ABSTRACT
INTRODUCTION AND OBJECTIVE: Continued vigilance of operative outcomes of COVID-19 patients is important given the relative novelty of the SARS-CoV-2 infection. We here sought to evaluate the 30-day mortality and cardiopulmonary adverse event rates in patients undergoing emergency surgery with perioperative COVID-19 infection, in comparison to a control group of medically managed COVID-19 patients that did not require surgical intervention. METHODS: A retrospective review of electronic medical data from a single tertiary-care center in Michigan was undertaken. Patients who had tested positive for SARS-CoV-2 infection either 7 days before or within 30 days after surgery during March-May 2020 were included in the study (n=52). Propensity score matched (1:6) patients who had been positive for SARS-CoV-2 infection during this time-period but did not undergo surgery were used as controls (n=314, Figure 1). The primary endpoint was 30-day mortality. Secondary endpoints included cardiac and pulmonary complications. Multivariable logistic regression analyses were utilized to account for baseline differences. A pvalue <0.05 was considered significant. RESULTS: The 30-day mortality (17.3% vs 13.1%, p=0.408) and cardiac (28.9% vs 19.1%, p=0.107) and pulmonary complication (55.8% vs 49.4%, p=0.392) rates were similar in patients in the surgical versus non-surgical group, respectively. Multivariable analyses confirmed that an emergency surgical intervention was not associated with increased odds for any of the studied adverse events (p >0.10 for all 3 endpoints). CONCLUSIONS: Patients undergoing emergency surgery with a co-diagnosis of SARS-CoV-2 infection in the perioperative period do not have an increased risk for short-term mortality or cardiopulmonary complications compared to the medically treated COVID-19 patients.
ABSTRACT
In this essay, I apply the Kantian (or at the very least, Kant-inspired) interpretation of enlightenment as radical enlightenment to the enterprise of philosophy within the context of our contemporary world-situation, and try to answer this very hard question: "As radically enlightened Kantian philosophers confronted by the double-whammy consisting of what I call The Hyper-State, together with the 2020-2021 COVID-19 pandemic, what should we dare to think and do?" The very hard problem posed by this very hard question is what I'll call The New Conflict of the Faculties. By way of a direct answer to this very hard question and by way of an effective solution to this very hard problem, I provide seven recommendations.
ABSTRACT
Patients undergoing fertility treatments, such as in-vitro fertilization (IVF), face unique challenges both physically and mentally. With the emergence of the COVID-19 global pandemic, IVF patients began to face additional obstacles as hospitals and clinics shut down in compliance with recommendations for limiting exposure risk. In order to assess the impact of COVID-19 on IVF patients, we conducted a qualitative analysis using 563 public Instagram posts collected from three randomly selected days in March 2020. After the exclusion of 354 posts, thematic coding was used to analyze 209 posts. Five major themes were identified including (1) the medical and physical experience of IVF, (2) emotional spectrum, (3) sources of social support, (4) coping mechanisms, and (5) education on social media. Posts were categorized based on whether COVID-19 was discussed and theme frequencies were compared. The majority of patients impacted by the pandemic discussed setbacks to care, such as clinic closures. In addition, posts authored by those impacted by COVID-19 contained more negative emotions and fewer positive emotions compared to unaffected users. Despite an increase in setbacks and negative emotions, posts offering support nearly tripled in frequency highlighting the resilience of the IVF community. Our thematic analysis supports the need for careful consideration of the psychological and social effects of cycle cancellations on the IVF community. Experiences and sentiments revealed by this study should be considered when a successive pandemic or global emergency threatens IVF treatment protocols.