Live Virtual Surgery and Virtual Reality in Surgery: Potential Applications in Hand Surgery Education.

Accelerated in part by the coronavirus disease 2019 pandemic, medical education has increasingly moved into the virtual sphere in recent years. Virtual surgical education encompasses several domains, including live virtual surgery and virtual and augmented reality. These technologies range in complexity from streaming audio and video of surgeries in real-time to fully immersive virtual simulations of surgery. This article reviews the current use of virtual surgical education and its possible applications in hand surgery. Applications of virtual technologies for preoperative planning and intraoperative guidance, as well as care in underresourced settings, are discussed. The authors describe their experience creating a virtual surgery subinternship with live virtual surgeries. There are many roles virtual technology can have in surgery, and this review explores potential value these technologies may have in hand surgery.

Side Effects after mRNA COVID-19 Vaccine as a Booster in Health Workers

Background: In Indonesia, around 400 health workers died due to Covid-19 between June-July 2021, therefore the health workers need to be given further immunity. Health workers were among the first to get a booster shoot. However, they may experience side effects after vaccination. We aimed to describe side effects of Moderna vaccine as a booster in health workers.Methods: A cross sectional study was conducted on health workers who received mRNA Covid-19 vaccine booster (Moderna) at Sulianti Saroso Infectious Disease Hospital, Indonesia and had filled the questionnaire assessing side effects form. We associated the form of the questionnaire assessing side effects from the originat-ing source of hospital immunization unit in September 2021.Results: A total of 101 health workers who received mRNA Covid-19 vaccine booster in Jul-Aug 2021 were included. Most of health worker experienced more than 3 side effects. The side effects were sore arm (100%);chills (72%);fatigue (57%);headache (53%) and fever (51%), other symptoms (28%). The side effects mostly happened a day of receiving a booster shot (61.4%). There was no association between age, gender, comorbid to amount of side effects (P>0.05).Conclusion: Since the public must fulfil the immunization program during pandemic, it is the responsibility of the healthcare provider to inform about the potential side effects and benefits of a new Covid-19 vaccine.

Quantitative Antibody Levels in Hospital Workers after Receiving three Doses of CoviD-19 vaccines

Hospital workers were at high risk for SARS-Cov-2 infection and the first population with authorized access to the three doses of vaccination against SARS-Cov-2 antigen. The study was aimed to compare SARS-Cov-2 antibody levels among hospital workers receiving the three doses of Covid-19 vaccines with a history of Covid-19 infection versus those without a history of infection. A cross sectional study was conducted at the Sulianti Saroso infectious Disease Hospital (SSiDH) in December 2021. The inclusion criteria were hospital workers in both subjects with and without previous Covid-19 infection and those who had received 3 doses of Covid-19 vaccines. Anti SARS-Cov-2 antibody levels measured by the Architect of SARS-Cov-2 igG ii Quant. There were 75 participants in the study, the median of anti SARS Cov-2 levels reported 8724.4 AU/mL (3396.8, 15773.2 AU/mL, interquartile range). They were divided into 2 groups according to the status of prior Covid-19 infection, hospital workers with and without previous of Covid-19 infection. There was no significance difference in antibody less than 25.000 AU/mL between hospital worker with and without previous Covid-19 infection (p=1,000). Meanwhile, the median of antibody levels was seen in the interval between the 3rd dose of vaccine within 1 month;2 to 3 months;4 to 5 months before the antibody measurement (14576.5 AU/mL;12407.4 AU/mL;5778.1 AU/mL, respectively). in this study, after three doses of Covid-19 vaccines, there was no significance difference in antibody levels of hospital worker with and without previous Covid-19 infection. Copyright © 2022 Oriental Scientific Publishing Company. All rights reserved.

Increased Mortality in Patients Undergoing Inpatient Endoscopy During the Early COVID-19 Pandemic.

BACKGROUND AND AIMS: The Coronavirus disease 2019 (COVID-19) pandemic led to the restructuring of most healthcare systems, but the impact on patients undergoing inpatient endoscopic procedures is unknown. We sought to identify factors associated with 30-day mortality among patients undergoing inpatient endoscopy before and during the first wave of the pandemic within an academic tertiary care center. METHODS: We studied patients who underwent inpatient endoscopic procedures from March 1-May 31 in 2020 (COVID-19 era), the peak of the pandemic's first wave across the care center studied, and in March 1-May 31, 2018 and 2019 (control). Patient demographics and hospitalization/procedure data were compared between groups. Cox regression analyses were conducted to identify factors associated with 30-day mortality. RESULTS: Inpatient endoscopy volume decreased in 2020 with a higher proportion of urgent procedures, increased proportion of patients receiving blood transfusions, and a 10.1% mortality rate. In 2020, male gender, further distance from hospital, need for intensive care unit (ICU) admission, and procedures conducted outside the endoscopy suite were associated with increased risk of 30-day mortality. CONCLUSIONS: Patients undergoing endoscopy during the pandemic had higher proportions of ICU admission, more urgent indications, and higher rates of 30-day mortality. Greater proportions of urgent endoscopy cases may be due to hospital restructuring or patient reluctance to seek hospital care during a pandemic. Demographic and procedural characteristics associated with higher mortality risk may be potential areas to improve outcomes during future pandemic hospital restructuring efforts.

The Use of Convalescent Plasma (CP) Transfusion Therapy in Moderate to Severe COVID-19 Patients: A Single Center Experience in Indonesia

Coronavirus disease 2019 (COVID-19) was declared as a world pandemic since early 2020. There was no specific antiviral agent that appeared to be active against the virus, and antiviral agent such as remdesivir, favipiravir were in limited supply. We evaluated the use of convalescent plasma (CP) administered as adjuctive treatment to standard of care in moderate to severe COVID-19 patients. We conducted a series of 9 moderate to severe patients of COVID-19 older than 18 years received CP transfusion from 9 recovered donors at a single institution (Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia) from January 2021 to June 2021. Out of 9 patients (age range 30-81 years, 6 males and 3 female), and all patients received at least 1 or 2 unit of 200 mL of CP from 9 recovered donors. There were 4 patients (age range 30-71 years, 4 male) that were not treated with antiviral therapy. Of the 9 patients, 2 severe cases were died, while all of moderate cases survived and they were discharged from the hospital (length of stay: 8-22 days). Our experience showed that CP transfusion in moderate COVID-19 patients might provide clinical benefit and it was well-tolerated. However, further development clinical trials with better designs and greater power is needed to evaluate the efficacy and safety of this treatment.

Reversal of SARS-CoV2-Induced Hypoxia by Nebulized Sodium Ibuprofenate in a Compassionate Use Program.

INTRODUCTION: Sodium ibuprofenate in hypertonic saline (NaIHS) administered directly to the lungs by nebulization and inhalation has antibacterial and anti-inflammatory effects, with the potential to deliver these benefits to hypoxic patients. We describe a compassionate use program that offered this therapy to hospitalized COVID-19 patients. METHODS: NaIHS (50 mg ibuprofen, tid) was provided in addition to standard of care (SOC) to hospitalized COVID-19 patients until oxygen saturation levels of > 94% were achieved on ambient air. Patients wore a containment hood to diminish aerosolization. Outcome data from participating patients treated at multiple hospitals in Argentina between April 4 and October 31, 2020, are summarized. Results were compared with a retrospective contemporaneous control (CC) group of hospitalized COVID-19 patients with SOC alone during the same time frame from a subset of participating hospitals from Córdoba and Buenos Aires. RESULTS: The evolution of 383 patients treated with SOC + NaIHS [56 on mechanical ventilation (MV) at baseline] and 195 CC (21 on MV at baseline) are summarized. At baseline, NaIHS-treated patients had basal oxygen saturation of 90.7 ± 0.2% (74.3% were on supplemental oxygen at baseline) and a basal respiratory rate of 22.7 ± 0.3 breath/min. In the CC group, basal oxygen saturation was 92.6 ± 0.4% (52.1% were on oxygen supplementation at baseline) and respiratory rate was 19.3 ± 0.3 breath/min. Despite greater pulmonary compromise at baseline in the NaIHS-treated group, the length of treatment (LOT) was 9.1 ± 0.2 gs with an average length of stay (ALOS) of 11.5 ± 0.3 days, in comparison with an ALOS of 13.3 ± 0.9 days in the CC group. In patients on MV who received NaIHS, the ALOS was lower than in the CC group. In both NaIHS-treated groups, a rapid reversal of deterioration in oxygenation and NEWS2 scores was observed acutely after initiation of NaIHS therapy. No serious adverse events were considered related to ibuprofen therapy. Mortality was lower in both NaIHS groups compared with CC groups. CONCLUSIONS: Treatment of COVID-19 pneumonitis with inhalational nebulized NaIHS was associated with rapid improvement in hypoxia and vital signs, with no serious adverse events attributed to therapy. Nebulized NaIHS s worthy of further study in randomized, placebo-controlled trials (ClinicalTrials.gov: NCT04382768).

Reversal of SARS-CoV2 Induced Hypoxia by Nebulized Sodium-Ibuprofen in a Compassionate Use Program (preprint)

BackgroundSodium-ibuprofenate in hypertonic saline (NaIHS) administered directly to the lungs by nebulization and inhalation has antibacterial and anti-inflammatory effects with the potential to deliver these benefits to hypoxic patients. We describe a compassionate use program that offered this therapy to hospitalized COVID-19 patients.MethodsNaIHS (50 mg ibuprofen, tid) was provided in addition to standard of care to hospitalized Covid-19 patients until oxygen saturation levels of >94% were achieved on ambient air. Patients wore a containment hood to diminish aerosolization. Outcome data from participating patients treated at multiple hospitals in Argentina between April 04, 2020, through October 31, 2020 are summarized.Results383 patients were treated, including 327 not on mechanical ventilation at baseline (MV) and 56 ICU patients receiving MV. For those not on baseline MV (59±0.8 years), 64% were male, most with at least one recognized risk factor for disease severity, and mean NEWS2 score prior to treatment initiation of 7.0±0.1. The average length of stay (ALOS) was 11.5±0.3 days and length of treatment (LOT) 9.0±0.2 days. In patients on baseline MV (60.6±2.2 years), 69.9% were male, baseline mean NEWS2 Score was 8.8±0.4, ALOS 15.5±1.4 days and LOT 10.5±0.7 days. Reversal of deterioration in oxygenation and NEWS2 scores was observed acutely following initiation of therapy. Overall in-hospital mortality was 10.7% among patients not on MV at baseline, and 19.6% among patients receiving MV at baseline. No serious adverse events were considered related to ibuprofen therapy.ConclusionsTreatment of COVID-19 pneumonitis with inhalational nebulized NaIHS was associated with rapid improvement in hypoxia and vital signs, with no serious adverse events attributed to therapy. Nebulized NaIHS is worthy of further study in randomized, placebo-controlled trials.(ClinicalTrials.gov:NCT04382768).