{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T23:25:23Z","timestamp":1715124323791},"reference-count":31,"publisher":"Scientific Scholar","license":[{"start":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T00:00:00Z","timestamp":1613952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["ruralneuropractice.com"],"crossmark-restriction":true},"short-container-title":["JNRP"],"abstract":"<jats:title>Abstract<\/jats:title>\n<jats:p>\n<jats:bold>Objective<\/jats:bold>\u2003This study assesses the impact of coronavirus disease 2019 (COVID-19) on the pattern of neurological emergencies reaching a tertiary care center.<\/jats:p>\n<jats:p>\n<jats:bold>Materials and Methods<\/jats:bold>\u2003This is a retrospective and single center study involving 295 patients with neurological emergencies mainly including acute stroke, status epilepticus (SE), and tubercular meningitis visiting emergency department (ED) from January 1 to April 30, 2020 and divided into pre- and during lockdown, the latter starting from March 25 onward. The primary outcome was number of neurological emergencies visiting ED per week in both periods. Secondary outcomes included disease severity at admission, need for mechanical ventilation (MV), delay in hospitalization, in-hospital mortality, and reasons for poor compliance to ongoing treatment multivariate binary logistic regression was used to find independent predictors of in-hospital mortality which included variables with <jats:italic>p<\/jats:italic> &lt;0.1 on univariate analysis. Structural break in the time series analysis was done by using Chow test.<\/jats:p>\n<jats:p>\n<jats:bold>Results<\/jats:bold>\u2003There was 53.8% reduction in number of neurological emergencies visiting ED during lockdown (22.1 visits vs. 10.2 visits per week, <jats:italic>p<\/jats:italic> = 0.001), significantly affecting rural population (<jats:italic>p<\/jats:italic> = 0.004). Presenting patients had comparatively severe illness with increased requirement of MV (<jats:italic>p<\/jats:italic> &lt; 0.001) and significant delay in hospitalization during lockdown (<jats:italic>p<\/jats:italic> &lt; 0.001). Poor compliance to ongoing therapy increased from 34.4% in pre-lockdown to 64.7% patients during lockdown (<jats:italic>p<\/jats:italic> &lt; 0.001), mostly due to nonavailability of drugs (<jats:italic>p<\/jats:italic> &lt; 0.001). Overall, 35 deaths were recorded, with 20 (8.2%) in pre-lockdown and 15 (29.4%) during lockdown (<jats:italic>p<\/jats:italic> = 0.001). Lockdown, nonavailability of local health care, delay in hospitalization, severity at admission, and need for MV emerged as independent predictors of poor outcome in stroke and delay in hospitalization in SE.<\/jats:p>\n<jats:p>\n<jats:bold>Conclusion<\/jats:bold>\u2003COVID-19 pandemic and associated lockdown resulted in marked decline in non-COVID neurological emergencies reporting to ED, with more severe presentations and significant delay from onset of symptoms to hospitalization.<\/jats:p>","DOI":"10.1055\/s-0040-1722810","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:29:27Z","timestamp":1614040167000},"page":"461-469","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Non-COVID Neurological Emergencies: A Silent Killer Going Unnoticed during COVID-19 Pandemic"],"prefix":"10.25259","volume":"12","author":[{"given":"Nikita","family":"Dhar","sequence":"first","affiliation":[{"name":"Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Govind","family":"Madhaw","sequence":"additional","affiliation":[{"name":"Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mritunjai","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niraj","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashutosh","family":"Tiwari","sequence":"additional","affiliation":[{"name":"Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinayak","family":"Jatale","sequence":"additional","affiliation":[{"name":"Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2021,2,22]]},"reference":[{"issue":"1","key":"10.1055\/s-0040-1722810\/ref-1","first-page":"157","article-title":"WHO declares COVID-19 a pandemic","volume":"91","author":"Cucinotta","year":"2020","journal-title":"Acta Biomed"},{"issue":"2","key":"10.1055\/s-0040-1722810\/ref-2","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1080\/1040841X.2020.1739001","article-title":"emergence of novel coronavirus and COVID-19: whether to stay or die out?","volume":"46","author":"Biswas","year":"2020","journal-title":"Crit Rev Microbiol"},{"issue":"1","key":"10.1055\/s-0040-1722810\/ref-3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/nyas.14379","article-title":"The SARS-CoV-2\/COVID-19 pandemic and challenges in stroke care in India","volume":"1473","author":"Sylaja","year":"2020","journal-title":"Ann N Y Acad Sci"},{"issue":"7","key":"10.1055\/s-0040-1722810\/ref-4","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1161\/STR.0b013e318296aeca","article-title":"An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"44","author":"Sacco","year":"2013","journal-title":"Stroke"},{"issue":"10","key":"10.1055\/s-0040-1722810\/ref-5","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1111\/epi.13121","article-title":"A definition and classification of status epilepticus: report of the ILAE task force on classification of status epilepticus","volume":"56","author":"Trinka","year":"2015","journal-title":"Epilepsia"},{"key":"10.1055\/s-0040-1722810\/ref-6","first-page":"998","author":"Karen","year":"2018","unstructured":"Roos, Kenneth L. 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