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Introduction This paper aims to provide an overview of the administrative and clinical preparations done in a tertiary care cancer hospital in continuing operation theatre (OT) services through the COVID pandemic.Methods Retrospective data collection, data for the past 1.5 years (COVID period) March 2020 to August 2021 were compared to surgical output for a similar duration of time before the COVID era (September 2018-February 2020).Results A total of 1,022 surgeries were done under anesthesia in the COVID period as against 1,710 surgeries done in a similar time frame in the pre-COVID era. Overall, we saw a 40%drop in the total number of cases. Thorax, abdominal, and miscellaneous surgeries (soft tissue sarcomas, urology, and gyneconcology) saw a maximum fall in numbers;however, head and neck cases saw an increase in numbers during the pandemic. Surgical morbidity and mortality were similar in the COVID and pre-COVID era. No cases of severe COVID infection were reported among the healthcare staff working in OT.Discussion We could successfully continue our anesthesia services with minimal risk to healthcare staff throughout the pandemic by adopting major guidelines in a pragmatic and practical approach with minor changes to suit our setup.
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Background: Cancer patients are at increased risk of infection due to immunosuppression, poor nutrition, and other health problems. Various studies have shown that cancer patients have a higher risk of serious complications related to Coronavirus disease (COVID-19) than patients without cancer, however, the strength of associated varied significantly across the studies. We aim to analyze the differences in the clinical characteristics, laboratory parameters, and hospital outcomes of COVID-19 among patients with and without cancer. Method(s): This was a retrospective study of 1873 patients including 102 cancer patients who presented with SARS-CoV-2 infection at our hospital. Our primary outcome was the in-hospital mortality rate due to COVID-19 and the secondary outcome was a comparison of demographic, clinical, laboratory, and treatment parameters of cancer patients compared to non-cancer patients. Multivariate logistic regression models were fitted to identify factors predictive of disease progression in the hospital, including death. Result(s): Cancer patients had a higher in-hospital mortality rate than non-cancer patients (26.5 vs 21.2 %, P=0.211). The proportion of people with anemia, thrombocytopenia, and leukopenia was significantly higher in the cancer group. The median value of inflammatory markers (ferritin, D-dimer, and IL-6) in the cancer group is approximately two times than non-cancer group. The odds of worsening [1.73 (1.01-2.95)] and death [2.83 (1.46-5.47)] during hospital stay were significantly higher in cancer patients. Hematological malignancies had higher odds of developing critical illness [4.96 (1.57-15.7)] and receiving mechanical ventilation [4.35 (1.27-15.0)] compared to non-cancer cases. In cancer patients, breathlessness and hypoxia at presentation were significant predictors of mortality when adjusted for other clinical features. Conclusion(s): Cancer patients with COVID-19 infection have abnormally high inflammatory responses compared with non-cancer patients and the development of breathlessness and hypoxia are important predictors of mortality. Patients with hematological malignancies have a higher risk of developing serious disease. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest. Copyright © 2022
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The severe acute respiratory syndrome coronavirus 2 disease (COVID-19) pandemic is not just about medical management in intensive care units (ICUs). The old population and those with severe comorbidities and chronic illnesses are more prone to die due to COVID-19 infection and integrating palliative care support in ICUs is the need of the hour. However, during this pandemic, there is a clear lack of palliative care in ICUs due to several barriers which we will discuss in this particular case. © 2021 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow
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Objective: The objective is to assess the clinical course and outcomes of heart transplant (HTx) recipients affected by COVID-19 disease in a tertiary care health care institution. Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is a contagious illness with alarming morbidity and mortality. The HTx recipients are chronically immunosuppressed and thus COVID-19 infection in them may result in an unpredictable clinical course. Materials and Methods: HTx recipients in a tertiary care transplant center in North India were retrospectively reviewed from January 2020 to January 2021. Case records of 28 patients of HTx were reviewed, and four (14%) were found to have developed Covid-19 infection. Clinical parameters and outcomes of these four HTx recipients with confirmed SARS-CoV-2 infection are described. Results: Fourteen percent of our HTx patients (4 out of 28 patients under follow-up) developed COVID-19 in the first infection wave. The study population consisted of 3 males and 1 female patient with a median age of 28 years (range 15-39). The most common presenting symptoms were fever (100%), myalgia (100%) and cough (75%). There was no mortality observed in this study. None required intensive care admission or mechanical ventilatory support. Three were managed with hospital admission while one was subjected to home isolation. The mean hospital stay was 13.5 days (12-17 days). Immunosuppressants were modified by reducing tacrolimus and mycophenolate, however, corticosteroids were continued. Conclusion: The dose modification rather than discontinuation of immunomodulatory agents should be established as standard of care for transplant recipients. Steroids may provide added benefit and should be continued. The morbidity and mortality in such cases may be lower than anticipated;however, this needs to be substantiated with larger multicentric studies.