COVID-19 Monitoring and Response for Military Bases in Singapore-Perspectives and Lessons From January to June 2020

Introduction Military forces around the world face an increased risk of the spread of communicable diseases, due to the close living quarters and congregated nature of the military camps. The Singapore Armed Forces (SAF) implemented a multi-pronged surveillance and containment strategy to reduce the risk of a coronavirus disease 2019 (COVID-19) outbreak within the local military camps. This paper details the epidemiological investigations of the COVID-19 cases in the SAF and highlights the strategies and public health measures undertaken, aligned with the national COVID-19 control strategy, to reduce the risk of COVID-19 transmission in the military camps. Materials and Methods Medical data of our military personnel who were infected with COVID-19 during the first 180 days of the pandemic were extracted from the military electronic health records. Contact tracing and activity mapping results were obtained from unit-level epidemiological data. A review of the organization's response plans, instructions, and orders was conducted to collate the measures implemented across the same time period. Results Prompt contact tracing and activity mapping was done for each of the 24 SAF military personnel diagnosed with COVID-19 between February 2020 and June 2020, with possible links among the cases identified and investigated. Conclusion A combination of strategies in the formulation of public health measures based on key principles of early warning and surveillance, prompt diagnosis, and early containment were successful in preventing the formation of COVID-19 clusters within the SAF. This will provide a framework for the management of future pandemics within the military setting, driven by strong governance and leadership, to meet the military's need to maintain operational readiness in a safe manner.

Trend on erectile rehabilitation after radical prostatectomy: Results of an international survey among urologists

Introduction & Objectives: In the last two decades, several therapeutic schemes have been proposed for erectile rehabilitation (ER) after radical prostatectomy (RP), but none has been standardized or validated due to the lack of high-level evidence in the Literature. We performed an international Survey focused on the current worldwide approach to ER, highlighting the contact and divergent aspects. Materials & Methods: We purposed an online Survey between July and December 2020 using email lists and Twitter, aiming to evaluate the ER protocols after RP performed by urologists and andrologists in daily practice. The following sections were investigated: 1) Demographics;2) Number and type of RP performed;3) Type and schedule, timing and duration of ER erectile programs;4) Standard treatment protocol. The specialists were contacted with the support of Confederación Americana de Urología (CAU), Urological SOcial MEdia (UroSoMe) Working Group, Functional Urology- Techno Urology- Research (FUTURe) Group and by a dedicated uro-andrologists spaces on Twitter platform of iTRUE Group. Results: The Survey was completed by 518 responders from 52 worldwide countries. The main criteria to candidate patients for ER were nerve sparing surgery (72.8%), lack of significant comorbidities (66.4%), patient’s request (55.4%), valid pre-operative EF (55%), age (48.1%), and partner’s willing (19.1%). Surgical techniques reported were: 38.9% open RP, 22.9% video laparoscopic RP, 38.2% robot- assisted RP. There were no significant differences (p>0.05) among the main surgical techniques and the time of EF recovery beginning, protocol and duration. The use of specific ER protocols was reported by 61.4%. The beginning of ER was reported by 33% of responders at catheter removal, after one month from surgery by 22%, and before RP by 15%. PDE5i were more frequently used as first line treatment (99.4%). Tadalafil 20 mg was the most prescribed in monotherapy, prescribed daily (48.2%) or 2-3 times/week (46%). PGE1 intra-cavernosal injection (67.9%) was the second more common prescription in monotherapy, followed by the association of PDE5i and vacuum device (29.6%). A minority of specialists 44/518 (8.5%) recommended low intensity shock wave therapy, while 63/518 (12.2%) proposed this in association to other therapies. The duration of ER was: in 16.2% <6 months, in 39% between 6 and 11 months;in 31.9% between 12 and 18 months;in 9.2% between 19-24 months, and in 3.7% >24 months. In case of first-line failure, the majority of the responders shifted to another treatment after at least 3 months (71%). During COVID-19 outbreak, the 37.4% of responders did not perform EF recovery consultations, while 26.8% had normal consultations, and 35.7% used telemedicine. Conclusions: This Survey showed an inhomogeneous approach to ER, reflecting the lack of high-level evidence on this topic. A worldwide accepted guideline on ER is therefore needed.

Adverse reactions and safety profile of the mRNA COVID-19 vaccines among Asian military personnel

INTRODUCTION: The use of novel mRNA platforms for COVID-19 vaccines raised concern about vaccine safety, especially in Asian populations that made up less than 10% of study populations in the pivotal vaccine trials used for emergency use authorisation. Vaccine safety issues also remain a concern in assessing the clinical risks and benefits of vaccine boosters, particularly in specific age groups or segments of the population. This study describes a vaccination exercise involving Asian military personnel, and the adverse reactions and safety events observed. METHODS: Minor adverse reactions, hospitalisations and adverse events of special interest were monitored as part of the organisation's protocol for safety monitoring of COVID-19 vaccinations. All vaccine recipients were invited to complete an online adverse reaction questionnaire. Medical consults at the military's primary healthcare facilities were monitored for vaccine-related presentations. All hospitalisations involving vaccine recipients were analysed. Adverse reaction rates between doses, vaccines and age groups were compared. RESULTS: A total of 127,081 mRNA vaccine doses were administered to 64,661 individuals up to 24 July 2021. Common minor adverse reactions included fever/chills, body aches and injection site pain. These were more common after dose 2. Younger individuals experienced minor adverse reactions more frequently. Rare cases of anaphylaxis, Bell's palsy and myocarditis/pericarditis were observed. No deaths occurred. CONCLUSION: Minor adverse reactions were less common than reported in other studies, and rates of anaphylaxis, Bell's palsy and myocarditis/pericarditis were comparable. Our study supports the favourable safety profile of mRNA COVID-19 vaccines, which may help guide decisions about booster doses if required.

Delayed Surgery for localised prostate cancer: A systematic review for the COVID-19 Pandemic

Introduction: The risks of delaying cancer surgery and the best management for these patients during COVID-19 is unknown. This systematic review aims to compare outcomes of patients with localised prostate cancer (PCa) who experienced any delay of radical prostatectomy (RP) (including surgical waiting times and use of neoadjuvant hormone therapy [NHT]), compared to those who underwent immediate RP. Methods: MEDLINE and Cochrane CENTRAL were searched for studies pertaining to the review question. Outcomes included (Biochemical) Recurrence-free survival, cancer-specific survival, overall survival and positive surgical margin (PSM). Results: 4,120 studies were retrieved. 36 observational studies investigated the effects of delayed RP. A variety of PCa risks and delay periods contributed to considerable heterogeneity in the include studies. When stratifying by PCa risk groups, low risk PCa (Grade Group [GG] 1) can be delayed safely from at least 26 weeks to 2.6 years, without significant effects on all outcomes. Similarly, RP can be safely delayed for 6 to 9 months in intermediate risk patients (GG 2/3). In high-risk patients (GG 4/5), the delay of RP for 2 or more months tends to associate with worsen recurrences, hence NHT should be considered. Ten RCTs show 3-months of NHT is non-inferior for oncological outcomes and superior for PSM compared to immediate RP. The risk of biases of the included studies ranged from low to serious risk. Conclusion: RP is safe to be delayed in low-risk and intermediate-risk PCa patients. High-risk patients should be offered NHT;there is no sufficient evidence extending NHT over 3-months.

Effect of SARS and COVID-19 outbreaks on urology practice and training.

INTRODUCTION: The objective was to investigate the changes in urology practice during coronavirus disease 2019 (COVID-19) pandemic with a perspective from our experience with severe acute respiratory syndrome (SARS) in 2003. METHODS: Institutional data from all urology centres in the Hong Kong public sector during the COVID-19 pandemic (1 Feb 2020-31 Mar 2020) and a non-COVID-19 control period (1 Feb 2019-31 Mar 2019) were acquired. An online anonymous questionnaire was used to gauge the impact of COVID-19 on resident training. The clinical output of tertiary centres was compared with data from the SARS period. RESULTS: The numbers of operating sessions, clinic attendance, cystoscopy sessions, prostate biopsy, and shockwave lithotripsy sessions were reduced by 40.5%, 28.5%, 49.6%, 44.8%, and 38.5%, respectively, across all the centres reviewed. The mean numbers of operating sessions before and during the COVID-19 pandemic were 85.1±30.3 and 50.6±25.7, respectively (P=0.005). All centres gave priority to cancer-related surgeries. Benign prostatic hyperplasia-related surgery (39.1%) and ureteric stone surgery (25.5%) were the most commonly delayed surgeries. The degree of reduction in urology services was less than that during SARS (47.2%, 55.3%, and 70.5% for operating sessions, cystoscopy, and biopsy, respectively). The mean numbers of operations performed by residents before and during the COVID-19 pandemic were 75.4±48.0 and 34.9±17.2, respectively (P=0.002). CONCLUSION: A comprehensive review of urology practice during the COVID-19 pandemic revealed changes in every aspect of practice.

Exploring the Residents' Perspective on Smart learning Modalities and Contents for Virtual Urology Education: Lesson Learned During the COVID-19 Pandemic. / Explorando la perspectiva de los residentes sobre las modalidades y contenidos de aprendizaje inteligente para la educación virtual de urología: lección aprendida durante la pandemia de la COVID-19.

PURPOSE: The COVID-19 outbreak has substantially altered residents' training activities. While several new virtual learning programs have been recently implemented, the perspective of urology trainees regarding their usefulness still needs to be investigated. METHODS: A cross-sectional, 30-item, web-based Survey was conducted through Twitter from April 4th, 2020 to April 18th, 2020, aiming to evaluate the urology residents' perspective on smart learning (SL) modalities (pre-recorded videos, webinars, podcasts, and social media [SoMe]), and contents (frontal lessons, clinical case discussions, updates on Guidelines and on clinical trials, surgical videos, Journal Clubs, and seminars on leadership and non-technical skills). RESULTS: Overall, 501 urology residents from 58 countries completed the survey. Of these, 78.4, 78.2, 56.9 and 51.9% of them considered pre-recorded videos, interactive webinars, podcasts and SoMe highly useful modalities of smart learning, respectively. The contents considered as highly useful by the greatest proportion of residents were updates on guidelines (84.8%) and surgical videos (81.0%). In addition, 58.9 and 56.5% of responders deemed seminars on leadership and on non-technical skills highly useful smart learning contents. The three preferred combinations of smart learning modality and content were: pre-recorded surgical videos, interactive webinars on clinical cases, and pre-recorded videos on guidelines. CONCLUSION: Our study provides the first global «big picture¼ of the smart learning modalities and contents that should be prioritized to optimize virtual Urology education. While this survey was conducted during the COVID-19 outbreak, our findings might have even more impact in the future.

Telemedicine and smart working: Spanish adaptation of the European Association of Urology recommendations. / Telemedicina y trabajo inteligente: adaptación al español de las recomendaciones de la Asociación Europea de Urología.

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.