ABSTRACT
The purpose of the study was to evaluate how AC dislocation epidemiology and postoperative outcomes have changed during COVID-19 pandemic, in order to take advantage of this peculiar period to better understand risk-and prognostic-factors. A retrospective analysis was performed between the patients surgically treated for acute AC dislocation between March and December of either the 2017, 2018, and 2020. Patients' characteristics and postoperative outcome was compared. Comparing the one-year Constant-Murley and DASH scores we found that COVID-19 period presented significant worst results. We found a significant decrease of rate of sport injury in COVID-19 period, and a significant increase of rate of road injury. The most common mechanisms were motorcycle accidents (23,81%) and cases of bicycle accidents (23,81%). No differences were found between age, sex, and failure rate. COVID-19 outbreak changed the epidemiology and the outcome of AC dislocation showing a strong correlation to two-wheel vehicle road accident, and a worst outcome of the patient treated during outbreak. © EuroMediterranean Biomedical Journal 2022.
ABSTRACT
Between March 21 and May 18 2020 we admitted 98 patients with COVID-19 to our ICU of whom 72 required invasive mechanical ventilation. Of these, 3 patients required extracorporeal support: One V-V ECMO for respiratory failure, one V-V ECMO for tracheoesophageal fistula, and one V-AV ECMO for cardiogenic shock due to pulmonary thromboembolism, to which we had to add an extra return cannula to improve oxygenation. Coagulation abnormalities have been described in COVID-19 with an increase in D-dimer, a modest decrease in platelet count, and delay in the prothrombin time (1). Pro-coagulant states however, may not be highlighted by a standard coagulation essay that's why we decided to assess them by ROTEM. Even with an ACT level kept between 180-200s, we found a normal value of aPTT and a ROTEM profile consistent with hypercoagulability: An acceleration of blood clot formation (CFT below the lower limit in INTEM and EXTEM) and a significantly higher clot strength (MCF above the upper limit in INTEM and EXTEM in two patients and in FIBTEM in all patients). For this reason, we titrate heparin infusion to maintain INTEM CT in a range between normal and 100 sec longer for all the ECMO run, without thrombotic complications. Despite the superiority of ROTEM to monitor anticoagulation in ECMO is not yet proven in literature, this test could help us to understand the coagulation profile of each patient and to titrate heparin where the coagulation function is greatly altered by the virus and by the circuit.
ABSTRACT
Objective: In the midst of the COVID-19 epidemic and the estimation that the vast majority of the population remains susceptible to SARS-CoV-2 infection, a comprehensive risk mitigation strategy to identify asymptomatic and pre-symptomatic carriers is key to providing safe clinical care during fertility treatment. The objective of this study was to evaluate the efficiency of a combined triage protocol and molecular testing for active SARS-CoV-2 viral infection for both patients and staff from a multi-site IVF network. Design: Prospective study. Materials and Methods: A symptomatic triage was performed whereby all patients were contacted by phone for the presence of COVID-19 symptoms or if they had been in contact with someone suspected or confirmed to be positive for the virus. Only patients determined to be at low risk for COVID-19 were allowed to enter the clinic for fertility treatment. Both patients and staff were required, upon arrival at the clinic, to wear a mask, complete a symptom-based questionnaire, record body temperature, and keep a safe social distance of more than 6 feet at all times. Any individual recording a fever over 100.4OF and/or two or more symptoms was instructed to stay/return home for self-quarantine. Specimen collection for viral screening involved an anterior nare sampling method and storage in a FDA approved viral transport medium. Viral RNA was isolated using the MagMAX™ Viral/Pathogen II (MVP II) Nucleic Acid Isolation Kit (Thermo Fisher Scientific). Molecular testing for active SARS-CoV-2 viral RNA infection was performed using the FDA emergency use authorized TaqPath™ RT-PCR COVID-19 test (Thermo Fisher Scientific) for every patient within 3-5 days prior to oocyte retrieval or an attempt to achieve a pregnancy, and for all staff bi-weekly. Positive cases were reported to each respective local State Health Department. Results: Of the 2,074 patients tested for COVID-19 between May and July 2020 across nine fertility clinics in the US, only 3 (0.15%) were found to be positive for SARS-CoV-2 viral RNA infection. In all cases the patients were asymptomatic and passed the triage protocol. PCR testing of staff bi-weekly identified 6 positive cases. All but one indicated having one or two mild symptoms. There were no recorded community transmissions among either patients to staff or between staff members. Conclusions: A comprehensive risk mitigation strategy that includes a combined triage protocol, safe social distancing and molecular testing for active SARS-CoV-2 viral RNA infection in both patients and staff enables early detection and isolation of infected asymptomatic or pre-symptomatic individuals, thereby creating a safe environment for patient care and staff welfare during the global COVID-19 pandemic.