Acute Portal Vein Thrombosis during COVID-19 Convalescent Phase.

Acute portal vein thrombosis represents a less common type of venous thromboembolism, even among the prothrombotic complications of coronavirus disease 2019 (COVID-19). Such complications are primarily reported during the active phase of infection. The case here describes acute portal vein thrombosis following resolution of COVID-19 in a 44-year-old male who presented with abdominal pain. Abdominal imaging identified portal and other splanchnic vein thromboses. Studies for hypercoagulable conditions were negative. Polymerase chain reaction was negative for severe acute respiratory syndrome coronavirus-2; however, IgG serology was positive. The case highlights the importance of considering thrombotic complications, particularly splanchnic vein thromboses, in patients with recent COVID-19.

Seroprevalence of anti-SARS-CoV-2 of IgG antibody by ELISA: Community-based, cross-sectional study from urban area of Malegaon, Maharashtra.

BACKGROUND: Given the high incidence of asymptomatic or subclinical SARS-CoV-2 infection, reported cases likely underestimate the overall prevalence and infectivity of COVID-19. Serological test for IgG can provide a better measure of disease activity by identifying asymptomatic or subclinical infection. This study was conducted to estimate the seroprevalence of SARS-CoV-2 infection and to the determinants of SARS-CoV-2 infection in the hotspot area of COVID-19. METHOD: It was a community-based, cross-sectional study using multistage sampling with a sample size of 360. After informed consent, the demographic information, past history of SARI/ILI, contact, COVID-19 status were collected. The blood samples were taken from one family member for anti-SARS-CoV-2 IgG antibody by ELISA testing kit. RESULTS: Majority of the study subjects had no history of SARI (86%) or any contact with COVID-19 case (98%). Overall seroprevalence of anti-SARS-CoV-2 of IgG antibody was 40% (95% CI 35-45%), infection fatality rate (IFR) was 0.7%. Seroprevalence varied significantly depending on religious background; with Muslims (53%) seroprevalence compared to other religious groups. Seroprevalence of homemaker/unemployed (49%) and laborer (55%) was significantly higher compared to business (30%) and service occupation (21%). Subjects with overcrowding conditions and poor ventilation was significantly associated with higher seroprevalence with odds ratio of 2.5 and 2.3, respectively. CONCLUSION: The antibody testing detects a large number of asymptomatic cases or previously infected cases which would have been missed by clinical history. Thus, the number of undiagnosed cases was found significantly higher even with rigorous implementation of lockdown.

Colorectal Services in Covid-19 Times: Minimally Invasive Surgery and Enhanced Recovery, the Need of the Hour.

The health services across the world have been deeply impacted by the ongoing COVID-19 pandemic which has resulted in diversion of resources to testing, isolating and treating COVID-19 patients. This meant cutting down resources and manpower away of various healthcare facilities and severely hampering the functioning of various cancer services across the world. It is however, important to understand, cancer itself is a life-threatening condition, and there is a need to continue running cancer care services, at least for those who needed the most. Various clinical societies have put forward guidelines and protocols to help continue surgical services during the pandemic. The role of minimally invasive surgery (MIS) was initially questioned at the start of the pandemic, however gradually increasing evidence favored MIS as it reduced hospital stay and complication. Enhanced recovery programs which have been introduced to various fields of surgery to improve outcomes and reduce hospital stay. It plays an essential role in times like this, where the optimal usage of minimal resources is essential. We embraced these methods to ensure safety of our patients and staff and at the same time provide the highest standards of care. Here we are presenting our experience of running a colorectal surgical unit during these difficult times with emphasis on promotion of minimally invasive surgery, at the epicenter of the pandemic in India.

The Technique and Justification for Minimally Invasive Surgery in COVID-19 Pandemic: Laparoscopic Anterior Resection for Near Obstructed Rectal Carcinoma.

Introduction: The recent COVID-19 pandemic outbreak has made surgeons change and take on newer strategies and safe exercises. All elective cases have been put off, but oncology cases need to be done to prevent progression of the disease. There is concern about minimally invasive surgery due to aerosol formation. Here we discuss how we have dealt with this in our colorectal surgery department taking into account current evidence about the danger of viral transmission during laparoscopic surgery. Discussion: We report a case of 28 years old female patient with carcinoma rectum. The patient had near total intestinal obstruction. She was operated on utilizing laparoscopic anterior resection. The air seal (CONMED, Utica, NY) and high-efficiency particulate air (HEPA) filter was utilized for safe gas evacuation. There is no evidence against laparoscopic surgery, which suggest viral transmission. One should take utmost precautions using N95 masks and personal protective equipment (PPE). Air filtration products like aerosol, HEPA filters will be of great aid in safe evacuation of gases. Conclusion: At present, there is no solid evidence to suggest viral transmission through surgical smoke. We believe due to effective smoke containment, less blood loss, and less postoperative stay, laparoscopy will be a non-inferior option than open surgical procedure. We advise taking all precautions for operating room staff to lessen the danger of transmission.