Associations between SARS-CoV-2 infections and thrombotic complications necessitating surgical intervention: A systematic review.

BACKGROUND: Several unique clinical features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19) infection, have been identified and characterized. One such feature, mostly among patients with severe COVID-19 infection, has become known as COVID-19-induced coagulopathy. Surgical patients with a history of or active COVID-19 infection bear a significantly higher risk for postoperative thrombotic complications. These patients may require surgical intervention to treat severe thrombotic complications. Few studies have been carried out to better characterize this association. The purpose of this study was to perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention. We hypothesized that patients with recent or active COVID-19 infection would have high rates of thromboembolic complications both arterial and venous in origin. AIM: To perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention. METHODS: The current systematic review implemented an algorithmic approach to review all the currently available English medical literature on surgical interventions necessitated by COVID-19 thrombotic complications using the preferred reporting items for systematic reviews and meta-analysis principles. A comprehensive search of the medical literature in the "PubMed", "Scopus", "Google Scholar" top 100 results, and archives of Plastic and Reconstructive Surgery was performed using the key words "COVID-19" AND "surgery" AND "thromboembolism" AND "complication". The search string was generated and the records which were not specific about surgical interventions or thrombotic complications due to COVID-19 infection were excluded. Titles and abstracts were screened by two authors and full-text articles were assessed for eligibility and inclusion. Finally, results were further refined to focus on articles that focused on surgical interventions that were necessitated by COVID-19 thrombotic complications. RESULTS: The database search resulted in the final inclusion of 22 retrospective studies, after application of the inclusion/exclusion criteria. Of the included studies, 17 were single case reports, 3 were case series and 2 were cross sectional cohort studies. All studies were retrospective in nature. Twelve of the reported studies were conducted in the United States of America, with the remaining studies originating from Italy, Turkey, Pakistan, France, Serbia, and Germany. All cases reported in our study were laboratory confirmed SARS-CoV-2 positive. A total of 70 cases involving surgical intervention were isolated from the 22 studies included in this review. CONCLUSION: There is paucity of data describing the relationship between COVID-19 infection and thrombotic complications necessitating the need for surgical intervention. Intestinal ischemia and acute limb ischemia are amongst the most common thrombotic events due to COVID-19 that required operative management. An overall postoperative mortality of 30% was found in those who underwent operative procedures for thrombotic complications, with most deaths occurring in those with bowel ischemia. Physicians should be aware that despite thromboprophylaxis, severe thrombotic complications can still occur in this patient population, however, surgical intervention results in relatively low mortality apart from cases of ischemic bowel resection.

Impact of gender-affirming hormone therapy on the development of COVID-19 infections and associated complications: A systematic review.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can produce a wide range of clinical manifestations from asymptomatic to life-threatening. Various researchers have worked to elucidate the pathogenic mechanisms underlying these variable presentations. Differences in individual responses to systemic inflammation and coagulopathy appear to be modulated by several factors, including sex steroid hormones. Transgender men or non-binary individuals who undergo gender-affirming hormone therapy (GAHT) are a unique population of interest for exploring the androgen-mediated coronavirus disease 2019 (COVID-19) hypothesis. As the search for reliable and effective COVID-19 treatments continues, understanding the risks and benefits of GAHT may mitigate COVID-19 related morbidity and mortality in this patient population. AIM: To investigate the potential role of GAHT in the development of COVID-19 infections and complications. METHODS: This systematic review implemented an algorithmic approach using PRISMA guidelines. PubMed, Scopus, Google Scholar top 100 results, and archives of Plastic and Reconstructive Surgery was on January 12, 2022 using the key words "gender" AND "hormone" AND "therapy" AND "COVID-19" as well as associated terms. Non-English articles, articles published prior to 2019 (prior to COVID-19), and manuscripts in the form of reviews, commentaries, or letters were excluded. References of the selected publications were screened as well. RESULTS: The database search resulted in the final inclusion of 14 studies related to GAHT COVID-19. Of the included studies, only two studies directly involved and reported on COVID-19 in transgender patients. Several clinical trials looked at the relationship between testosterone, estrogen, and progesterone in COVID-19 infected cis-gender men and women. It has been proposed that androgens may facilitate initial COVID-19 infection, however, once this occurs, testosterone may have a protective effect. Multiple clinical studies have shown that low baseline testosterone levels in men with COVID-19 are associated with worsening outcomes. The role of female sex hormones, including estrogen and progesterone have also been proposed as potential protective factors in COVID-19 infection. This was exemplified in multiple studies investigating different outcomes in pre- and post-menopausal women as well as those taking hormone replacement therapy. Two studies related specifically to transgender patients and GAHT found that estrogen and progesterone could help protect men against COVID-19, and that testosterone hormone therapy may increase the risk of contracting COVID-19. CONCLUSION: Few studies were found related to the role of GAHT in COVID-19 infections. Additional research is necessary to enhance our understanding of this relationship and provide better care for transgender patients.

Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action.

Telemedicine has facilitated the delivery of affordable and accessible health care. However, little has been discussed about its use in gender-affirming care (GAC). Telemedicine has the potential to overcome many barriers encountered by transgender individuals such as limited geographic access to care and financial constraints, which have both been exacerbated by the COVID-19 pandemic. Telemedicine may also enhance opportunities for training in gender-affirming surgery. A systematic review of the literature on telehealth and GAC was performed. Identified uses of telehealth included: an electronic teleconsultation service, a virtual peer health consultation service, and an open online course on LGBT+ rights and health care for health care providers and laypeople. As the medical and health care communities adjust to the new reality of health care, efforts should be made to effectively incorporate telemedicine into GAC.

Mental Health Disorders in Nurses During the COVID-19 Pandemic: Implications and Coping Strategies.

Nurses caring for patients who contract coronavirus disease 2019 (COVID-19) have experienced significant traumas in the form of increased workloads, negative patient outcomes, and less social support system access. Nurses should be provided with information regarding early detection, coping skills and treatment for anxiety, depression, post-traumatic stress syndrome (PTSS)/post-traumatic stress disorder (PTSD), and other mental health disorders. Early intervention is important as mental health disorders can cause dysfunction, internal suffering, and in the most extreme situations, lead to death if not properly cared for. Healthcare corporations should consider providing coverage for mental health treatment for employees who experience COVID-19 traumas. With the implementation of healthy coping skills and therapeutic intervention, nurses will be able to let go of the negative impacts that the COVID-19 pandemic has caused and reintegrate into their roles as caring and entrusted health care providers. The current paper evaluates the mental health disorders encountered by nurses in the COVID-19 era based on the current medical literature and aims to provide practical coping strategies.

Doctority: Plastic Surgery-An Informative Podcast for Applicants to Learn about Plastic Surgery Training Programs.

The COVID-19 pandemic limited the ability of medical students to participate in plastic surgery sub-internships and to attend residency interviews in person during the 2020-2021 match cycle. A podcast and accompanying online directory were created to introduce integrated plastic surgery residency programs to medical students from the perspective of current residents. Since July 2020, a total of 49 plastic surgery residents representing 42 programs have participated in the podcast. Topics of discussion included program logistics, faculty leadership, and aspects of resident lifestyle of interest to medical students and future residency candidates. The podcast has had a total of 5072 downloads (mean 121 downloads per episode). The majority of listeners (90%) were in the United States. Twenty-five plastic surgery applicants who participated in the 2020-2021 National Resident Matching Program match cycle responded to a feedback survey. Listeners reported that the podcast was useful for preparing for interviews, making rank lists, and learning about programs that they otherwise would not have considered. Most listeners (90%) ranked the podcast as one of their top three resources for learning about plastic surgery programs during the application and interview process. Future directions include completion of episodes for all integrated plastic surgery programs and expansion to other surgical subspecialties and plastic surgery fellowships.

Considerations for resuming global surgery outreach programs during and after the coronavirus disease 2019 (COVID-19) pandemic.

BACKGROUND: The coronavirus disease 2019 pandemic has disrupted the delivery of safe surgical care worldwide. One specific aspect of global surgical care that has been severely limited is the ability for physicians and trainees to participate in global surgical outreach programs in low- and middle-income countries. METHODS: A narrative review of the literature regarding global surgical outreach programs during the coronavirus disease 2019 pandemic was performed. Factors that must be considered in the reinstatement of global surgical outreach programs were identified, and suggestions to address them were provided based on the available literature and the experiences of the senior authors. RESULTS: As global surgical outreach programs were canceled at the start of the pandemic, many academic surgeons turned to digital solutions to continue to engage with low- and middle-income country partners. With the advent of coronavirus disease 2019 vaccines and improved access to testing and treatment worldwide, the recommencement of global surgical outreach programs may begin to be considered. Important considerations before initiation include vaccine and testing availability for visiting providers, local staff, and patients, local hospital capacity, staff and equipment shortages, and the characteristics of the patient population and visiting providers. Region- and country-specific factors, including local infection rates and concomitant health crises, must also be taken into account. Expansion of digital collaborative efforts may further deepen international connections and promote sustainable models of care. CONCLUSION: With careful consideration, global surgical outreach programs may begin to be safely restarted in the near future. The current article evaluates individual factors that must be considered to safely restart global surgical outreach programs as the coronavirus disease 2019 pandemic is better controlled.

Impact of the COVID-19 Pandemic on the Education of Plastic Surgery Trainees in the United States.

The current COVID-19 pandemic has vastly impacted the health care system in the United States, and it is continuing to dictate its unprecedented influence on the education systems, especially the residency and fellowship training programs. The impact of COVID-19 on these training programs has not been uniform across the board, with plastic surgery residency and fellowship programs among the hardest hit specialties. Implementation of social distancing regulations has affected departmental educational activities, including preoperative, morbidity and mortality conferences and journal clubs; operating room educational activities; as well as the overall education of plastic surgery trainees in the United States. Almost all elective and semielective surgeries across the United States were suspended for a few months during the COVID-19 pandemic; this constitutes a significant portion of plastic surgery cases. Considering the current staged reopening policies, it may be a long time, if ever, before restrictions are completely lifted. In this paper, we review the multidimensional impact of the current COVID-19 pandemic on the training programs of plastic surgery residents and fellows in the United States and worldwide, along with some potential solutions on how to address existing challenges.

The Financial Impacts of the COVID-19 Crisis on the Practices of Cosmetic/Aesthetic Plastic Surgeons.

The global pandemic of coronavirus 2019, or COVID-19, has undeniably impacted all facets of healthcare, affecting both its function and provision. Due to the cessation of all non-emergent surgical cases in the USA and worldwide, the professional lives and practices of many physicians have been negatively affected. However, among different physicians and specifically plastic surgeons, cosmetic/aesthetic plastic surgeons have been disproportionately affected by the COVID-19 pandemic as the majority of their cases are semi-elective and elective. The ability to perform semi-elective and elective cases is dependent on state and local authorities' regulations, and it is currently uncertain when the ban, if ever, will be completely lifted. Financial constraints on patients and their future inability to pay for these procedures due to the COVID-19-related economic recession are things to consider. Overall, the goal of this unprecedented time for cosmetic/aesthetic plastic surgeons is for their medical practices to survive, to conserve cash flow although income is low to none, and to maintain their personal finances. In this paper, the authors review the financial impacts of the current COVID-19 pandemic on the practices of cosmetic plastic surgeons in the USA and worldwide, along with some potential approaches to maintain their practices and financial livelihoods. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .