Analysis of a post covid multi-disciplinary meeting operating in a digitally supportive virtual platform

Background: The BCCE is an NAPBC internationally accredited unit operating around a surgical oncology breast specialist surgeon, three reconstructive surgeons;four radiological units four pathology labs;8 medical oncologists and 3 radiation oncologists. Whilst the centre was affected by the SARS Covid- 19 pandemic, a rapid restructuring of the MDM procedure allowed for a return to -pre-pandemic service delivery and optimum time-to-treatment of 21days. Methods: Over the 2021 period the BCCE saw 778 newly diagnosed cancer patients, these are all reviewed at a 25 member MDM with 308 patients having full radiological review during the meetings and 609 full pathological reviews prior to treatment discussion amongst the members. These MDM discussions occurred within 6 days of clinical examination due to the integration of multiple specialists and facilities resulting in rapid appointments. Further pathological analysis of 203 patients occurred beyond initial presentation as well as over 350 OncotypeDx reviews. Five hundred and seventy-one individual patient treatment feedback discussions occurred directly postoperatively and 459 treatment plans were reviewed prior to secondary treatment pathways. Results: Digital MDM's resulted in a full return to the centre's optimum level of care, a 7 day MDM review with a 21-day treatment pathway plan proposal, whilst still under the effect of pandemic lockdown regulations. A 6-month comparison (during lockdown regulations) showed a 15% increase in patients seen whilst supported with virtual consultation platforms and digitally supported MDM decisions. Conclusions: Whilst the SARS Covid-19 pandemic affected service delivery. Medical IT transference to full digital MDM allowed for improved review and treatment planning. This improved service delivery to patients with physician and navigator knowledge transfer, resulting in growth of the unit.

Analysis of immediate reconstructive procedures performed a single reconstructive surgeon over a three year period in a multi-disciplinary unit from Johannesburg SA

Background: From September 2018 to June 30 2021 1358 immediate reconstructive procedures were performed by a single reconstructive surgeon in a multi-disciplinary unit. 2000 breast cancer patients were seen over this time This data tracks the types of procedures done and the changes in the procedures including over the time of the SARS COVID19 pandemic. Mastectomies were skin and nipple-sparing (SSM) with implant or autologous reconstruction. Breast-conserving surgery (BCT)had a variety of oncoplastic techniques performed from therapeutic mammoplasties (TM) with opposite side matchings (OSM) and parenchymal flaps (PF) with no OSM. A subset of the BCT had intra-operative radiation therapy. Intra-operative pathology is available for all cases as well as Biovision radiology in theatre. Materials and Methods: Full analysis of the data set was performed on a per-procedure basis, the data set strictly excluded any patient with an incomplete dataset or categorization outside of the study directive to avoid any possible inflation. The data was divided into 2 groups.SSM and immediate reconstruction (either direct to implant(DTI)) or goldilocks mastectomy (GM)and thoraco-epigastric flap (TE)reconstruction or breast-conserving surgery (BCT) with reconstruction. Timelines of what procedures were done each year and the differences per year were analysed Results: For the period of 2018 and 2019, one hundred and three bilateral SSM DTI procedures were performed with six Unilateral SSM and DTI and for the same period ninety-one GM with TE reconstructions For the period of 2020, sixty-one Bilateral DTI and 3 unilateral DTI were performed with twenty-two GM;TE For the first half of 2021 forty bilateral SSM and DTI and, a single unilateral SSM DTI was performed with eight GM;TE Over the same three year period a total of 205 Parenchymal Flap procedures and 559 therapeutic mammoplasties (TM) There was a 99.8% immediate reconstructive rate with no loss of prosthesis over the entire period Conclusions: Whilst the 2020 COVID19 pandemic had a large influence on hospital conditions (restriction of surgical time and bed availability);adaptations within the unit allowed for reconstructive procedures to be offered to all eligible patients, offering every patient immediate reconstruction based on patient-, oncological factors and patient’s preference.

SARS-CoV-2 serosurvey among adults involved in healthcare and health research in Guinea-Bissau, West Africa.

OBJECTIVES: Many African countries have reported fewer COVID-19 cases than countries elsewhere. By the end of 2020, Guinea-Bissau, West Africa, had <2500 PCR-confirmed cases corresponding to 0.1% of the ∼1.8 million national population. We assessed the prevalence of SARS-CoV-2 antibodies in urban Guinea-Bissau to help guide the pandemic response in Guinea-Bissau. STUDY DESIGN: Cross-sectional assessment of SARS-CoV-2 antibody in a cohort of staff at the Bandim Health Project. METHODS: We measured IgG antibodies using point-of-care rapid tests among 140 staff and associates at a biometric research field station in Bissau, the capital of Guinea-Bissau, during November 2020. RESULTS: Of 140 participants, 25 (18%) were IgG-positive. Among IgG-positives, 12 (48%) reported an episode of illness since the onset of the pandemic. Twenty-five (18%) participants had been PCR-tested between May and September; 7 (28%) had been PCR-positive. Four of these seven tested IgG-negative in the present study. Five participants reported that somebody had died in their house, corresponding crudely to an annual death rate of 4.5/1000 people; no death was attributed to COVID-19. Outdoor workers had a lower prevalence of IgG-positivity. CONCLUSIONS: In spite of the low official number of COVID-19 cases, our serosurvey found a high prevalence of IgG-positivity. Most IgG-positives had not been ill. The official number of PCR-confirmed COVID-19 cases has thus grossly underestimated the prevalence of COVID-19 during the pandemic. The observed overall mortality rate in households of Bandim Health Project employees was not higher than the official Guinean mortality rate of 9.6/1000 people.

Systematic review and meta-analysis of the effect of pertussis vaccine in pregnancy on the risk of chorioamnionitis, non-pertussis infectious diseases and other adverse pregnancy outcomes.

BACKGROUND: Several countries have introduced maternal immunisation with pertussis vaccine to provide protection against pertussis in early infancy. There is increasing interest in non-specific effects of vaccines including that non-live vaccines may enhance susceptibility to non-targeted infections in females. Some studies have shown increased risk of chorioamnionitis among women receiving pertussis vaccine during pregnancy. We aimed to conduct a systematic review and meta-analysis of the effect of maternal pertussis immunisation on the risk of chorioamnionitis, as well as the secondary outcomes of non-pertussis infections in women, non-pertussis infections in infants, spontaneous abortion or stillbirth, maternal death and infant death. METHODS: We searched PubMed and Embase for articles published until January 14, 2021. We screened articles for eligibility and extracted data using Covidence. Quality was assessed using Cochrane RoB tool and Newcastle-Ottawa Scale. Data were imported into RevMan for pooling and conduction of a meta-analysis stratified by study type. Outcomes are presented as risk ratios. RESULTS: We identified 13 observational studies and six randomized controlled trials eligible for inclusion. We pooled data on chorioamnionitis from six observational studies and found maternal pertussis vaccine (mostly compared with other maternal immunizations with non-live vaccines) to be associated with an increased risk among the pertussis vaccinated women, RR = 1.27 [CI 95%: 1.14-1.42]. We found no difference in the analysis of our secondary outcomes of non-pertussis infections, spontaneous abortion or stillbirth and death. CONCLUSION: We found an increased risk of chorioamnionitis among women who received pertussis vaccine in pregnancy. The large number of women receiving pertussis vaccine during pregnancy, as well as the growing evidence of non-live vaccines causing increased susceptibility to infections, indicates a need for further randomised trials to assess potential adverse effects of maternal immunisation with pertussis-containing vaccines.