SARS-CoV-2: Operating room management strategies and recommendations

Since the outbreak of SARS-CoV-2/COVID-19 in Wuhan, China in 2019, it has rapidly spread to the world, and the number of infections has gradually increased. The hospitalization rate of patients has also gradually increased, which poses a huge challenge to hospitals and medical staff for patients with SARS-CoV-2 requiring surgical treatment. Therefore, avoiding cross-infection in the operating room is an important protective work. The operating room is an important department of the hospital, scientific and reasonable management is particularly important. Therefore, we have put forward corresponding suggestions and strategies for preoperative preparation and evaluation of patients, intraoperative management, postoperative terminal management, and protection of medical staff, and hope that these measures can better prevent and control the infection of SARS-CoV-2 in the operating room.

Clinical Characteristics, Risk Factors and Cardiac Manifestations of Cancer Patients with COVID-19 (preprint)

Background: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular features, which may be deteriorated in cancer patients.Methods: We retrospectively assessed 1,244 COVID-19 patients from February 1st to August 31st (140 cancer and 1104 non-cancer patients). Clinical data and laboratory findings were obtained and compared between cancer and non-cancer groups. Risk factors for in-hospital mortality were identified by multivariable COX regression models.Findings: The median age of cancer group was older than that in non-cancer patients [61 (57-67) vs. 56 (40-68), p < 0.001]. For cancer group, 56% were in severe and critical status, while the proportion was 10% for non-cancer group. Cancer patients had increased levels of leukocyte, neutrophil count and BUN (all p < 0.01), while lymphocyte count was significantly lower (p < 0.001). The most common solid tumor types were gastrointestinal cancer (26%), lung cancer (21%), breast and reproductive cancer (both 19%). There is a rising for cardiac biomarkers, including Pro-BNP, cTnI, MYO, CK-MB, and D-Dimer in COVID-19 cancer population, especially in deceased cancer subjects. The 30-day in hospital mortality in cancer group was dramatically raised than that in non-cancer group (12.9% vs. 4.0%, p<0.01). In multivariable COX regression models, fever, disease severity status, underlying diseases were risk factors for mortality. The Pro-BNP and D-Dimer levels were significantly increased in cancer subjects with cardiovascular disease.Interpretation: COVID-19 cancer patients relate to deteriorating conditions, increased risk of admission to intensive care units and in-hospital mortality. They display severely impaired myocardium, damaged heart function and imbalanced homeostasis of coagulation, which warrants more aggressive treatment. Funding: The current work was supported by the National Natural Science Foundation Project of China (Grant No. 81670304) and the Fundamental Research Funds for the Central Universities of China (NO.2042019kf0058).Declaration of Interests: All authors report no relationship or conflict of interest to disclose.Ethics Approval Statement: This study was approved by the National Health Commission of China and the institutional review board at Renmin Hospital of Wuhan University (Wuhan, China).

Epidemiological and clinical characteristics of 47 corona virus disease 2019 non-survivors in Huoshenshan Hospital

Objective To provide a basis for further optimizing the diagnosis and treatment strategies of severe and critical corona virus disease 2019 (COVID-19) by investigating and analyzing the epidemiological and clinical characteristics of the death cases. Methods The epidemiological and clinical characteristics of 47 death cases obtained from Huoshenshan Hospital in Whuhan, Hubei Province were retrospectively analyzed. Results All the patients developed initial symptoms in Wuhan. The time from onset to admission was (12.60±5.60) days. Most of them were male (68.09%) with non-nosocomial infection (91.49%), advanced age (>60 years, 89.36%). Over half of the cases (51.06%) reported a history of contact with suspected or confirmed patients, and comorbidity of chronic diseases (70.21%). Multiple organ dysfunction syndrome (MODS) occurred in 29 cases (61.70%) with heart failure (51.06%) and renal failure (36.17%). The main clinical symptoms included fever, fatigue, dyspnea and cough. At admission,most cases were severe (55.32%) or critical (42.55%), and the in-hospital survival was longer for the severe than for the critical (P=0.02). 76.59% of the patients received invasive mechanical ventilation, and they had a longer in-hospital survival than those with non-invasive mechanical ventilation (P<0.05). Conclusions This group of cases occurred during the peak of the COVID-19 outbreak in China, characterized by male, elder and history of chronic diseases. Acute respiratory distress syndrome (ARDS) caused by COVID-19 was responsible for patients' death, and MODS manifestated by heart and kidney failure also implicated in the process. Disease severity and invasive mechanical ventilation were related to in-hospital survival.