Background: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. Aims: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy (MT), stroke, and intracranial hemorrhage (ICH) hospitalizations over a 3-month period at the height of the pandemic (March 1 to May 31, 2020) compared with two control 3-month periods (immediately preceding and one year prior). Methods: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. Results: The hospitalization volumes for any stroke, ICH, and MT were 26,699, 4,002, and 5,191 in the 3 months immediately before versus 21,576, 3,540, and 4,533 during the first 3 pandemic months, representing declines of 19.2% (95%CI,-19.7 to -18.7), 11.5% (95%CI,-12.6 to -10.6), and 12.7% (95%CI,-13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/MT centers. High-volume COVID-19 centers (-20.5%) had greater declines in MT volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p<0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusion: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, MT procedures, and ICH admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/MT volumes.

Introduction: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The objective was to examine whether subarachnoid hemorrhage(SAH) hospitalizations and ruptured aneurysm coiling interventions demonstrated similar declines. Methods: We conducted a global, retrospective, observational study across 6 continents, 37 countries, and 140 comprehensive stroke centers. Patients with diagnosis of SAH, ruptured aneurysm coiling interventions, COVID-19 were identified using ICD-10 codes or by prospectively maintained stroke databases. The 3-month cumulative volume, monthly volumes for SAH hospitalizations and ruptured aneurysm coiling procedures were compared for the period before (1-year and immediately before) and during the COVID-19 pandemic (March 1 to May 31, 2020). Results: There was a significant decline in SAH hospitalizations with 2,044 admissions in the 3 months immediately before and 1,585 admissions during the pandemic, representing a decline of 22.5% (95%CI, -24.3 to -20.7, p<0.0001). Embolization of ruptured aneurysms declined with 1,170 to 1,035 procedures, respectively, representing an 11.5%(95%CI, -13.5 to -9.8, p=0.002) drop. Hospitals with higher COVID-19 hospitalization burden demonstrated greater declines in SAH and ruptured aneurysm coiling compared to lower COVID-19 burden. A relative increase in coiling of ruptured aneurysms was noted in low coiling volume hospitals of 41.1% (95%CI, 32.3-50.6, p=0.008) despite a decrease in SAH admissions in this tertile. Conclusions: There was a global decrease in subarachnoid hemorrhage admissions and ruptured aneurysm embolizations during the COVID-19 pandemic. Among low-volume coiling SAH hospitals, there was an increase in the ruptured aneurysm coiling intervention. These findings in SAH are consistent with a global decrease in other emergencies such as stroke and myocardial infarction.*On behalf of the SVIN COVID-19 Collaborators

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SummaryBackground: Many disorders can occur during pregnancy, labour, postpartum. Some women become normal, some seriously ill and some die. It is essential to know disorders' burden.Objectives: of present study were to know burden of disorders, which cause severe illnesses, during pregnancy, birth, post birth, profile of such cases.Material Methods: Analysis of profile of cases admitted over 5 years at rural referral institute was done. Criteria was admission to intensive care area with system for ventilatory support in obstetric department.Results: Majority of women were of 20-29 years, mean age 24 years, 2.6% adolescents. 39.7% were rural, 36.2% urban, 24.1% from urban settlements with low resources, 69.7% were antenatal, 18.5% intranatal, 11.8% postnatal. Sixty two percent were nullipara. Severe morbidity had 'U' curve in relation to age. Hypertensive disorders (53% of severely ill cases) were commonest basic disorder, next were medical disorders (26%)(severe anaemia, heart disease, malaria, infective hepatitis, pneumonia).Others were, late haemorrhage 12%, (antepartum and postpartum haemorrhage), early pregnancy complications(abortions, ectopic pregnancy, hydatiform mole) 5%, puerperal sepsis 2%, acute fatty liver of pregnancy 1.2%, rupture uterus 0.8%. Conclusion:Severe maternal morbidity with reference to age followed a 'U' curve. More cases were primigravida. Highest ratio was of cases from low resource urban settlements. Majority of severely ill cases were antenatal, some postnatal too. Commonest primary cause of severe illness was hypertensive disorders, followed by medical disorders, haemorrhage, complications of early pregnancy, puerperal sepsis, acute fatty liver of pregnancy, rupture uterus in descending order. Quality maternal care, at primary level, timely referral, quality maternal care at referral is essential. Also a lot of research is needed for prevention of some disorders, their severity.