21/50 (42%) patients had post-stroke dysphagia during their hospital course. Among infarcts, Total Anterior Circulation Infarcts (TACI) had 100% incidence of dysphagia, followed by Partial Anterior Circulation Infarcts (PACI-36%), Posterior Circulation infarcts (POCI-33%), and Lacunar infarcts (LACI-18%). 67% of hemorrhages had post-stroke dysphagia. Staff swallowing assessment had a sensitivity and specificity of 75% and 73% respy., for predicting respiratory morbidity. The corresponding figures for Pulse oximetry were 79% and 91%.
Background: A number of acute respiratory infections outbreaks such as the 2009 influenza A (H1N1) and the Middle East respiratory syndrome coronavirus (MERS-CoV) have emerged and presented a considerable global public health threat. Epidemiologic evidence suggest that diabetic subjects are more susceptible to these conditions. However, the global influence of diabetes to the severity of H1N1 and MERS-CoV is yet to be evaluated.Objective: The aim of this study was to carry out a systematic review and meta-analysis documenting the prevalence of diabetes in sever H1N1 and MERS-CoV to enable estimating its contribution to the severity of these conditions.Methods & Materials: A search strategy was developed for online databases (PubMed, Ovid MEDLINE, Embase and Embase Classic) using H1N1, MERS-CoV and DIABETES as search terms. Reports documenting the prevalence of diabetes in these conditions were identified. Meta-analysis for the proportions of diabetes in sever conditions (95% confidence intervals, CI) was carried out (29 H1N1 studies, n=92,948 subjects and 9 MERS-CoV studies, n=308). Weighted averages of the extracted information and subgroup analysis (by region) were carried out.Results: Average age of H1N1 patients (38.0 ± 9.2 yrs) was lower than that MERS-CoV patients (54.9 ± 10.1 yrs, p<0.05). The prevalence rates of clinical symptoms such as pyrexia, dyspnea, pharyngitis and pertussis were comparable between the two conditions. Compared to MERS-CoV patients, H1N1 subjects exhibited 3-fold lower prevalence of cardiovascular diseases and 2-and 4fold higher obesity and immunosuppression rates, respectively. The prevalence of diabetes in sever H1N1 was 14.6% (95%CI: 12.3-17.0%; p<0.001), a 3.7-fold lower than in p<0.001). The contribution of diabetes to the severity of H1N1 from Asia (18%) and North America (20%) was 2-fold higher than that from South America (9.8%) and Europe (10%).
Conclusion:The effect of diabetes is 4-fold higher in MERS-CoV than in H1N1 and may play a significant role in the susceptibly to these conditions and vulnerability to their ensuing sever complications. The high prevalence of diabetes in H1N1 in North America and Asia may reflect its elevated prevalence in these regions.
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