Effects of the COVID-19 pandemic on the management of diabetic foot ulcers: experiences from a dedicated diabetic foot care center.

INTRODUCTION: As did many other nations, the Turkish government implemented precautions and lockdown measures in response to the rapid spread of the COVID-19 viral infection. The pandemic has caused millions of deaths globally, resulted in the development of comorbidities, and negatively affected national health care systems. The increased workload at hospitals and spread of the virus among health care professionals have resulted in delays in health care services delivery. The fear of COVID-19 transmission has resulted in people mostly staying at home. OBJECTIVE: The aim of this study is to present the effects of the pandemic on the behavior of patients with diabetic foot ulcers (DFUs). MATERIALS AND METHODS: Patients with DFU were categorized into 2 groups: patients hospitalized during the COVID-19 pandemic and patients hospitalized during the same period in 2019 (prepandemic). Demographic data, length of hospital stay, place of residence, Wagner grade of DFU, comorbidities, laboratory parameters, wound duration, duration of diabetes, and treatments applied were recorded. RESULTS: During the pandemic, the length of hospital stay decreased, and patient referrals from other cities significantly decreased (P <.001). Hemoglobin A1c level was higher and Wagner grade was more advanced during the pandemic period (P =.014 and P =.033, respectively). The number of patients undergoing debridement alone decreased during the pandemic period, while those requiring amputation increased (P =.008 and P =.005, respectively). CONCLUSIONS: Patients with DFU delayed seeking timely proper medical advice during the pandemic. This resulted in a significantly higher amputation rate, with physical, psychosocial, and economic consequences. Virtual techniques (eg, video consultation) can be used to identify patients who require hospitalization. Close follow-up can be provided via home nursing care and by supplying advanced wound care products for in-home use. Patients with DFU should be encouraged to seek proper medical advice and take recommended precautions.

Management of burns during coronavirus disease pandemic: Single center experience and outcomes.

BACKGROUND: Prolonged stays and multiple operations in burn management increase the risk of transmission. We would like to discuss our experience in hospitalized burn patients with Coronavirus disease (covid-19) infection. METHODS: In-patient burns with confirmed COVID-19 infection were studied. Age, gender, burned total body surface area (TBSA), number and sort of operations and dressing changes, intensive care unit stay, ward stay, total length of stay, and morbidity and mortality were analyzed. Medical staff observed for infection. RESULTS: The mean age of the 11 positive patients was 51 (±19.37) years and burned TBSA was 34.36% (±21.97%). Six (54.5%) patients presented with negative polymerase chain reaction (PCR) tests; however, symptoms and findings revealed the illness. Patients underwent 85 operations including hydrosurgery. Totally, 475 dressing changes were done. Respiratory failure caused three mortalities without sepsis. Age, TBSA, and deep dermal burn percent of the mortalities showed no difference. None of the staff and hospitalized other patients had hospital acquired COVID-19 infection. CONCLUSION: Healthcare must continue during pandemics. Awareness, proper usage of personal protective equipment, keeping social distance, and strengthened access control to the clinic are important priorities to avoid viral transmission. The difficulty in PCR negative patients was the confusing effect of burns as most of the laboratory and radiologic findings overlaps with the major burns' consequences. Findings, cannot be explained by the clinical course of burn, should indicate COVID infection. Regarding our results, burn patient treatment routines can be applied safely by competence to focused and re-adopted precautions as there were no hospital acquired COVID-19. Patients must trained for cross-contamination. Healthcare's must prioritize their own health under all situations including pandemics. Updating, the preventive cautions and rigid compliance are a must.

Does pandemic lockdowns affect the burn patient's admission?

BACKGROUND: 2020 has started with Covid-19 pandemic. During the pandemic, govermental stringent precautions and lockdown measures have applied in Turkey. Although there was no limition for health care, people hesitate to go hospitals with the fear of Coronovirus transmission and all addmisions to hospitals decreased. METHODS: Data of all patients admitted to our burn outpatient clinic during the pandemic period between March16, 2020 and June 1, 2020 compered with the same period in 2019. Demographic information and burn-specific variables of each patient were analysed. RESULTS: Thirty nine patient admited to our clinic at covid period and 130 patient at 2019. There was a 70% reduction of admissions. In this stduy during pandemic period patients delayed days for admission, number of dressing change and total healing times were significantly longer, higher and longer (p<0.001, p<0.001, p<0.001, respectively). The number of surgery-required patients, hospitalization rates and the number of grafting were significantly high at the pandemic time (p=0.003, p=0.007 and p=0.036, respectively). Burn wound infection at admission has also found more frequent at covid-period (p<0.001). CONCLUSION: Covid-19 pandemic made people hesitate to go to hospital even for emergencies. Unfortunately this fear caused unexpected consequences. Patients have developed complications due to delayed addmisions to specified medical centers for specific health problems. As a result, patients requiring special treatment, should be encouraged to immediatly seek professional medical advice especially for reel emergencies even during pandemic.