ABSTRACT
Objectives: The purpose of this study was to investigate localised prostate cancer treated with or without neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy, and the impact of Covid-19 treatment disruption, on clinico-pathologic outcomes. Patients and methods: Data was retrospectively collected from 124 consecutive patients treated with robot-assisted laparoscopic prostatectomy between November 2019-September 2020. Sixty-two patients were treated before 13 March 2020 (historic cohort) and 62 afterwards (covid cohort). Thirty-seven patients in the covid cohort additionally received neoadjuvant androgen deprivation therapy (mean duration of 3 months) consisting of bicalutamide 150 mg once a day for 4 weeks, with leuprolide 3.75 mg monthly injections commencing after week 1, up until the date of surgery. Results: Statistical analysis found no difference in peri-operative measures and length of stay for patients treated with or without neoadjuvant androgen deprivation therapy. Patients with delayed surgical treatment offered neoadjuvant androgen deprivation therapy showed a trend towards a reduction in positive surgical margins (p=0.134), N1 disease (p=0.424) and pathological down-staging (50% patients with pT2 disease). Patients within the covid cohort experienced significantly increased detectable prostate-specific antigen levels (p<0.007). Conclusion: Our study demonstrated that a three-month duration of neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy may improve pathological outcomes but this time-frame is inadequate to influence detectable prostate-specific antigen levels. Covid-19-related treatment delays led to significantly increased detectable prostate-specific antigen levels. Level of evidence: 2b.
ABSTRACT
Background: Coronavirus 2019 or CoVid-19 is a new strain of virus from the coronaviridae family which was first detected in Wuhan, China. CoVid-19 has been declared as a world pandemic with approximately 100,000 cases and 14,000 fatalities across 100 countries worldwide. Aim of the Study: The objective of this research is to assess the level of awareness, knowledge, and perception of CoVid-19 among students of university considering the recent outbreak. Methods: A cross-sectional study was conducted. Stratified random sampling was used as respondents were divided into medical and non-medical strata. Questionnaires were distributed to 300 students from 6 different faculties and the results were analyzed. Results: Our results indicated that gender, ethnicity, and type of courses do not hold statistical significance against the knowledge and perception of CoVid-19. There is a significant association though between ethnicity and awareness to CoVid-19 (p = 0.021) and between gender and awareness to CoVid-19 (p = 0.002). Conclusion: The outcome of this study proves our hypothesis that there is no significant association in the level of knowledge and perception towards CoVid-19 between the medical and non-medical students of the university.
ABSTRACT
BACKGROUND: Patient-ventilator dyssynchrony is commonly due to patient pathophysiologic factors and imprecise ventilator settings. In unusual circumstances, such dyssynchrony can also be due to faults within the equipment preventing from its normal operation during assisted mechanical ventilation. CASE DESCRIPTION: We report a patient showing an unusual pattern of dyssynchronous breathing related to a blocked scavenging system caused by the failure of its rod valve to open. Collection of water condensate inside its reservoir bag leading to a weight drag and deformation of its shape was found to be the cause. Specifically, our patient manifested as failure to trigger with the development of high positive end-expiratory pressure (PEEP) and paradoxical pressure changes during pressure support ventilation. CONCLUSION: Water condensation distal to the ventilator exhaust gas outlet may not be immediately apparent. Clinicians should remain alert with patient-ventilator dyssynchrony, especially with an unusual pattern, as it may signify equipment faults, such as expiratory gas flow obstruction within the scavenging system. HOW TO CITE THIS ARTICLE: Chan KM, Ng YC, So HY. An Unusual Pattern of Dyssynchronous Breathing due to Expiratory Flow Obstruction in the Scavenging System Caused by the Weight of Water Condensate. Indian J Crit Care Med 2020;24(11):1128-1131.