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  1. Iwata H, Tanabe S, Sakai N, Nishimura A, Tatsukawa R
    Environ Pollut, 1994;85(1):15-33.
    PMID: 15091681
    Persistent organochlorines in air, river water and sediment samples were analysed from eastern and southern Asia (India, Thailand, Vietnam, Malaysia, Indonesia) and Oceania (Papua New Guinea and Solomon Islands) to elucidate their geographical distribution in tropical environment. The concentrations of organochlorines in these abiotic samples collected from Taiwan, Japan and Australia were also monitored for comparison. Atmospheric and hydrospheric concentrations of HCHs (hexachlorocyclohexanes) and DDTs (DDT and its metabolites) in the tropical developing countries were apparently higher than those observed in the developed nations, suggesting extensive usage of these chemicals in the lower latitudes. CHLs (chlordane compounds) and PCBs (polychlorinated biphenyls) were also occasionally observed at higher levels in the tropics, implying that their usage area is also expanding southward. Distribution patterns of organochlorines in sediments showed smaller spatial variations on global terms, indicating that the chemicals released in the tropical environment are dispersed rapidly through air and water and retained less in sediments. The ratios of organochlorine concentrations in sediment and water phases were positively correlated with the latitude of sampling, suggesting that persistent and semivolatile compounds discharged in the tropics tend to be redistributed on a global scale.
  2. Kondo T, Sakai N, Yazawa T, Shimizu Y
    Sci Total Environ, 2021 Jun 20;774:145075.
    PMID: 33609845 DOI: 10.1016/j.scitotenv.2021.145075
    The Soil and Water Assessment Tool (SWAT) ecohydrological model was utilized to simulate fecal contamination in the 1937 km2 Selangor River Watershed in Malaysia. The watershed conditions posed considerable challenges owing to data scarcity and tropical climate conditions, which are very different from the original conditions that SWAT was developed and tested for. Insufficient data were compensated by publicly available data (e.g., land cover, soil, and weather) to run SWAT. In addition, field monitoring and interviews clarified representative situations of pollution sources and loads, which were used as input for the model. Model parameters determined by empirical analyses in the USA (e.g., surface runoff, evapotranspiration, and temperature adjustment for bacteria die-off) are thoroughly discussed. In particular, due consideration was given to tropical climate characteristics such as intense rainfall, high potential evapotranspiration, and high temperatures throughout the year. As a result, the developed SWAT successfully simulated fecal contamination ranging several orders of magnitude along with its spatial distribution (i.e., Nash-Sutcliffe Efficiency (NSE) = 0.64, Root Mean Square Error-Observations Standard Deviation Ratio (RSR) = 0.64 at six mainstem sites, and NSE = 0.67 and RSR = 0.57 at 12 major tributaries). Moreover, mitigation countermeasures for future worsening of fecal contamination (i.e., E.coli concentration > 20,000 CFU/100 mL for 690 days during nine years at a raw water intake point for Kuala Lumpur [KL] residents) were analyzed through scenario simulations, thereby contributing to discussing effective watershed management. The results propose improving decentralized sewage treatment systems and treating chicken manure with effective microorganisms in order to guarantee water safety for KL residents (i.e., E.coli concentrations <20,000 CFU/100 mL throughout the period, considering Malaysian standards). Accordingly, this study verified the applicability of SWAT to simulate fecal contamination in areas that are difficult to model and suggests solutions for watershed management based on quantitative evidence.
  3. Santhi VA, Sakai N, Ahmad ED, Mustafa AM
    Sci Total Environ, 2012 Jun 15;427-428:332-8.
    PMID: 22578698 DOI: 10.1016/j.scitotenv.2012.04.041
    This study investigated the level of bisphenol A (BPA) in surface water used as potable water, drinking water (tap and bottled mineral water) and human plasma in the Langat River basin, Malaysia. BPA was present in 93% of the surface water samples at levels ranging from below limit of quantification (LOQ; 1.3 ng/L) to 215 ng/L while six fold higher levels were detected in samples collected near industrial and municipal sewage treatment plant outlets. Low levels of BPA were detected in most of the drinking water samples. BPA in tap water ranged from 3.5 to 59.8 ng/L with the highest levels detected in samples collected from taps connected to PVC pipes and water filter devices. Bottled mineral water had lower levels of BPA (3.3±2.6 ng/L) although samples stored in poor storage condition had significantly higher levels (11.3±5.3 ng/L). Meanwhile, only 17% of the plasma samples had detectable levels of BPA ranging from 0.81 to 3.65 ng/mL. The study shows that BPA is a ubiquitous contaminant in surface, tap and bottled mineral water. However, exposure to BPA from drinking water is very low and is less than 0.01% of the tolerable daily intake (TDI).
  4. Sakai N, Mohd Yusof R, Sapar M, Yoneda M, Ali Mohd M
    Sci Total Environ, 2016 Apr 01;548-549:43-50.
    PMID: 26799806 DOI: 10.1016/j.scitotenv.2016.01.040
    Beta-agonists and sulfonamides are widely used for treating both humans and livestock for bronchial and cardiac problems, infectious disease and even as growth promoters. There are concerns about their potential environmental impacts, such as producing drug resistance in bacteria. This study focused on their spatial distribution in surface water and the identification of pollution sources in the Langat River basin, which is one of the most urbanized watersheds in Malaysia. Fourteen beta-agonists and 12 sulfonamides were quantitatively analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). A geographic information system (GIS) was used to visualize catchment areas of the sampling points, and source profiling was conducted to identify the pollution sources based on a correlation between a daily pollutant load of the detected contaminant and an estimated density of human or livestock population in the catchment areas. As a result, 6 compounds (salbutamol, sulfadiazine, sulfapyridine, sulfamethazine, sulfadimethoxine and sulfamethoxazole) were widely detected in mid catchment areas towards estuary. The source profiling indicated that the pollution sources of salbutamol and sulfamethoxazole were from sewage, while sulfadiazine was from effluents of cattle, goat and sheep farms. Thus, this combination method of quantitative and spatial analysis clarified the spatial distribution of these drugs and assisted for identifying the pollution sources.
  5. Sakai N, Sakai M, Mohamad Haron DE, Yoneda M, Ali Mohd M
    Chemosphere, 2016 Dec;165:183-190.
    PMID: 27654221 DOI: 10.1016/j.chemosphere.2016.09.022
    Fourteen beta-agonists were quantitatively analyzed in cattle, chicken and swine liver specimens purchased at 14 wet markets in Selangor State, Malaysia, by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The health risks of ractopamine and clenbuterol residues in the Malaysian population were assessed based on quantitative data and meat consumption statistics in Malaysia. Wastewater samples collected at swine farms (n = 2) and cattle/cow farms (n = 2) in the Kuala Langat district were analyzed for the presence for the 14 compounds. Wastewater in chicken farms was not collected because there was negligible discharge during the breeding period. The environmental impacts caused by beta-agonists discharged from livestock farms were spatially assessed in the Langat River basin using a geographic information system (GIS). As a result, 10 compounds were detected in the liver specimens. Ractopamine, which is a permitted compound for swine in Malaysia, was frequently detected in swine livers; also, 9 other compounds that are prohibited compounds could be illegally abused among livestock farms. The health risks of ractopamine and clenbuterol were assessed to be minimal as their hazard quotients were no more than 7.82 × 10(-4) and 2.71 × 10(-3), respectively. Five beta-agonists were detected in the wastewater samples, and ractopamine in the swine farm resulted in the highest contamination (30.1 μg/L). The environmental impacts of the beta-agonists in the Langat River basin were generally concluded to be minimal, but the ractopamine contamination released from swine farms was localized in coastal areas near the estuary of the Langat River basin because most swine farms were located in that region.
  6. Sakai N, Chu SY, Mori K, Yaruss JS
    J Fluency Disord, 2017 Mar;51:50-59.
    PMID: 28212720 DOI: 10.1016/j.jfludis.2016.11.002
    PURPOSE: This study evaluates the psychometric performance of the Japanese version of the Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A), a comprehensive assessment tool of individuals who stutter.

    METHODS: The OASES-A-J was administered to 200 adults who stutter in Japan. All respondents also evaluated their own speech (SA scale), satisfaction of their own speech (SS scale) and the Japanese translation version of the Modified Erickson Communication Attitude scale (S-24). The test-retest reliability and internal consistency of the OASES-A-J were assessed. To examine the concurrent validity of the questionnaire, Pearson correlation was conducted between the OASES-A-J Impact score and the S-24 scale, SA scale and SS scale. In addition, Pearson correlation among the impact scores of each section and total were calculated to examine the construct validity.

    RESULTS: The OASES-A-J showed a good test-retest reliability (r=0.81-0.95) and high internal consistency (α>0.80). Concurrent validity was moderate to high (0.55-0.75). Construct validity was confirmed by the relation between internal consistency in each section and correlation among sections' impact scores. Japanese adults showed higher negative impact for 'General Information', 'Reactions to Stuttering' and 'Quality of Life' sections.

    CONCLUSION: These results suggest that the OASES-A-J is a reliable and valid instrument to measure the impact of stuttering on Japanese adults who stutter. The OASES-A-J could be used as a clinical tool in Japanese stuttering field.

  7. Chu SY, Sakai N, Mori K, Iverach L
    J Fluency Disord, 2017 Mar;51:1-7.
    PMID: 28212717 DOI: 10.1016/j.jfludis.2016.09.006
    PURPOSE: This study reports Japanese normative data for the Unhelpful Thoughts and Beliefs about Stuttering (UTBAS) scales. We outline the translation process, and evaluate the psychometric properties of the Japanese version of the UTBAS scales.

    METHODS: The translation of the UTBAS scales into Japanese (UTBAS-J) was completed using the standard forward-backward translation process, and was administered to 130 Japanese adults who stutter. To validate the UTBAS-J scales, scores for the Japanese and Australian cohorts were compared. Spearman correlations were conducted between the UTBAS-J and the Modified Erickson Communication Attitude scale (S-24), the self-assessment scale of speech (SA scale), and age. The test-retest reliability and internal consistency of the UTBAS-J were assessed. Independent t-tests were conducted to evaluate the differences in the UTBAS-J scales according to gender, speech treatment experience, and stuttering self-help group participation experience.

    RESULTS: The UTBAS-J showed good test-retest reliability, high internal consistency, and moderate to high significant correlations with S-24 and SA scale. A weak correlation was found between the UTBAS-J scales with age. No significant relationships were found between UTBAS-J scores, gender and speech treatment experience. However, those who participated in the stuttering self-help group demonstrated lower UTBAS-J scores than those who did not.

    CONCLUSION: Given the current scarcity of clinical assessment tools for adults who stutter in Japan, the UTBAS-J holds promise as an assessment tool and outcome measure for use in clinical and research environments.

  8. Sakai N, Dayana E, Abu Bakar A, Yoneda M, Nik Sulaiman NM, Ali Mohd M
    Environ Monit Assess, 2016 Oct;188(10):592.
    PMID: 27679511
    Polychlorinated biphenyls (PCBs) were monitored in surface water collected in the Selangor River basin, Malaysia, to identify the occurrence, distribution, and dechlorination process as well as to assess the potential adverse effects to the Malaysian population. Ten PCB homologs (i.e., mono-CBs to deca-CBs) were quantitated by using gas chromatography-mass spectrometry (GC/MS). The total concentration of PCBs in the 10 sampling sites ranged from limit of detection to 7.67 ng L(-1). The higher chlorinated biphenyls (tetra-CBs to deca-CBs) were almost not detected in most of the sampling sites, whereas lower chlorinated biphenyls (mono-CBs, di-CBs, and tri-CBs) dominated more than 90 % of the 10 homologs in all the sampling sites. Therefore, the PCB load was estimated to be negligible during the sampling period because PCBs have an extremely long half-life. The PCBs, particularly higher chlorinated biphenyls, could be thoroughly dechlorinated to mono-CBs to tri-CBs by microbial decomposition in sediment or could still be accumulated in the sediment. The lower chlorinated biphenyls, however, could be resuspended or desorbed from the sediment because they have faster desorption rates and higher solubility, compared to the higher chlorinated biphenyls. The health risk for the Malaysia population by PCB intake that was estimated from the local fish consumption (7.2 ng kg(-1) bw day(-1)) and tap water consumption (1.5 × 10(-3)-3.1 × 10(-3) ng kg(-1) bw day(-1)) based on the detected PCB levels in the surface water was considered to be minimal. The hazard quotient based on the tolerable daily intake (20 ng kg(-1) bw day(-1)) was estimated at 0.36.
  9. Sakai N, Shirasaka J, Matsui Y, Ramli MR, Yoshida K, Ali Mohd M, et al.
    Chemosphere, 2017 Apr;172:234-241.
    PMID: 28081507 DOI: 10.1016/j.chemosphere.2016.12.139
    Five homologs (C10-C14) of linear alkylbenzene sulfonate (LAS) were quantitated in surface water collected in the Langat and Selangor River basins using liquid chromatography-tandem mass spectrometry (LC-MS/MS). A geographic information system (GIS) was used to spatially analyze the occurrence of LAS in both river basins, and the LAS contamination associated with the population was elucidated by spatial analysis at a sub-basin level. The LAS concentrations in the dissolved phase (<0.45 μm) and 4 fractions separated by particle size (<0.1 μm, 0.1-1 μm, 1-11 μm and >11 μm) were analyzed to elucidate the environmental fate of LAS in the study area. The environmental risks of the observed LAS concentration were assessed based on predicted no effect concentration (PNEC) normalized by a quantitative structure-activity relationship model. The LAS contamination mainly occurred from a few populated sub-basins, and it was correlated with the population density and ammonia nitrogen. The dissolved phase was less than 20% in high contamination sites (>1000 μg/L), whereas it was more than 60% in less contaminated sites (<100 μg/L). The environmental fate of LAS in the study area was primarily subject to the adsorption to suspended solids rather than biodegradation because the LAS homologs, particularly in longer alkyl chain lengths, were considerably absorbed to the large size fraction (>11 μm) that settled in a few hours. The observed LAS concentrations exceeded the normalized PNEC at 3 sites, and environmental risk areas and susceptible areas to the LAS contamination were spatially identified based on their catchment areas.
  10. Sakai N, Yamamoto S, Matsui Y, Khan MF, Latif MT, Ali Mohd M, et al.
    Sci Total Environ, 2017 May 15;586:1279-1286.
    PMID: 28236484 DOI: 10.1016/j.scitotenv.2017.02.139
    Volatile Organic Compounds (VOCs) in indoor air were investigated at 39 private residences in Selangor State, Malaysia to characterize the indoor air quality and to identify pollution sources. Twenty-two VOCs including isomers (14 aldehydes, 5 aromatic hydrocarbons, acetone, trichloroethylene and tetrachloroethylene) were collected by 2 passive samplers for 24h and quantitated using high performance liquid chromatography and gas chromatography mass spectrometry. Source profiling based on benzene/toluene ratio as well as statistical analysis (cluster analysis, bivariate correlation analysis and principal component analysis) was performed to identify pollution sources of the detected VOCs. The VOCs concentrations were compared with regulatory limits of air quality guidelines in WHO/EU, the US, Canada and Japan to clarify the potential health risks to the residents. The 39 residences were classified into 2 groups and 2 ungrouped residences based on the dendrogram in the cluster analysis. Group 1 (n=30) had mainly toluene (6.87±2.19μg/m3), formaldehyde (16.0±10.1μg/m3), acetaldehyde (5.35±4.57μg/m3) and acetone (11.1±5.95μg/m3) at background levels. Group 2 (n=7) had significantly high values of formaldehyde (99.3±10.7μg/m3) and acetone (35.8±12.6μg/m3), and a tendency to have higher values of acetaldehyde (23.7±13.5μg/m3), butyraldehyde (3.35±0.41μg/m3) and isovaleraldehyde (2.30±0.39μg/m3). The 2 ungrouped residences showed particularly high concentrations of BTX (benzene, toluene and xylene: 235μg/m3 in total) or acetone (133μg/m3). The geometric mean value of formaldehyde (19.2μg/m3) exceeded an 8-hour regulatory limit in Canada (9μg/m3), while those in other compounds did not exceed any regulatory limits, although a few residences exceeded at least one regulatory limit of benzene or acetaldehyde. Thus, the VOCs in the private residences were effectively characterized from the limited number of monitoring, and the potential health risks of the VOCs exposure, particularly formaldehyde, should be considered in the study area.
  11. Sakai N, Alsaad Z, Thuong NT, Shiota K, Yoneda M, Ali Mohd M
    Chemosphere, 2017 Oct;184:857-865.
    PMID: 28646768 DOI: 10.1016/j.chemosphere.2017.06.070
    Arsenic and 5 heavy metals (nickel, copper, zinc, cadmium and lead) were quantitated in surface water (n = 18) and soil/ore samples (n = 45) collected from 5 land uses (oil palm converted from forest, oil palm in peat swamp, bare land, quarry and forest) in the Selangor River basin by inductively coupled plasma mass spectrometry (ICP-MS). Geographic information system (GIS) was used as a spatial analytical tool to classify 4 land uses (forest, agriculture/peat, urban and bare land) from a satellite image taken by Landsat 8. Source profiling of the 6 elements was conducted to identify their occurrence, their distribution and the pollution source associated with the land use. The concentrations of arsenic, cadmium and lead were also analyzed in maternal blood (n = 99) and cord blood (n = 87) specimens from 136 pregnant women collected at the University of Malaya Medical Center for elucidating maternal exposure as well as maternal-to-fetal transfer. The source profiling identified that nickel and zinc were discharged from sewage and/or industrial effluents, and that lead was discharged from mining sites. Arsenic showed a site-specific pollution in tin-tungsten deposit areas, and the pollution source could be associated with arsenopyrite. The maternal blood levels of arsenic (0.82 ± 0.61 μg/dL), cadmium (0.15 ± 0.2 μg/dL) and lead (2.6 ± 2.1 μg/dL) were not significantly high compared to their acute toxicity levels, but could have attributable risks of chronic toxicity. Those in cord blood were significantly decreased in cadmium (0.06 ± 0.07 μg/dL) and lead (0.99 ± 1.2 μg/dL) but were equivalent in arsenic (0.82 ± 1.1 μg/dL) because of the different kinetics of maternal-to-fetal transfer.
  12. Chu SY, Sakai N, Lee J, Harrison E, Tang KP, Mori K
    J Fluency Disord, 2020 09;65:105767.
    PMID: 32535211 DOI: 10.1016/j.jfludis.2020.105767
    PURPOSE: Adults who stutter (AWS) often develop social anxiety disorder. This study was to provide comparative data on the Liebowitz Social Anxiety Scale-Japanese version (LSAS-J) from AWS and non-stuttering adult controls.

    METHODS: LSAS-J, a 24-item self-reported survey of social phobia and avoidance across various daily situations, was administered to 130 AWS (Mean Age = 41.5 years, SD = 15.8, 111 males) and 114 non-stuttering adults (Mean Age = 39.5, SD = 14.9, 53 males). The test-retest reliability and internal consistency of the LSAS-J were assessed. A between-subject multivariate analysis of variance (MANOVA) was also conducted to determine whether attitude toward social anxiety differed between AWS and AWNS, or by age (<40 and ≥ 40 years old), or sex (female and male).

    RESULTS: AWS reported higher scores on both fear subscales of the LSAS-J. Age had no significant influence on the social anxiety levels reported by either participant group. Sex differences were found in the fear subscales, with females scoring higher on both fear subscales, although these were only marginally significant (p = .06). LSAS-J showed good test-retest reliability and high Cronbach's alpha coefficient, indicating that it is an internally consistent measure of attitudes about social anxiety.

    CONCLUSION: Given the similarly high incidence of social anxiety in adults in Japan who stutter compared with those in other countries, social anxiety should be identified and assessed during clinical decision making and before decisions are made about stuttering treatment. LSAS-J is an easy tool to administer, and showed reliable results of social phobia and avoidance for AWS.

  13. Sulong NA, Latif MT, Sahani M, Khan MF, Fadzil MF, Tahir NM, et al.
    Chemosphere, 2019 Mar;219:1-14.
    PMID: 30528968 DOI: 10.1016/j.chemosphere.2018.11.195
    This study aimed to determine the distribution and potential health risks of polycyclic aromatic hydrocarbons (PAHs) in PM2.5 collected in Kuala Lumpur during different monsoon seasons. The potential sources of PM2.5 were investigated using 16 priority PAHs with additional of biomass tracers namely levoglucosan (LV), mannosan (MN) and galactosan (GL). This study also investigated the cytotoxic potential of the extracted PAHs towards V79-4 cells. A high-volume air sampler (HVS) was used to collect PM2.5 samples for 24 h. PAHs were extracted using dichloromethane (DCM) while biomass tracers were extracted by a mixture of DCM/methanol (3:1) before analysis with gas chromatography-mass spectrometry (GC-MS). The cytotoxicity of the PAHs extract was determined by assessing the cell viability through the reduction of tetrazolium salts (MTT). The results showed that the total mean ± SD concentrations of PAHs during the southwest (SW) and northeast (NE) monsoons were 2.51 ± 0.93 ng m-3 and 1.37 ± 0.09 ng m-3, respectively. Positive matrix factorization (PMF) using PAH and biomass tracer concentrations suggested four potential sources of PM2.5; gasoline emissions (29.1%), natural gas and coal burning (28.3%), biomass burning (22.3%), and diesel and heavy oil combustion (20.3%). Health risk assessment showed insignificant incremental lifetime cancer risk (ILCR) of 2.40E-07 for 70 years of exposure. MTT assay suggested that PAHs extracts collected during SW monsoon have cytotoxic effect towards V79-4 cell at the concentrations of 25 μg mL-1, 50 μg mL-1, 100 μg mL-1 whereas non-cytotoxic effect was observed on the PAHs sample collected during NE monsoon.
  14. Pierot L, Jarayaman M, Szikora I, Hirsch J, Baxter B, Miyachi S, et al.
    Can J Neurol Sci, 2019 05;46(3):269-274.
    PMID: 30890199 DOI: 10.1017/cjn.2019.1
    After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
  15. Pierot L, Jayaraman MV, Szikora I, Hirsch JA, Baxter B, Miyachi S, et al.
    AJNR Am J Neuroradiol, 2018 11;39(11):E112-E117.
    PMID: 30442688 DOI: 10.3174/ajnr.A5853
  16. Nogueira RG, Qureshi MM, Abdalkader M, Martins SO, Yamagami H, Qiu Z, et al.
    Neurology, 2021 06 08;96(23):e2824-e2838.
    PMID: 33766997 DOI: 10.1212/WNL.0000000000011885
    OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.

    METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.

    RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions.

    CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

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