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1.
Am J Crit Care ; : e1-e22, 2022 Sep 06.
Article in English | MEDLINE | ID: covidwho-2245189

ABSTRACT

BACKGROUND: Health care professionals (HCPs) performing tracheostomies in patients with COVID-19 may be at increased risk of infection. OBJECTIVE: To evaluate factors underlying HCPs' COVID-19 infection and determine whether tracheostomy providers report increased rates of infection. METHODS: An anonymous international survey examining factors associated with COVID-19 infection was made available November 2020 through July 2021 to HCPs at a convenience sample of hospitals, universities, and professional organizations. Infections reported were compared between HCPs involved in tracheostomy on patients with COVID-19 and HCPs who were not involved. RESULTS: Of the 361 respondents (from 33 countries), 50% (n = 179) had performed tracheostomies on patients with COVID-19. Performing tracheostomies on patients with COVID-19 was not associated with increased infection in either univariable (P = .06) or multivariable analysis (odds ratio, 1.48; 95% CI, 0.90-2.46; P = .13). Working in a low- or middle-income country (LMIC) was associated with increased infection in both univariable (P < .001) and multivariable analysis (odds ratio, 2.88; CI, 1.50-5.53; P = .001). CONCLUSIONS: Performing tracheostomy was not associated with COVID-19 infection, suggesting that tracheostomies can be safely performed in infected patients with appropriate precautions. However, HCPs in LMICs may face increased infection risk.

2.
Crit Care Explor ; 4(11): e0796, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2230797

ABSTRACT

Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either "early" (within 14 d of intubation) or "late" (more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.

3.
Critical care explorations ; 4(11), 2022.
Article in English | EuropePMC | ID: covidwho-2125109

ABSTRACT

OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either “early” (within 14 d of intubation) or “late” (more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, –16 to –8;p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, –23 to –9 d;p < 0.001) and 22 days (95% CI, –31 to –12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0;95% CI, 1.8–5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.

4.
J Egypt Public Health Assoc ; 97(1): 21, 2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2098478

ABSTRACT

BACKGROUND: The world is facing an extraordinarily unprecedented threat from the COVID-19 pandemic triggered by the SARS-CoV-2 virus. Global life has turned upside down, and that several countries closed their borders, simultaneously with the blockage of life cycle as a result of the shutdown of the majority of workplaces except the food stores and some few industries. MAIN BODY: In this review, we are casting light on the nature of COVID-19 infection and spread, the persistence of SARS-CoV-2 virus in food products, and revealing the threats arising from the transmission of COVID-19 in food environment between stakeholders and even customers. Furthermore, we are exploring and identifying some practical aspects that must be followed to minimize infection and maintain a safe food environment. We also present and discuss some World Health Organization (WHO) guidelines-based regulations in food safety codes, destined to sustain the health safety of all professionals working in the food industry under this current pandemic. CONCLUSION: The information compiled in this manuscript is supporting and consolidating the safety attributes in food environment, for a prospective positive impact on consumer confidence in food safety and the citizens' public health in society. Some research is suggested on evaluating the use and potentiality of native and chemical modified basic proteins as possible practices aiming at protecting food from bacterial and viral contamination including COVID-19.

5.
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology ; 134(3):e69, 2022.
Article in English | ScienceDirect | ID: covidwho-1983746

ABSTRACT

Purpose Macroglossia is pathological condition which resulted in hypertrophy of tongue muscles. It is classified into congenital and acquired macroglossia. Idiopathic macroglossia (IM) is tongue hypertrophy without systemic or genetic causes. This condition has a significant impact on the quality of life, and often require tracheostomy and percutaneous endoscopic gastrostomy (PEG) to sustain living. Guidelines regarding treatment for this subtype are scant. The purpose of this project to present diagnosis and management of a series of patients with idiopathic macroglossia. Methods This was a retrospective case series of a cohort of patients with IM who were treated by Oral and Maxillofacial Surgery (OMS) service at University of Texas Health Science Center in Houston (UTHealth) and Emory University from 2019 to 2021. Inclusion criteria are (1) 18 years or older, (2) diagnosed with macroglossia, (3) managed with surgery, (4) with normal tongue tissue on histopathology results, and (5) with a negative COVID test. Patients were excluded if they are younger than 18 years old and diagnosed with macroglossia due to an underlying etiology such as congenital anomaly, systemic conditions, and intraoral inflammatory changes. Study variables were patient demographics, social history, medical comorbidities, clinical presentation, clinical dimensions, presence of tongue protrusion, difficulty feeding, difficulty in breathing, imaging characteristics/dimensions, pathological findings, management (tracheostomy, PEG, glossectomy), and length of inpatient stay. The outcome variables were normalization of tongue size, return of parenteral nutrition, and able to tolerate tracheostomy decannulation. Data were collected using a standardized collection form. Descriptive statistics were computed. Results Five patients (mean age, 45 years) with IM met inclusion criteria. All patients had history of hypertension, cerebral vascular disease, and prolong intubation. All patients presented with anterior tongue enlargement, with mean dimension of 13 × 6 cm, full or partial dentition, altered tongue sensation. They were all managed with tracheostomy to secure the airway, PEG and partial glossectomy. Average length of inpatients stay was 10 days. All IM achieved clinical resolution, 80% of the patients had their tracheostomy decannulated and PEG tube removed. Conclusion Management of macroglossia requires multidisciplinary approach. While etiology can often be identified and medical treatment can be initiated for reversible causes, most of the macroglossia cases previously reported required surgical management. Surgical reduction offers the best functional and cosmetic results and minimizes morbidity. In the case idiopathic macroglossia, management should involve tracheostomy and feeding access for the initial stabilization followed by reduction glossectomy for improvement of functional outcomes.

6.
Oral Surg Oral Med Oral Pathol Oral Radiol ; 134(5): 528-532, 2022 11.
Article in English | MEDLINE | ID: covidwho-1763921

ABSTRACT

OBJECTIVE: The purpose of this study was to describe patterns of burns to the head and neck in children during the early COVID-19 pandemic. STUDY DESIGN: This cross-sectional study reviewed pediatric patients in the Burn Care Quality Platform Registry. Patients were included if they were ≤17.9 years old and had sustained burns to the head and neck. Patients were separated into the following groups: March 13 to September 13, 2019 (before COVID-19 pandemic, BC) or March 13 to September 13, 2020 (during the initial 6 months of the COVID-19 pandemic, C19). The study team collected patient-related variables, details regarding burn injury, burn severity, and hospital course. Univariate and bivariate analyses were calculated. The chi-squared test was used for categorical variables. Statistical significance was P < .05. RESULTS: Fifty-five children with head and neck burn injuries were included. There was a 200% increase in burns to the head and neck region in children in April 2021 compared with previous year. Burns to head and neck in White children occurred more often during C19 (P = .03). The study revealed differences in timing of presentation (time of burn injury to emergency department admission) in different racial groups during (White children [P = .05]), and after the pandemic (African American children [P = .02]). CONCLUSIONS: There was a transient increase in burns to the head and neck region in children during the early pandemic compared with the historic cohort.


Subject(s)
Burns , COVID-19 , Child , Humans , Adolescent , Pandemics , COVID-19/epidemiology , Cross-Sectional Studies , Burns/epidemiology , Burns/therapy , Hospitalization , Retrospective Studies
7.
J Oral Maxillofac Surg ; 79(11): 2299-2305, 2021 11.
Article in English | MEDLINE | ID: covidwho-1487859

ABSTRACT

PURPOSE: During coronavirus disease-19 (COVID-19) pandemic, hospitals faced challenges which were different than previous years. The purpose this study was to report frequency of firearm injuries (FI) to head and neck during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study reviewed patients in the Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, GA. Patients were included if they sustained FI to head and neck, were listed in TR, and were treated at GMH. Patients were stratified according to date of injury into 1) before COVID-19 pandemic, (BC19) or 2) during initial 5 months of COVID-19 pandemic, (C19). Variables were patient demographics, illegal substance use, etiology, place of injury, distressed communities index, location of injury, Glasgow Coma scale on arrival, cardiopulmonary resuscitation in Emergency Department (ED), shock on admission, disposition from ED, length of stay, days on mechanical ventilation and discharge status. Descriptive, univariate, and bivariate analysis were completed. Chi square test was used for categorical variables. Statistical significance was P < .05. RESULTS: There were 215 patients who met inclusion criteria. There were 96 patients (78 males) with a mean age of 31.5 years old during BC19. There were 119 patients (101 males) with a mean age 32.7 years old during C19. There was a 10.4% increase in FI to head and neck during COVID-19. Our data showed that alcohol use was associated with FI during C19 (P≤ .0001). FI to base of skull occurred 34.5% more often during C19 (P = .002). Cranial injuries occurred 26% more often during BC19 (P = .03). During BC19, 85.4% of the patients arrived alive to GMH, but only 16% arrived alive during C19 (P ≤ .0001). CONCLUSIONS: There were more FI to head and neck during COVID-10 pandemic than during the previous time period.


Subject(s)
COVID-19 , Firearms , Wounds, Gunshot , Adult , Cross-Sectional Studies , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Wounds, Gunshot/epidemiology
8.
J Burn Care Res ; 2021 Jul 23.
Article in English | MEDLINE | ID: covidwho-1322638

ABSTRACT

Coronavirus disease 2019 (COVID- 19) affected daily activities since December 2019. Burn injuries to head and neck can result in cosmetic and functional deformities. The purpose of this study was to characterize patients with burns to head and neck during the pandemic. This cross-sectional study reviewed patients in Burn Care Quality Platform Registry. Patients were included if they were age 18 years of age or older, and sustained burns to head and neck. Patients were stratified according to date of injury into: (1) March 13 to September 13, 2019 (i.e., before COVID-19 pandemic, BC19) or (2) March 13 to September 13, 2020. March 13, 2020 was chosen because (1) COVID-19 was announced as a national emergency on that date and (2) it was the last day of in-person schools in state of Georgia. Data collection included patient demographics, admission details, burn details, and hospital related variables were documented. During the study period, 157 patients had burn to head and neck (BC-19; 70, C-19; 71). Our data showed a 375% increase in March following the announcement of the pandemic (BC19; 4, C19;19). Admissions from another facility were statistically more than in C19 group (p=<0.0001). For C19 group, there were 53% more admissions from ED than BC19 (p=0.001). Additionally, in BC19 group patients presented with concomitant inhalation injuries significantly more than C19 group (p=0.04). In conclusion, the total number of burns is the same during BC and C19, however there was a significant spike in number of cases in March 2020.

9.
Oral Surg Oral Med Oral Pathol Oral Radiol ; 132(5): e169-e174, 2021 11.
Article in English | MEDLINE | ID: covidwho-1230698

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic caused delays in medical and surgical interventions in most health care systems worldwide. Oral and maxillofacial surgeons (OMSs) delayed operations to protect themselves, patients, and staff. This article (1) presents one institution's experience in the management of pediatric craniomaxillofacial trauma during the COVID-19 pandemic and (2) suggests recommendations to decrease transmission. METHODS: This was a retrospective review of children aged 18 years or younger who underwent surgery at Children's Healthcare of Atlanta in Atlanta, GA, between March and August 2020. Patients (1) were aged 18 years old or younger, (2) had one or more maxillofacial fractures, and (3) underwent surgery performed by an OMS, otolaryngologist, or plastic surgeon. Medical records were reviewed regarding (1) fracture location, (2) COVID-19 status, (3) timing, (4) personal protective equipment, and (5) infection status. Descriptive statistics were computed. RESULTS: Fifty-eight children met the inclusion criteria. The most commonly injured maxillofacial location was the nose. Operations were performed 50.9 hours after admission. Specific prevention perioperative guidelines were used with all patients, with no transmission occurring from a patient to a health care worker. CONCLUSIONS: With application of our recommendations, there was no transmission to health care workers. We hope that these guidelines will assist OMSs during the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Adolescent , Child , Humans , Personal Protective Equipment , Retrospective Studies , SARS-CoV-2
10.
Oral Surg Oral Med Oral Pathol Oral Radiol ; 132(2): 137-144, 2021 08.
Article in English | MEDLINE | ID: covidwho-1071828

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has increased anxiety among the general population. The purpose of this project was to investigate attitudes and anxiety among oral and maxillofacial surgery (OMS) residents during the early COVID-19 pandemic. MATERIALS AND METHODS: This was a cross-sectional study. OMS residents were sent electronic invitations to answer a survey. The survey was sent in April and May 2020. Residents enrolled in OMS residency programs accredited by the Commission on Dental Accreditation were included. Predictor variable was attitudes of OMS residents toward the pandemic. The outcome variable was anxiety levels of OMS residents due to the pandemic according to the Hospital Anxiety and Depression Scale-A. Other variables were demographic characteristics, general knowledge regarding the pandemic, and attitudes of OMS residents toward the pandemic. Statistical analysis was performed using Fisher's exact test, Wilcoxon rank sum test, and univariate and multivariate logistic regression (P < .05). RESULTS: We received 275 responses. The majority of respondents were males (74.5%) aged 26 to 30 (52.7%). Residents reported different levels of anxiety (i.e., mild 58.2%, severe 41.8%). Based on multivariate analysis, moderate or severe anxiety was associated with being female (P = .048) and a senior resident (P = .049). Factors such as potential deployment to other services, availability of personal protective equipment, and unclear disease status of patients contributed to anxiety. CONCLUSION: Our study found that during the early COVID-19 pandemic, all residents experienced some anxiety. Senior OMS residents and female OMS residents experience higher anxiety levels than other residents.


Subject(s)
COVID-19 , Internship and Residency , Surgery, Oral , Anxiety/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
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