Sample (years 2008-2014) in adults hospitalized for primary headache disorders (migraine, tension-type headache [TTH], and cluster headache [CH]) using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. We performed weighted analyses using the chi-square test, Student's t-test, and Cochran-Armitage trend test. Multivariate survey logistic regression analysis with weighted algorithm modelling was performed to evaluate morbidity, disability, and discharge disposition. Among US hospitalizations during 2013-2014, regression analysis was performed to evaluate the odds of having opioid abuse among headache disorders. Results A total of 5,627,936 headache hospitalizations were present between 2008 and 2014 of which 3,098,542 (55.06%), 113,332 (2.01%), 26,572 (0.47%) were related to migraine, TTH, and CH, respectively. Of these headache hospitalizations, 128,383 (2.28%) patients had abused opioids. There was a significant increase in the prevalence trend of opioid abuse among patients with headache disorders from 2008 to 2014. The prevalence of migraine (63.54% vs. 54.86%), TTH (2.29% vs. 2.01%), and CH (0.59% vs. 0.47%) was also higher among opioid abusers than nonabusers (p<0.0001). Opioid abusers with headaches were more likely to be younger (43 years old vs. 50 years old), men (30.17% vs. 24.78%), white (80.83% vs. 73.29%), Medicaid recipients (30.15% vs. 17.03%), and emergency admissions (85.4% vs. 78.51%) as compared to opioid nonabusers with headaches (p<0.0001). Opioid abusers with headaches had higher prevalence and odds of morbidity (4.06% vs. 3.70%; adjusted odds ratio [aOR]: 1.48; 95% CI:

AAP approves pacifier use for soothing and calming, it recommends delaying its use until breastfeeding is well established. Though pacifiers have protective effects against SIDS, prolonged use of a pacifier can lead to complications. AAFP discourages the use by 6 months to 1 year of age. Pacifier use guidelines are not established primarily due to a paucity of information regarding initiation, termination, benefits, and harmful effects of pacifiers by parents. We aim to investigate pacifier use among caregivers of 0-1-year-old infants. It was a descriptive study of parents or caregivers of children 0-1 year of age who completed a questionnaire focused on pacifier use. Statistical analysis was calculated using SPSS version 23. 133 caregivers were interviewed. 118(88.7%) caregivers were mothers. 91 (68.4%) of caregivers identified as Hispanic and 42 (30.1%) as African American. Caregivers reported that mean pacifier use was 16 months and 3.4 hours/day. 106 (80%) reported the most common use of the pacifier alone was to calm the baby. For the weaning method, 37 (27.8%) stated that gradual decrease of pacifiers was useful whereas 33 (24.8%) stated that abrupt removal of pacifiers was effective. 72 (54.1%) reported that their family and friends recommended pacifiers. 11 (8.3%) caregivers reported that information about pacifiers was provided by medical and day-care providers. Pacifier use was not significantly related to the feeding method during the first two months of life. This study identifies impressions and common misconceptions of pacifier use which may assist in the development of comprehensive guidelines.