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COVID-19 has now become an endemic disease and a definitive set of protocols should be applied worldwide for safe clinical and surgical practice. Minimal access surgery is becoming more popular and standard of care for many routine surgeries. However, during COVID-19, a lot of dilemmas were there about whether to perform minimal access surgery or not. As of now, most of the guidelines are established on the opinions of expert committees and the level of evidence is not much high. Minimal invasive approaches are still a safe approach during the COVID-19 pandemic with proper case selection and with additional safety precautions. Hence, we have reviewed the literature for the safe practice of minimal access surgery during COVID-19.Copyright ©2022 Published by Scientific Scholar on behalf of Global Journal of Medical, Pharmaceutical, and Biomedical Update.
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Objective: To increase public awareness on importance of blood pressure (BP) screening for hypertension prevention and management through a national campaign in Nepal. Design: Opportunistic BP screening campaign was carried out among people 18 years or more in the year 2020, following the COVID-19 safety measures. The study used a cross-sectional survey design. Method: Systolic and diastolic BP data of the participants were obtained from three consecutive measurements of which second and third measurements were used to estimate the mean. Hypertension was defined as the systolic BP more than or equal to 140 and/or diastolic BP more than or equal to 90 mmHg or currently taking antihypertensive medicine. The screening campaign was conducted in 25 sites of the country. Measurement was done using OMRON automatic monitors. Altogether, 115 volunteer research assistants with public health background used mobilized for data collection. Logistic regression analysis was used to identify the factors associated with hypertension. Results: In total, 11,481 people participated in the BP screening campaign of which more than half were females (57%, 6568/11,481). Mean age of the participants was 45 ± 17 years. Mean systolic and diastolic BP were 125.8 ± 18 and 81.6 ± 10.5 respectively. Nearly a third (31.1%, 3592/11,481) of participants were hypertensive of which only 40% (1444/3592) were aware about their hypertension status. However, only about 80% (1146/14444) hypertensive participants were talking medicines. High age-group, high body mass index and smoking were found associated with hypertension adjusting age, sex and body mass index and smoking status of the participants. Conclusions: Blood pressure screening campaign provided an important opportunity to identify undiagnosed hypertension and raise awareness on hypertension among the general population. Awareness raising programs at the population and targeted interventions are warranted for prevention and control of hypertension in Nepal among older, overweight, and obese people and smokers.
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Objective: Nepal has been participating in the May Measurement Month (MMM) aiming to raise hypertension awareness and improve health seeking behavior to control high blood pressure in communities and present data for policymakers. This study compares the results from 2017 to 2021. Design and Methods: Opportunistic cross-sectional surveys to measure the proportion of hypertension, its awareness, treatment, control, and risk factors among> = 18 years of age annually from 2017 to 2021 in Nepal. Although MMM was not executed globally due to the COVID-19 pandemic in 2020, it was conducted in Nepal by following safety measures. We administered the structured questionnaire and took three BP readings while sitting at 1-minutes intervals. Measures of association were calculated using the logistic regression model adjusting for age and sex. The same definition of hypertension (a mean of 2nd and 3rd BP reading> = 140/90 mmHg, or participants were treated with medicines for known hypertension) was applied for all years. Results: The summary characteristics from 2017 to 2021 are presented in Table 1. Baseline characteristics were similar for all five studies except for low tobacco use in 2017. The proportion of hypertension ranges from 20.6% to 31.3% (24.4% in 2017, 27.8% in 2018, 27.5% in 2019, 31.3% in 2020, and 20.6% in 2021). Awareness, treatment, and control were also similar across five years, ranging from 39.5% to 49.9%, 29.5% to 39.1%, and 46.0% to 56.0% respectively. Smoking, alcohol use, body mass index> = 25, diabetes, and history of myocardial infarction (MI) or stroke were associated with hypertension after adjusting for age and sex across multiple studies. Conclusions: A five-year comparison of the MMM study in Nepal showed that hypertension awareness, treatment, and control have been suboptimal, suggesting an urgent need to implement a nationwide prevention and control program together with a national screening program. (Table Presented).
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INTRODUCTION: Corticosteroids are standard of care for hospitalized COVID-19 patients requiring oxygen supplementation. However, studies evaluating the clinical impact of corticosteroid use beyond 10 days for treatment of COVID-19 are limited. We sought to analyze the impact of extending corticosteroid duration beyond 10 days on 28-day mortality, median hospital length of stay (LOS), intensive care unit (ICU) LOS, mechanical ventilation (MV) duration, and secondary infection risk in patients with COVID-19. METHOD(S): This single-center retrospective study examined 139 hospitalized adult ICU patients receiving corticosteroids for COVID-19 from August 2020 to January 2021. Patients were divided into two groups: standard therapy (<=10 days of corticosteroids;n=45) and extended therapy (>10 days of corticosteroids;n=94). The effect of corticosteroid duration on outcomes was analyzed, with adjustments for confounders made by multivariate regression analysis. RESULT(S): 28-day mortality was not impacted by steroid duration (37/94 [39%] in extended therapy arm vs 22/45 [48%] in standard therapy arm;p=0.29). Rate of secondary infection was higher (40% vs 18%;p< 0.01) and median ICU LOS was longer (14 (9-20) days vs 9 (3-17) days;p=0.01) in the extended therapy group compared to the standard therapy group. However, median hospital LOS and MV duration did not differ between the groups (p=0.07 and p=0.34, respectively). After multivariate analysis, risk of secondary infection remained elevated in the extended therapy arm versus the standard therapy arm (40% vs 18%;adjusted p= 0.04);however, after multivariate analysis, steroid duration did not impact 28-day mortality (p=0.60), ICU LOS (p=0.10), or hospital LOS (p=0.06). CONCLUSION(S): Extending corticosteroid therapy beyond 10 days did not impact mortality at 28 days among a cohort of critically ill patients with COVID-19 but was associated with higher rates of secondary infection.
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Purpose: To evaluate the knowledge, attitude, and practices (KAP) of patients who have undergone kidney and/or liver solid organ transplants (SOTs) during the COVID-19 pandemic. Method(s): This single institution cross-sectional study was conducted on patients who underwent a liver and/or kidney transplantation between June 01, 2020, and June 30, 2021 at Methodist Dallas Medical Center, Dallas, Texas, USA. A KAP questionnaire of 26 questions assessing KAP regarding COVID-19 was designed and sent to 1,053 SOT recipients. A score of 70% or higher was deemed to be sufficient for each corresponding category. Statistical significance amongst parameters was determined using Chi-Square test or Fisher's exact test. Result(s): A total of 238 out of 1,053 (22.6%) SOT patients responded to the survey questionnaire. Socio-demographic and clinical characteristics breakdown can be seen in Figure Attached. Those who scored sufficiently in knowledge were more likely to score higher in the practices portion of the survey (OR 4.25, 95% CI 1.59-11.38, p < 0.01). Those above 61 years of age were less likely to score higher than those between 41-60 years of age (OR 0.46, 95% CI 0.23-0.93, p = 0.0314). Combined liver and kidney transplant patients were more likely to score higher than liver only transplant patients (OR 4.84, 95% CI 1.01-23.24, p < 0.05). Patients on triple immunosuppression were more likely to adhere to sufficient COVID-19 practices than those who were not on triple immunosuppression (OR 4.07, 95% CI 1.99-8.33, p < 0.001). Conclusion(s): In this study we observed correlations between practice scores and knowledge, age, type of SOT, and use of triple immunosuppression. This information will better help medical workers, public health officials, and health education programs target areas of improvement to improve overall safety of this vulnerable population against COVID-19. (Table Presented).
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Objective. Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological symptoms. To compare the clinical features, imaging and treatments in patients with and without COVID 19. To compare the mortality and in-hospital stay among patients with and without COVID 19 and negative patients. Materials and methods. In this retrospective, single-center study, we included all the patients who attended the department of neurology with neurologic symptoms with confirmed COVID-19 and long COVID-19 from June 2020 to January 2021. Data on clinical signs, diagnosis, laboratory findings were collected and analyzed from the records for positive patients and compared with neurologic patients without COVID-19 admitted in the same period. Statistical analysis: The mean values between study groups were compared using an independent sample t-test and Mann Whitney u test. Categorical outcomes were compared using the Chi square test. Data was analyzed using coGuide soft-ware. Results. Headache was the common neurologic manifestation present in COVID positive patients compared to COVID negative patients (39.13%). There was no statistically significant difference between the two groups in baseline parame-ters. Laboratory parameters like CRP, Serum Ferritin, LDH, D-dimer, ESR, and IL-6 showed a significant increase in COVID positive patients (P <0.05). In-hospital mortality was more in COVID positive patients than COVID negative patients (P <0.011). Conclusion. The study showed varied neurologic symptoms in COVID patients, with headache as the common symptom. Hospital stay, morbidity, mortality, and inflammatory parameters were more in COVID positive patients compared to COVID negative patients.
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COVID-19 patients have a high incidence of acute kidney injury (AKI) and a notable increase in mortality once AKI has developed. The goal of this study is to help identify critically ill COVID-19 patients who are at higher risk of developing severe AKI and renal failure in hopes that earlier identification can lead to improved outcomes. We performed a retrospective study of COVID-19-positive patients in the intensive care unit (ICU) at a major Southwest United States quaternary hospital from March 20 to November 26, 2020whohad a Nephrocheck® test, an FDA-approved lab test that allows for assessment of AKI risk. Patients who met the criteria were put into risk groups based on theirNephrocheck®value: low-risk (<0.3), intermediate-risk (0.3-2.0), and high-risk (>2.0). Patients in the study were evaluated for outcomes of mortality, ICU length of stay, need for renal replacement therapy, urinary output, and degree of AKI. Univariate analysis, primarily Fisher's exact test, was used to compare the groups. In total, 38 COVID-19 patients with Nephrocheck® values were identified. Of the 38 COVID-19 patients who had a Nephrocheck® lab obtained, 5 were low risk, 19 were intermediate risk, and 14 were high risk. The intermediate-risk (OR = 18, 95% CI =. 7540547 -1019.974, P = 0.0441) and thehigh-risk (or = 19.5, 95% CI =. 8208219 - 1098.472, P = 0.0374) groups had higher odds of developing stage 3 AKI by creatinine compared to the low-risk group.Also, the high-risk group had higher odds of developing stage 3 AKI by urinary output compared to the intermediate-risk (OR = 8.1, 95% CI = 0.97 - 97.06, P = 0.0419) and low-risk (lower limit of 95% CI of OR = 2.22, P = 0.0275;exact CI not possible with zero count cells) groups. Mortality, ICU length of stay, and need for renal replacement therapy were not statistically different between the three risk groups. Our findings suggest that Nephrocheck® is able to identify and risk stratify COVID-19 patients in the ICU who are at increased risk of developing a severe AKI. These results are limited by the small sample size and the non-uniform timing of the Nephrocheck® labs being drawn for each patient.
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Introduction: Inclusion of patients with kidney disease in COVID vaccine trials remains low. It is important to report association of disease exacerbation so that patients may undergo post vaccination monitoring. We hereby present a case of worsening IgA nephropathy temporarily associated with COVID vaccination Case Description: 63-year-old Hispanic female with past medical history of hypertension, psoriatic arthritis presented to the hospital with gross hematuria for 6 weeks starting 3 days after 2nd dose of Pfizer COVID vaccine. Her PCP had sent her to ER 5 days after onset of hematuria as had noted a creatinine (Cr) of 1.6 with 3+ protein and >20 RBCs on urinalysis suspicious for nephritic syndrome. On review she had serum Cr of 0.5 about 4 months ago with no proteinuria or hematuria before. In the ER she was given antibiotics for urinary tract infection and outpatient referral for nephrology. She could not make the outpatient appointment and with continued gross hematuria for a month, she presented to the ER again where she was noted to have Cr of 10 mg/dl and urine protein:cr ratio of 7.3gm/gm. Renal imaging including CT urogram was normal. Renal biopsy showed IgA nephropathy, M1S0E0T1C1 with a fibrocellular crescent and acute tubular necrosis likely secondary to lyzed red cells in setting of multiple RBC casts in the tubules. She was put on 250 mg Solumedrol for 3 doses followed by 1 mg/kg of Prednisone with eventual downtrend in Cr to 4.5 in 15 days. Discussion: There have been 2 cases reported in literature with known IgA nephropathy who developed gross hematuria post COVID 19 vaccination. SARS-COV 2 vaccines use nucleoside modified purified mRNA which does elicit higher neutralizing antibody titre and strong cluster of differentiation response leading to production of several proinflammatory cytokines. Thus, there is a concern that vaccines might exacerbate immune mediated glomerular diseases. IgA1 is involved in the pathogenesis of IgA nephropathy and patients with IgA nephropathy have higher than normal IgA1 response to other vaccines like influenza. Also while studying the antibody response to COVID 19 illness patients with IgA nephropathy are known to express higher IgA response compared to IgG and IgM along with reports of concurrent worsening of the glomerulonephritis. Nephrologists should closely follow patients with IgA nephropathy to establish the frequency of disease activation post vaccination.
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Bats maintain and transmit many viruses (Filoviruses, Rubulaviruses, Henipaviruses, Lyssaviruses, and Coronaviruses etc.);most of them are pathogenic to human but bats act as reservoir host without causing any pathogenesis. Coronavirus disease-2019 (COVID-19) pandemic is a twenty-first-century awakening for the human world that signifies the zoonotic viral challenge. Bats fauna are suspected to originate viral outbreaks through solid evidence that is lacking worldwide. The bats like Pteropus giganteus, Rousettus leschenaultii, Eonycteris spealea, Rhinolophus sinicus, R. affinis, R. ferremequinum, Nyctalus noctula, and Scotophillus sp. are reported for viral evidence that are also extended to Nepal's geography. Bats bush-meat culture persist in Chepang community of Nepal indicates a high risk of a zoonotic viral outbreak in the future. Though Nepal has no evidence of any viral outbreak until the COVID-19 pandemic situation, precaution is warned for bat conservation and bat roost management to ensure bat virus safety.
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Ganges River water quality was assessed to record the changes due to the nation-wide pandemic lockdown. Satellite-based (Sentinel-2) water quality analysis before and during lockdown was performed for seven selected locations spread across the entire stretch of the Ganges (Rishikesh-Dimond Harbour). Results revealed that due to the lockdown, the water quality of the Ganges improved with reference to specific water quality parameters, but the improvements were region specific. Along the entire stretch of Ganges, only the Haridwar site showed improvement to an extent of being potable as per the threshold set by the Central Pollution Control Board, New Delhi, India. A 55% decline in turbidity at that site during the lockdown was attributed to the abrupt halt in pilgrimage activities. Absorption by chromophoric dissolved organic matter which is an indicator of organic pollution declined all along the Ganges stretch with a maximum decline at the downstream location of Diamond Harbour. Restricted discharge of industrial effluent, urban pollution, sewage from hotels, lodges, and spiritual dwellings along the Ganges are some of the reasons behind such declines. No significant change in the geographic trend of chlorophyll-a was observed. The findings of this study highlight the importance of regular monitoring of the changes in the Ganges water quality using Sentinel-2 data to further isolate the anthropogenic impact, as India continues the phase-wise opening amidst the pandemic.