The effect of COVID-19 outbreak on endourological treatments for urinary stones: A retrospective multicentric study

Introduction & Objectives: The COVID-19 outbreak has brought challenges to the global healthcare community. The management of upper urinary tract stones has been affected even further, with potential severe sequelae for patient’s health.Materials & Methods: We report a multicentric retrospective study involving 9 Centers regularly delivering treatment for upper tract urinary stonesacross the country. All Centers suffered significant limitations during the pandemic period due to government limitations. We compared the 12months-period prior to COVID-19 (from march 1st 2019 to February 28th 2020, named as period A) with post-COVID-19 period (from march 1st,2020 to February 28th, 2021 named as period B). Aim of the study was to compare endourological procedures for upper urinary stones duringperiod A and the period B. This study investigated all types of surgeries for stones delivered in both elective and emergency setting.Results: A total of 4018 procedures were collected, including 2176 procedures in period A. In period B, 1842 procedures were carried out,corresponding to a loss of 15.35% of cases (p<0.001). Looking into elective cases, 1622 procedures were delivered in period A, compared to 1280in period B, resulting in a loss of 342 cases corresponding to 21.81% (p=0.001). All types of stone treatments resulted affected, including ESWL(from 487 cases in period A to 344 in period B, -29.37%, p=0.001), PCNLs (from 170 to 125 cases, corresponding to -26.47%, p:0.008), retrogradesurgery for renal stones (from 433 to 387 cases, -10.63%, p=0.008) and for ureteric stones (from 614 cases to 484, -21.18%, p.008). Additionally,waiting lists resulted affected, with significant delays in period B. In particular, for ureteric stones, mean waiting time in period A was 61.5 dayscompared to 87.5 days in period B (p=0.008). Regarding renal stones, waiting list increased from 64.74 days in period A to 85.66 days in periodB for RIRS. The waiting list for percutaneous surgeries increased from 79 days to 103 days (p.001). We did not find any patient which acquiredCOVID-19 during hospitalization for elective or urgent surgery. We also found a longer waiting list for pre-stented patients, resulting to be 86.5 daysin period B compared to 64 days in period A (p<0.005).Conclusions: Our study showed how COVID-19 caused a significant disruption in endourological services across the country. Our data underlined how less patients received treatment in a longer time. This can potentially lead to an increased risk of stone-related complications, including sepsis and kidney loss

Online group psychotherapy for patients with binge eating disorder during COVID-19 emergency

IntroductionOn March 13th 2020, in execution of the Law Decree 14/2020 regarding the reorganization of National Health Care related to COVID-19 emergency, all non-urgent outpatient healthcare services were suspended in Italy. The present work describes remote support and online group psychotherapy set in motion during COVID-19 emergency for outpatients with Binge Eating Disorder.ObjectivesAim of the present work is to describe and evaluate online support and group psychotherapy for outpatients with Binge Eating Disorder during lockdown due to COVID-19 emergency. Outcomes were evaluated by remote administration of questionnaires.Methods20 outpatients with Binge Eating Disorder, treated by psychotherapists of Hospital Psychology Unit in Psychiatry Day Hospital of an Italian General Hospital, received remote support by phone calls and online group psychotherapy from march to may 2020. During the first two weeks, patients were supported via phone calls. From the third week on, they took part to online group psychotherapy sessions, held every week at the same day and time. Pre-post remote administration of Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and the Questionnaire of Eating Behaviours (Scheda dei Comportamenti Alimentari, SCA) was used to evaluate outcomes. Data were analyzed by Student’s t-test.ResultsNo significant difference was found, thus indicating stability of symptomatology.ConclusionsLockdown was a highly stressful period, in which many people lost control on eating behaviours and those with Binge Eating Disorder were expected to have an exacerbation of symptoms. Remote support and online group psychotherapy proved effective in protecting patients from a possible aggravation of their condition.

Early spontaneous pneumothorax, pneumomediastinum and pneumorrhachis in an adolescent with SARS-CoV-2 infection.

We report a case of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, occurring in an adolescent resulting positive to SARS-CoV-2 nasopharyngeal swab. At the admission in Emergency Department, the child presented with left cervical and sternal pain, without respiratory symptoms. Radiological studies showed sizeable pneumomediastinum, bilateral apical pneumothorax, massive emphysema subcutaneous and pneumorrhachis. Patients' clinical conditions stood stable during the monitoring and he only needed conservative management. To our knowledge, this is the first description of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, in a COVID-19 adolescent without concomitant pneumonia.

Telephone consultation during Coronavirus outbreak in a Pediatric Emergency Department: methodological approach of a tertiary care center in a COVID-19 hospital setting.

OBJECTIVE: A computerized system of telephone consultation has been experimented at the Pediatric Emergency Department (ED) of Policlinico Gemelli Hospital in Rome during the outbreak of Coronavirus Disease 2019 (COVID-19). MATERIALS AND METHODS: Twenty monothematic items with a series of questions to evaluate child's clinical conditions have been set up in order to evaluate the different situations according to their severity. All items were highlighted according to conventional scores corresponding to the different answers (yes/no) given by the child's parents. This system has been implemented with large diffusion of computer programs and applications by the availability of a computer station in every ED room. RESULTS: The system allows healthcare workers to establish the medical check-up urgency which may be immediate, within the next 24 hours or scheduled in the pediatric ward. Therefore, it has been implemented a telephone triage consultation with a standardized method. CONCLUSIONS: Telephone consultation during outbreaks, considering the risks of contagion, allows healthcare workers to decrease the concern of families and to reduce indiscriminate access to ED. The remote approach will not solve logistic and setting problems related to COVID-19 outbreak17, but it would be a valid tool to improve medical evaluation without deep change in infrastructure and clinical organization.