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1.
Journal de chirurgie viscerale ; 157(3):S6-S12, 2020.
Article | WHO COVID | ID: covidwho-728654

ABSTRACT

The COVID-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery Healthcare priorities and circuits are being modified Emergency surgery is still a priority Functional surgery is to be deferred Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk The question looms large in cancer surgery - go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery For each type of cancer - colon, pancreas, oesogastric, hepatocellular carcinoma - morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time Strategies can be proposed based on this comparison For colonic cancers T1-2, N0, it is advisable to defer surgery For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait For rectal cancers T3-4 and /or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections Most complex surgery with high morbidity and mortality - oesogastric, hepatic or pancreatic - is most often best deferred

2.
Patient Saf. Surg. ; 1(14)20200709.
Article in English | ELSEVIER | ID: covidwho-637200

ABSTRACT

Up to 20% of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients develop severe inflammatory complications with diffuse pulmonary inflammation, reflecting acute respiratory distress syndrome (ARDS). A similar clinical profile occurs in severe trauma cases. This review compares pathophysiological and therapeutic principles of severely injured trauma patients and severe coronavirus disease 2019 (COVID-19). The development of sequential organ failure in trauma parallels deterioration seen in severe COVID-19. Based on established pathophysiological models in the field of trauma, two complementary pathways of disease progression into severe COVID-19 have been identified. Furthermore, the transition from local contained disease into systemic and remote inflammation has been addressed. More specifically, the traumatology concept of sequential insults ('hits') resulting in immune dysregulation, is applied to COVID-19 disease progression modelling. Finally, similarities in post-insult humoral and cellular immune responses to severe trauma and severe COVID-19 are described. To minimize additional 'hits' to COVID-19 patients, we suggest postponing all elective surgery in endemic areas. Based on traumatology experience, we propose that immunoprotective protocols including lung protective ventilation, optimal thrombosis prophylaxis, secondary infection prevention and calculated antibiotic therapy are likely also beneficial in the treatment of SARS-CoV-2 infections. Finally, rising SARS-CoV-2 infection and mortality rates mandate exploration of out-of-the box treatment concepts, including experimental therapies designed for trauma care.

3.
Acta Clin Belg ; : 1-5, 2020 Jun 16.
Article in English | MEDLINE | ID: covidwho-600078

ABSTRACT

OBJECTIVE: Recent publications on Coronavirus Disease-2019 (COVID-19) report that diabetic people with or without co-morbidities are at higher risk of developing severe and/or fatal illnesses. METHOD AND RESULT: We report the first case of a 60-year-old man with a 27-year history of type 1 diabetes mellitus, infected by SARS-CoV-2 presenting with an euglycaemic ketoacidosis and an acute respiratory distress syndrome. CONCLUSION:  This case report reminds us of the importance of adjusting more recent glucose-lowering drugs, including sodium-glucose cotransporter 2 inhibitors, in the overall management of type 1 diabetic individuals during the ongoing COVID-19 outbreak. ABBREVIATIONS: COVID-19: Coronavirus disease 2019 (SARS-CoV-2) virus, T1DM: Type 1 diabetes mellitus, T2DM: Type 2 diabetes mellitus, SGLT2i: Sodium-glucose cotransporter 2 inhibitor, DKA: diabetic ketoacidosis, euDKA: euglycaemic diabetic ketoacidosis.

4.
Ann Endocrinol (Paris) ; 81(2-3): 101-109, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-380104

ABSTRACT

Diabetes is among the most frequently reported comorbidities in patients infected with COVID-19. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. On the other hand, diabetes is a risk factor for developing severe and critical forms of COVID-19, the latter requiring admission to an intensive care unit and/or use of invasive mechanical ventilation, with high mortality rates. The characteristics of diabetic patients at risk for developing severe and critical forms of COVID-19, as well as the prognostic impact of diabetes on the course of COVID-19, are under current investigation. Obesity, the main risk factor for incident type 2 diabetes, is more common in patients with critical forms of COVID-19 requiring invasive mechanical ventilation. On the other hand, COVID-19 is usually associated with poor glycemic control and a higher risk of ketoacidosis in diabetic patients. There are currently no recommendations in favour of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Metformin and SGLT2 inhibitors should be discontinued in patients with severe forms of COVID-19 owing to the risks of lactic acidosis and ketoacidosis. Finally, we advise for systematic screening for (pre)diabetes in patients with proven COVID-19 infection.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Acidosis, Lactic/chemically induced , Acidosis, Lactic/epidemiology , Acidosis, Lactic/virology , Betacoronavirus/physiology , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Critical Illness/epidemiology , Critical Illness/therapy , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/epidemiology , Diabetic Ketoacidosis/virology , Humans , Mass Screening/methods , Mass Screening/standards , Metformin/therapeutic use , Obesity/complications , Obesity/epidemiology , Obesity/therapy , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Prediabetic State/complications , Prediabetic State/diagnosis , Prediabetic State/epidemiology , Prediabetic State/therapy , Renin-Angiotensin System/physiology , Risk Factors , Risk Management , Severity of Illness Index , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Withholding Treatment
5.
J Visc Surg ; 157(3S1): S7-S12, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-39755

ABSTRACT

The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. Emergency surgery is still a priority. Functional surgery is to be deferred. Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk. The question looms large in cancer surgery-go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. For each type of cancer-colon, pancreas, oesogastric, hepatocellular carcinoma-morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time. Strategies can be proposed based on this comparison. For colonic cancers T1-2, N0, it is advisable to defer surgery. For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers T3-4 and/or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections. Most complex surgery with high morbidity and mortality-oesogastric, hepatic or pancreatic-is most often best deferred.


Subject(s)
Coronavirus Infections , Digestive System Diseases/surgery , Digestive System Neoplasms/surgery , Pandemics , Pneumonia, Viral , Health Services Needs and Demand , Humans , Laparoscopy , Postoperative Care , Practice Guidelines as Topic , Time-to-Treatment
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