ABSTRACT
The 2019 novel coronavirus (SARS-CoV2) is the causal agent of the newly-termed Coronavirus Disease 2019 (COVID-19). In January 2020, the World Health Association (WHO) declared the COVID-19 as an epidemic. Abnormal coagulation parameters in COVID-19 patients currently are considered as prognostic factors of severity. Our aim is to summarize the current data available in the literature. Materials and Methods. An electronic search was performed in the Database of publications on coronavirus disease (COVID-19) of the World Health Organization. Thrombin Time (TT), Prothrombin Time (PT), Fibrinogen (FIB), Activated Partial Thromboplastin Time (APPT), and D-Dimer have been detected as parameters to study in every COVID-19 patient. Clinical Application. The coagulation function panel has been described to be altered in critical COVID-2019 patients. DIC, which plays an important role in advanced stage, is known to be associated with sepsis. Anticoagulant therapy, mainly with low molecular weight heparin (LMWH), appears to be associated with better prognosis in patients with severe COVID-19. Discussion. Coagulation function in patients with SARS-CoV2 infection is significantly deranged compared with normal patients. FIB and D-Dimer/FDP are the most significantly altered values and the early deetection of alteration could be useful to address therapies. D-Dimer/FDP (DD/FDP) alteration correlates with severity. Markedly elevated D-Dimer can be used to guide the introduction of anticoagulation therapy and evaluate prognosis of COVID-19. In every patient admitted with SARS-CoV2 infection PT, FIB, D-Dimer/FDP, and platelets must be ordered. We suggest daily extraction for every patient admitted and tested positive for COVID-19.Copyright © 2020 by the Association of Clinical Scientists, Inc.
ABSTRACT
Most of the time forefoot surgery requires the use of a tourniquet, and therefore, the surgery is usually performed with either a popliteal block or an ankle block. Surgical departments have traditionally relied on an anesthesiol-ogist to perform these procedures. The elective nature of the forefoot surgery and the lack of surgical anaesthetists due to the COVID-19 pandemic have become mandatory to find alternatives to continue performing these surgeries in order to avoid an increase of waiting lists. The foot and ankle wide-awake local anaesthesia with no tourniquet (WALANT) technique is an adaptation from the one used for hand surgery. This technique requires no sedation, no regional or general anaesthesia, and the patient is fully conscious during the operation. WALANT technique con-sists of administration of lidocaine and epinephrine for local anaesthesia and vasoconstriction. This technique allows the surgeon to perform the surgery with the patient fully awake and without a tourniquet. In addition, this gives the advantage to perform an intraoperative as-sessment of function. WALANT for foot and ankle surgery is a suitable, safe, and cheap technique. Taking into con-sideration the lack of anaesthetists, operating rooms, and hospital resources observed during SARS-CoV-2 epidemic, this technique represents an acceptable alternative to consider in order to be able to continue performing se-lected cases of foot and ankle surgery.
ABSTRACT
Background. Antimicrobial resistance is a major public health threat internationally but, particularly in Colombia. High and increasing rates of carbapenemases are challenging. Implementing antimicrobial stewardship programs (AMSs) in a large, academic, public network hospitals in Bogotá, Colombia.will help curb inappropriate antibiotic use. Methods. AMS was established in April 2020 consisting of an administrative champion, Infectious Diseases staff, nurse, General Physician, microbiologist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The AMS tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with AMS recommendations. Defined daily dose (DDD) of drugs and health economics evaluations of antimicrobials (April-December 2020). Recommendations are placed in the electronic medical record as a progress note. Results. From April to December 2020, 1013 patients were evaluated by means of a prospective methodology. Unnecessary 689 days of hospitalization and 4420 days of antibiotic therapy were avoided. Among the top antibiotics discontinued were piperacillin tazobactam for the months of July, August, November and December, while for September and October was meropenem. The intensive care unit was the most frequently intervened service (52%), followed by hospitalization (43%) and the emergency department (5%).Over the course of the year, there was significant adherence to the program, with 100% in July, followed by 93.3% in April, 87% in December, 86.6% in May and June, 83% in November, 80% in September, 73.3% in August and 57% in October. The AMS program was able to save $47.409US in antibiotics and $55.529US in hospitalization, and 11% decrease in nephrotoxicity events (14 renal failures were avoided), which also saved additionally $ 23.503 US for a total of an estimated cost saving for the network public hospitals of $ 126.441 US by 2020. Conclusion. Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, academic, public network hospitals in Bogotá, Colombia demonstrated feasibility and economic benefits even in a Covid19 pandemic situation.
ABSTRACT
In the face of the confusion and uncertainty that COVID-19 has caused over the last year, Geography has proven to be a useful aid in the interpretation of the spatial dynamics that explain the transmission of the virus. Applied cartography and GIS analysis of epidemiological data have been consolidated as essential tools for interpreting the health crisis. This paper explores the usefulness of maps for the study of the evolution of the pandemic in Castile and Leon, one of the Spanish regions with the highest levels of infection and mortality. Based on the statistical variables of sick and dead people at the scale of the Basic Health Area (BHA), a first analytical approach is carried out by means of a sequence of dynamic maps during the first wave. Afterwards, a systematic study is carried out using thematic mapping for the period of the three waves, a period between March 2020 and March 2021. The analysis unravels the differential impact of the disease between rural and urban areas and reveals the problems of the mismatch between the functional divisions of the territory (BHA, as units of health analysis) and the scale of administrative management (municipalities, as the effective scale of action).