This week’s Vaticano Updates – the most important news from the Holy Father and the Vatican.
Pope Francis has advanced the causes of five people on the path to sainthood Blessed Peter To Rot from Papua New Guinea
Blessed Ignatius Shoukrallah Maloyan from Turkey
and Blessed María Carmen from Venezuela will be proclaimed saints
The pope also approved the beatification of Italian diocesan priest Carmelo De Palma and declared Brazilian priest José Antônio de Maria Ibiapina a “venerable” of the Church.
received Polish President Andrzej Duda in a meeting in Rome
The talks took place ahead of the 20th anniversary of St
John Paul II’s death and near the millennium of the coronation of Poland’s first king
the discussion covered also the ongoing war in Ukraine and broader concerns about European security and peace.
Pope Francis encouraged the faithful to continue their Lenten journey as a time of healing and to grow their faith in Jesus Christ
In his message the Holy Father said the Pharisees were “scandalized” by Jesus and would “murmur behind his back” because he welcomed sinners
Francis added that Jesus heals the wounds and helps to love each other as brothers and sisters
Pope Francis has appointed Archbishop Giovanni Cesare Pagazzi as the new archivist and librarian of the Holy Roman Church
previously served as secretary of the Dicastery for Culture and Education. The 58-year-old prelate holds a doctorate in theology from the Pontifical Gregorian University and has taught at numerous theological institutions across Italy
The Vatican has published the official calendar of liturgical celebrations planned for Holy Week
but it has not clarified whether Pope Francis will preside
After the pontiffs’ release from the hospital
doctors have prescribed complete rest for at least two months
It is expected that Pope Francis will give the Urbi et Orbi blessing
the canonization of Carlo Acutis on Divine Mercy Sunday after Easter is confirmed in the Vatican planner
a celebration that usually requires the presence of the pope
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Rudolf Gehrig has been working for EWTN since 2013, among other things as a reporter, TV presenter, and producer. From 2019 to 2022 he was chief correspondent for German-speaking Europe at CNA Deutsch before moving to the Italian capital as a Rome correspondent and has since reported for EWTN Vatican and CNA Deutsch directly from the heart of the universal Church.
reported that Pope Francis also cleared the canonization of an archbishop and a religious sister as well as the beatification of Italy’s Father Carmelo de Palma
he declared Father José Antônio de Maria Ibiapina
During Japan’s occupation of Papua New Guinea during World War II
Peter helped prepare couples for marriage because missionaries were imprisoned
He eventually had to carry out his apostolate in secret due to religious persecution
and confronted his brother when he took a second wife
Peter was imprisoned for two months and died from poisoning there in July 1945.
The Pope approved the canonization of Blessed Ignatius Choukrallah Maloyan
he was appointed as archbishop of Mardin in 1911 by Pope Pius X
Blessed Ignatius was arrested along with 13 priests and 600 other Christians during the Armenian genocide
for refusing to renounce the faith.
Pope Francis approved the canonization of Blessed Maria del Monte Carmelo
born Carmen Elena Rendíles Martínez in Caracas on August 11
She is set to become the first Venezuelan-born saint
Maria was a religious sister who helped found the Congregation of the Servants of Jesus in 1946
She spent the last three years of her life in a wheelchair after a car accident
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The COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset. Prospective population-based data about stroke care in the pandemic are limited. This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville, Brazil.
A prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville, Brazil, and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before. Patients with transient ischemic attack (TIA) or stroke had their profiles, incidences, subtypes, severity, access to reperfusion therapy, in-hospital stay, complementary investigation, and mortality compared.
The COVID-19 pandemic is associated with a reduction in TIA, without any influence on stroke profile, the quality of stroke care, in-hospital investigation or mortality. Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemic's negative effects, even with scarce resources.
Volume 14 - 2023 | https://doi.org/10.3389/fneur.2023.1122875
Introduction: The COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset
Prospective population-based data about stroke care in the pandemic are limited
This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville
Methods: A prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville
and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before
Patients with transient ischemic attack (TIA) or stroke had their profiles
Results: The profiles of TIA/stroke patients in both periods were similar
There was a reduction in incidence of TIA (32.8%; p = 0.003)
intravenous thrombolysis (IV) and mechanical thrombectomy (MT) rates and intervals from door to IV/MT were similar
Patients with cardioembolic stroke and atrial fibrillation had their in-hospital stay abbreviated
The etiologic investigation was similar before and during the pandemic
but there were increases in cranial tomographies (p = 0.02)
chest X-rays (p < 0.001) and transcranial Doppler ultrasounds (p < 0.001)
The number of cranial magnetic resonance imaging decreased in the pandemic
Discussion: The COVID-19 pandemic is associated with a reduction in TIA
Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemic's negative effects
Since the early spread of the novel coronavirus SARS-CoV-2 around the world, many doubts have arisen about the consequences of the pandemic, including SARS-CoV-2 itself and its association with neurological complications, especially cerebrovascular diseases. After early reporting of severe stroke in young infected patients, an association between COVID-19 and stroke was suggested and quickly generated concern (1–6)
Observational studies showed an 11.5–41.4% reduction of all stroke hospital admissions, in particular transient ischemic attack (TIA) and minor strokes, in the first months of the pandemic (11–16). Other studies have also revealed a significant reduction in neuroimaging for acute stroke by 22.8–39% (9, 14) and reperfusion therapies by 12.7–27% (16, 17)
While observational data have clearly made inroads into our understanding of associations between COVID-19 and TIA/strokes
real-world prospective longitudinal population-based data are still lacking
Such information would be especially valuable to gain further understanding of the nature of that possible association and
the development of clinical strategies to address it
Our study aimed to analyze the effects of COVID-19 on the incidence of TIA/stroke
including the epidemiological profile and severity of these patients
and the response of the local health care system
We hypothesized that stroke patient profiles would worsen over the pandemic in terms of comorbidities and pathology severity
as well as stroke admissions would decrease due to the strain the pandemic would exert on the healthcare system
It would be reasonable to expect a decline in IV and MT rates and an increase in the intervals between door and IV/MT
inadequate stroke management throughout the pandemic would result in deteriorating investigation
shortened hospital stays in order to give priority to COVID-19 patients
The study methodology was based on directives from Sudlow and Warlow (20), and the WHO (21)
consisting of a step-by-step protocol procedure in the surveillance of stroke with three “steps,” ensuring coverage for all in-hospital and community cases of TIA and stroke
The diagnoses were identified by their related ICD-10 codes (primary
or tertiary discharge codes) and/or classifications in stroke databases at participating centers
Both diagnosis and etiology of TIA/stroke were reviewed weekly by a stroke team
composed of neurologists and specialized nurses
With a population of 604,708, Joinville is the largest city in Santa Catarina State, which is located in southern Brazil (22)
It is supported by three public plus three private hospitals and they all run 24-h Computed Tomography
The largest hospital in the city is a public institution (Hospital Municipal São José) and the referral service for stroke care
responsible for treating eighty percent (80%) of all stroke patients
Hospital Municipal and two private hospitals regularly perform mechanical thrombectomy (MT) and intravenous thrombolysis (IV) in Joinville
All cases of first-ever TIA/Stroke from March 2019 to February 2020 were recorded
as well as from March 2020 to February 2021
These two groups were compared (12 months before pandemic or “pre-COVID” vs
12 months after pandemic onset or “post-COVID”)
TOAST classification was used for the etiological classification of stroke (25). Bamford's Classification and the National Institute of Health Stroke Scale (NIHSS) score were used for stroke severity (26, 27). The modified Rankin Scale (mRS) was used to assess the patient's level of disability (28)
The analyzed variables were age (years old)
and pre-existing comorbidities (referred to the use of medication for more than 1 year)
heart diseases such as atrial fibrillation (AF)
acute myocardial infarction and congestive heart failure
Measures included the final TOAST classification
Bamford's classification; NIHSS score on admission
hospital-specific variables included reperfusion therapy rates (IV and MT)
time intervals (in minutes) between admission and neuroimaging (door-to-imaging)
admission and reperfusion therapies (door-to-needle for IV and door-to-puncture for MT)
number of performed complementary tests for in-hospital investigation
The in-hospital investigation included cranial computed tomography (CT)
electrocardiogram (ECG) and chest X-ray (X-ray)
In cases of TIA and stabilized cerebral infarction
the sequence of tests included carotid and vertebral artery duplex (CVD)
transthoracic echocardiogram (TTE) and transcranial Doppler ultrasound (TCD)
when clinical data suggest a cardioembolic source or heart disease
patients underwent transesophageal echocardiography (TEE) and holter cardiogram (HOLTER)
The same personal judgment justifies the additional investigation with brain magnetic resonance imaging (MRI)
neck and cranial magnetic resonance angiography (MRA) or computer tomography angiography (CTA)
COVID-19 testing was performed for any symptomatic patient
either on hospital admission or at any time during hospitalization
new or unexplained loss of taste or smell were the most common symptoms to justify COVID-19 testing
A frequency distribution table was set up for all variables
using mean and standard deviation for parametric variables
and median and interquartile intervals for non-parametric variables
The comparison between means for continuous variables was performed using Student's t-test
Comparative univariate analysis between events was performed using Fisher's exact test for discrete/binary variables
Statistical analyses were carried out using Microsoft Excel®2010
A p-value < 0.05 was considered statistically significant
This was an investigator-initiated project supported by University of Joinville's Region (Univille) and the Joinville Municipal Health Department
The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication
The first author wrote the first draft of the manuscript with subsequent input of all co-authors
The institutional review boards from the coordinating sites (University of Joinville's Region and Federal University of Paraná) considered that the investigators did not have access to protected health information
and thus no IRB oversight was required since the study did not meet the federal description of human subject research
All patients or their legally authorized representatives were interviewed for demographic and clinical data collection
after informed written consent and local ethic committee approval
A total of 1,894 patients with cerebrovascular events were registered. 963 cases were registered before (“pre-COVID”) and 931 cases after the pandemic onset (“post-COVID”). From these 1,894 patients, 467 (228 pre-COVID plus 239 post-COVID) were defined as recurrent events and excluded from the study. A total of 735 pre-COVID plus 692 post-COVID patients have had first-ever cerebrovascular events (Figure 1)
The cumulative annual crude incidences of TIA/stroke in Joinville before and after the pandemic outbreak were similar
with 124.5 and 115.8 new cases per 100,000 inhabitants
Only 35 TIA/stroke patients tested positive for COVID-19
Flowchart of all TIA/stroke patients from March 2019 to February 2021
and functional outcome of first-ever TIA/stroke patients pre and post-COVID 19
The IV and MT rates were similar, although a higher absolute number of procedures occurred during the pandemic. The time intervals between hospital admission and IV/MT were also similar in both periods (Table 1)
The average in-hospital stay during the pandemic for almost all stroke patients was similar to the prior year. Only patients with cardioembolic stroke (CS) due to AF had a significantly shorter in-hospital stay (Table 1)
All patients were subjected to the same investigation protocol. Nevertheless, some exams were performed more frequently during the pandemic, such as CT (p = 0.025), TCD (p < 0.001), X-ray (p < 0.001), and TTE (p = 0.001). Conversely, MRI was performed less frequently compared to the previous year (p = 0.016) (Table 1)
There was no increase in in-hospital mortality during the pandemic, just a non-significant trend of reduction (p = 0.067) (Table 1)
the present study showed a similar and even better stroke care system 1 year after the COVID-19 outbreak
Our longer period of observation and a transitory impact of the pandemic on stroke dynamics can explain these findings
We also demonstrate that people with mild and especially temporary symptoms did not seek medical attention
maybe due to fear of contracting COVID-19 in crowded emergency rooms
The low incidence of COVID-19 in stroke patients during the pandemic period can again explain this finding
The prevalence of stroke with undetermined etiology due to incomplete evaluation was also similar in both periods
A greater difficulty in completing an adequate investigation during the pandemic was not observed
which often delay or even prevent the performance of some complementary tests
and TTE) indicates a proper etiological investigation even in adverse conditions
and can be explained by updating in-hospital acute stroke protocols as well as structured training programs for hospital staff
Only individuals with cardioembolic stroke due to atrial fibrillation had their hospital stays shortened
In order to ensure that these patients received appropriate anticoagulation at home
the public home care service and the local hematology center collaborated to collect and transport blood samples
These strategic and structural adjustments made it possible for patients to leave the hospital on safe follow-up arrangements sooner
door-to-needle and door-to-procedure intervals did not worsen during the pandemic
which is extremely important since these therapies reduce mortality and have a time-dependent efficacy
The in-hospital mortality of stroke patients did not increase during the pandemic period, in contrast to the previously reported data showing an increase in-hospital mortality by 9% after 1 year (14, 16)
We believe this unchanged mortality rate is largely the consequence of a strong and effectively implemented approach for managing the recent pandemic challenges
rather than just a low prevalence of COVID-19 patients in our sample
Patients with cardioembolic stroke and atrial fibrillation received special attention by home caring monitoring
A limitation of this study is that all analyses were performed on a mixed sample of COVID-19 positive and negative patients
and some results were compared to studies that included COVID-19-positive stroke patients
Because of the early difficulties implementing COVID-19 testing in Joinville and a stroke management protocol that included COVID testing only for symptomatic patients
the low incidence of COVID-19-positive cases in our sample is probably underestimated
the pandemic's “collateral effect” on the local healthcare system may have an impact on both COVID-19 positive and negative patients
Every city or region has its own health system context
COVID-19 infection curves with different behaviors
some have used distinct and even more radical strategies to contain the pandemic (such as “lockdown”)
The results reported here from Joinville do not necessarily reflect the success (or otherwise) of strategies elsewhere in Brazil
It is also important to note that Joinville has experienced an increase in COVID-19 vaccination rates over the course of our study (23)
Since our study lacked these vaccine-related data
it is not possible to rule out a potential effect on reducing the risk of COVID infection-related complications and even strokes
Our study provides important real population-based data for understanding the dynamics of the COVID-19 pandemic and its consequences on stroke care in Joinville
Statistics collected throughout the course of the first year following the start of the pandemic showed that TIA/stroke patients were neither younger nor presented more severe pathology on admission
but shorter for patients with cardioembolic stroke and atrial fibrillation indeed
we identified fewer MRI scans and more CT scans
The access to reperfusion therapies and in-hospital mortality did not worsen
in-hospital stroke mortality did not increase during the pandemic
We believe our findings reflect not only a low incidence of COVID-19 in stroke patients
but mainly an effective response of the local stroke care system
This study provides strong evidence that interdisciplinary initiatives
structured and well-developed services tend not to suffer such negative impacts under adverse external conditions
The original contributions presented in the study are included in the article/supplementary material
further inquiries can be directed to the corresponding author
and VZ contributed to conception and design of the study
FR performed the statistical analysis and wrote the first draft of the manuscript
All authors contributed to manuscript revision
This research was supported by University of Joinville's Region (Univille) and the Joinville Municipal Health Department
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations
Any product that may be evaluated in this article
or claim that may be made by its manufacturer
is not guaranteed or endorsed by the publisher
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Lange MC and Zétola VF (2023) Stroke profile and care during the COVID-19 pandemic: What changed and what did not
Received: 13 December 2022; Accepted: 27 January 2023; Published: 16 February 2023
Copyright © 2023 dos Reis, de Magalhães, Diegoli, Longo, Moro, Safanelli, Nagel, Lange and Zétola. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY)
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*Correspondence: Felipe Ibiapina dos Reis, cmVpc2ZlbGlwZWlyQGdtYWlsLmNvbQ==
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