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Background and Purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year., Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020)., Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths., Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Objective: The aim of this study was to assess the number of stroke-related admissions and acute treatments during the first two waves of COVID-19 and lockdowns in the Capital Region of Denmark and the Region of Zealand., Materials & Methods: The weekly numbers of admitted patients with stroke were retrieved from electronic patient records from January 2019 to February 2021 and analysed to reveal potential fluctuations in patient volumes during the pandemic., Results: A total of 23,688 patients were included, of whom 2049 patients were treated with tissue-type plasminogen activators (tPA) and 552 underwent endovascular thrombectomy (EVT). We found a transient decrease in the number of weekly admitted patients (pts/week) with all strokes (-9.8 pts/week, 95% CI: -19.4; -0.2, p = .046) and stroke mimics (-30.1 pts/week, 95% CI: -39.9; -20.3, p < .001) during the first lockdown compared to pre-COVID-19. The number of subarachnoid haemorrhage, intracerebral haemorrhage, and ischaemic stroke admissions showed insignificant declines. Analysing all COVID-19 periods collectively revealed increased volumes of ischaemic stroke (+6.2 pts/week, 95% CI: +1.6; +10.7, p = .009) compared to pre-COVID levels, while numbers of stroke mimics remained lower than pre-COVID. Weekly tPA and EVT treatments remained constant throughout the study period., Conclusions: Our results are comparable with other studies in finding reductions in stroke-related admissions early in the pandemic. This is the first study to report increased stroke volumes following the first wave of the pandemic. The mechanisms behind the observed drop and subsequent rise in strokes are unclear and warrant further investigation., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Stroke is a leading cause of death and disability with effective treatment, including thrombolysis or thrombectomy, being time-critical for favourable outcomes. While door-to-needle time in hospital has been optimized for many years, little is known about the ambulance on-scene time (OST). OST has been reported to account for 44% of total alarm-to-door time, thereby being a major time component. We aimed to analyse ambulance OST in stroke patients eligible for thrombolysis and identify potential areas of time optimization., Methods: A study-specific registration form was developed to record detailed information about OST consumption in cases where the Emergency Medical Services (EMS) suspected a stroke from July 2014-May 2015. Registration forms were completed by ambulance personnel and included details on estimated time spent: 1) localising patient, 2) clinical examination, 3) consulting with the on-call neurologist, 4) mobilising patient to the ambulance, 5) treatment in ambulance before departure. Additionally, estimated total OST was noted. For patients found eligible for further evaluation at a stroke centre, time points were analysed using multivariate Poisson regressions., Results: A total of 520 cases were included. The median OST was 21 min (Interquartile Range (IQR) 16-27). Time consumption was significantly lower (17 vs 21 min, p = 0.0015) when electrocardiography (ECG) was obtained in-hospital instead of on-scene, when intravenous (IV) access was established during transportation instead of before transportation (17 vs 21 min, p < 0.0001), and when the quality of communication with the stroke centres was rated as "good" as opposed to "acceptable/poor" (21 vs 23 min, p = 0.014). Neither the presence of relatives nor ambulance trainees had a significant effect on OST., Conclusions: In-hospital ECG recording and IV cannulation during transport were found to reduce OST, while "acceptable/poor" communication was found to prolong OST relative to "good" communication. These components of pre-hospital stroke management represent potential opportunities for lowering OST with relatively simple changes, which could ultimately lead to earlier treatment and better patient outcome., Trial Registration: Unique identifier: NCT02191514 .

During the later years, Critical Care Medicine (CCM) has seen a rise in the possibilities of performing biochemical analyses at the point of care, or even continuous monitoring of biochemical variables. In general, point of care testing (POCT) is advantageous, by decreasing Therapeutic Turnaround Time, number of errors, and by reduction of blood-volume lost for analyses. Though not much evidence exist to prove beneficial effects with respect to early diagnostic accuracy, decrease in length of stay in Intensive Care Unit (ICU), decrease of costs, or decreased morbidity/mortality, clinicians in general agree that POCT is a prerequisite for early recognition of life-threatening conditions, and for titration of commonly applied therapies. Limitations in POCT include staff-dissatisfaction, diminished analytical accuracy, just as POCT-data must be integrated in the patients' medical record and the institutional information systems. Finally, POCT may induce economical stress, depending on many variables. All together, a strong, multidisciplinary, interdepartmental team-approach seems necessary to ensure cost-effectiveness. At present, POCT is not a replacement for conventional laboratory services in CCM, but a supplement. Before POCT can be introduced on a larger scale in CCM we must prove it reliable, consistent and cost-beneficial in order to avoid spreading of technology that provides more data and costs than true information and benefit.

Twenty-four healthy subjects participated in a triple crossover study in which some of the widely used psychomotor tests were applied as indicators of psychomotor ability. Diazepam was administered in doses of 10 mg intravenously, 10 mg rectally, and 35 mg rectally. Plasma levels of diazepam and performance decrement in the Trieger dot test (DOT), the perceptual speed test (PST), the digit symbol substitution test (DSST), and continuous reaction time were measured up to 12 hr after administration. The psychomotor effects were quite similar after administration of 10 mg diazepam intravenously and rectally. When the 35-mg rectal administration was compared to the 10-mg administrations, performance was still affected at 12 hr.

Ten patients with chronic pain were randomized to an open, balanced, crossover study. Each patients received two different preparations of racemic methadone, i.e., tablets and intravenous infusion. The pharmacokinetic parameters of the R- and S-enantiomers of the racemate are reported. The analgesically active R-methadone has a significantly longer mean elimination half-life than the optical antipode S-methadone (t1/2 = 37.5 and 28.6 h, respectively). The mean total volume of distribution is 496.6 L for R-methadone and 289.1 L for S-methadone. Significant differences in the mean clearance between R- and S-methadone are seen (0.158 and 0.129 L/min, respectively). However, the lagtime after oral administration and the bioavailability did not show differences between the isomers. The data suggest that both enantiomers of methadone should be measured if correlations between pharmacodynamics and kinetics are made due to the stereoselective differences in half-life, total volume of distribution, and clearance.

The extent of local irritation after rectal administration of diazepam in solution was studied in 24 adults (mean weight of 70 kg). The trial was randomized using a triple cross-over design. A burning sensation was reported in 60%, 12% and 0% of subjects up to 15 min after administration of diazepam 35 mg, diazepam 10 mg and placebo, respectively. Endoscopic assessment 24 h after medication showed mechanical irritation in three subjects and local irritation probably caused by diazepam, the vehicle, or both, in four. No correlation was found between subjective complaints and objective findings. Control endoscopy 7 days after medication revealed no pathology. It is suggested that a rectal solution of diazepam in doses up to 0.5 mg kg-1 is a safe form of medication in respect of irritation of the rectal mucosa.

Body temperature, P-cortisol, P-glucose, P-transferrin, P-orosomucoid, P-IgM, hematocrit and total and differential leucocyte counts were investigated in 16 men undergoing inguinal herniotomy. The patients were randomized to epidural analgesia (n = 8) or epidural analgesia + assumed blockade of prostaglandin synthesis, blockade of receptors for histamine1, histamine2 and serotonin2, and inhibition of fibrinolysis with indomethacin, astemizole, ranitidine, ketanserin and tranexamic acid, respectively (n = 8). The rectal temperature and blood granulocyte counts rose significantly and similarly after surgery in both groups. Acute-phase protein (transferrin and orosomucoid) changes were also similar in both groups, as were P-cortisol and P-glucose, which did not increase in response to the neural blockade. Other factors than neural stimuli, prostaglandins, histamine, serotonin and activation of fibrinolysis are concluded to be effective in releasing postoperative leucocytosis, rise in body temperature and changes in acute-phase proteins.

A case of carbamazepine (Tegretol) poisoning is presented. The symptoms and signs were surprisingly severe after ingestion of only 10g. Treatment and unusual features of the case are discussed.

A randomized cross-over investigation was carried out on 24 healthy volunteers to investigate the occurrence of bruising following compression on the extended or flexed elbow respectively, following venepuncture in the cubital fossa. Following 48 uncomplicated venepunctures (24 x 2) a total of 8 (17%) were found to have bruising, four of these after compression on the extended elbow and four after compression on the flexed elbow. It is concluded that there are no differences in the frequencies of bruising following closed venepuncture in the cubital fossa regardless of whether the subsequent compression is undertaken on the extended or flexed elbow.