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Objectives: This scoping review aimed to determine whether the COVID-19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy centres. Method(s): This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines.1,2 A literature search was performed in Medline, Embase, Web Of Science and Scopus as well as grey literature. Keywords including "COVID-19" and "Proton Therapy" were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 14 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Result(s): Six of 14 articles included statements regarding treatment of COVID-19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of alternative therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment volume and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Discussion/Conclusion: Few publications detailed patient selection or workflow methods used during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in proton therapy, collecting this data could aid in future planning for proton therapy in Australia.
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Background: The 2020 COVID- 19 pandemic had various effects on local healthcare. The aim of this study was to assess the extent to which local healthcare and healthcare workers were affected by the COVID- 19 pandemic. Method(s): In this observational study we examined and compared intensive care units (ICUs) before (2019) and during (2020) the COVID- 19 pandemic to assess its effects. Emergency patient data were obtained from the Saitama Prefecture Emergency Medical Information System. The effect of COVID- 19 on emergency care responses was compared with the admission and refusal of patients in 2019 and 2020. We also examined the number of patients who were admitted to ICUs and required surgery. The effect on ICUs was examined with the number of Nurses' incident reports and severity percentages calculated from the integrated team medical care and safety system. We also compared the overtime hours of physicians on the basis of employment records. Result(s): In 2019, 2,136 emergency requests were made to admit patients, and 1,811 patients (85%) were admitted. In contrast, in 2020, 2,371 emergency requests were made, and 1,822 patients (76%) were admitted, representing a decrease to 76% (p = 0.931). The percentage of patients for whom admission was refused was significantly greater in 2020 (506 patients, 21.3%) than in 2019 (303 patients, 14.1%;p = 0.0004). In 2020, the number of neurosurgical, cardiac, and vascular operations increased and, over time, the number of operations increased for all surgical units. The number of incidents reported in ICUs increased significantly from 396 in 2019 to 510 in 2020 (p = 0.001). Conclusion(s): Although intensive care management was restricted, the numbers of patients and physician overtime hours were greater during the COVID- 19 pandemic than before, and the resulting environment led to an increase in the number of incidents. The ICU environments must be proactively improved to prepare for more severe situations in the future.Copyright © 2022 Jikei University School of Medicine. All rights reserved.
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Intro: COVID-19 pandemic era makes quality of obstetric triage care including caesarean section in obstetric true emergency cases delayed. Maternal fetal triage index (MFTI) score is an instrument used to define true emergency in obstetric cases. Decision to delivery interval (DDI) is time interval from caesarean section decision to delivery within <30 minutes standard in emergency cases.This study was designed to evaluate the decision to delivery time interval and its effect on perinatal outcomes and the associated factors during category-1 emergency caesarean section deliveries. Method(s): A prospective observational descriptive study was conducted from 2020-2022 at Kariadi tertiary Hospital. A total of 40 clients who were undergone category-1 emergency caesarean section were included in this study. This is a indepht analysis pregnant women confirmed with COVID-19 infection and had true emergency cases based on MFTI score (stat-priority 1). Finding(s): Among 346 pregnant women with COVID-19, total 160 C-section cases with 40 eligible data were included in this study. Gestational age mostly in their second and third trimester. Maternal comorbidities were diabetes in pregnancy, HIV, pre eclampsia, SLE and thyroid disease. This study showed that DDI <30 minutes were found in 34 cases (85%), DDI 30-60 minutes as many as 6 (15%), and no (0%) DDI >60 minutes. Emergency cases with the shortest DDI were umbilical cord prolapse 3 (100%), fetal distress 14 (93%), placental abruption 5 (83%), impending uterine rupture 5 (83%), and antepartum hemorrhage 7 (70%). Perinatal outcome were Apgar score lower than 7 at 1 minutes (25%) and stillbirth (5%). Conclusion(s): Most of DDI in this study met the recommendation of <30 minutes, but some cases did not meet the standard. This can be caused by multifactorial factors such as advice from the doctor in charge, patient transfer distance, operating room preparation, and anesthetic preparation due to COVID-19.Copyright © 2023
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Background: Renewed interest in regional anaesthesia during the recent COVID-19 pandemic has inspired application of neuraxial anaesthesia for previously unconventional indications, such as awake abdominal surgeries. These patients needed little sedation, since studies demonstrate that neuraxial anaesthesia causes sedation as measured by the bispectral index (BIS). In contrast, no published study has investigated the possible sedative effects of non-neuraxial regional anaesthesia. This pilot randomised controlled trial (RCT) was designed as a template for, and to test the feasibility of, performing a definitive RCT to establish if non-neuraxial regional anaesthesia has any sedative effect. Method(s): Forty participants presenting for forearm surgery were randomly allocated to two treatment groups (supraclavicular block and control). Their level of sedation was monitored with BIS prior to surgery for 60 minutes. Specific feasibility outcomes were planned and data were collected according to CONSORT 2010 recommendations. Result(s): Out of 48 patients screened, 41 (85.42%) were invited to participate. Forty patients (97.56%) consented and 100% of these completed the study. In four participants (10%), BIS electrodes needed replacement, while inadequate contact was shown in three participants (7.50%). Data collection and form completion were deemed "easy" and block success rate was 100%. Differences in mean BIS between groups were < 5 and a difference of 10% between groups in incidence of BIS < 80 (85% block group, 75% control group) was shown. Conclusion(s): We propose that progression to formal RCT is feasible only with specific modifications to the study design. The decrease in BIS value from baseline should be measured per patient and a clinically significant decrease should be estimated;emergency patients should be excluded;the sample size should be 500 patients;and multiple trial sites should be used. Further consideration should be given to whether such a trial would provide clinically useful information, and would justify the risks, patient discomfort and the considerable financial cost.Copyright © 2023, Medpharm Publications. All rights reserved.
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Background: Although hypersensitivity reactions to corticosteroids are rare in the general population, they are not uncommon in high-risk patients who receive repeated doses of them. It is known that delayed reactions are more common than immediate ones. Atopic dermatitis is a risk factor for the development of allergic contact dermatitis from topical corticosteroids. Patients can also develop hypersensitivity reactions to nasal, inhaled, oral and parenteral corticosteroids. Method(s): We reported one case of a 72-year- old man with history of chronic obstructive pulmonary disease (GOLD 4) and atopic dermatitis, who experienced a morbilliform rash after intravenous hydrocortisone administration during his hospital admission for SARS-COV- 2 infection. Since 1995 he had experienced several late skin reactions with corticosteroids and after performing an allergy study he was diagnosed of delayed hypersensitivity to corticosteroids with good tolerance for intravenous hydrocortisone and inhaled mometasone. Closed patch tests were performed with hydrocortisone with immediate and late lectures of 48-96 hours. We also performed a controlled intravenous challenge with hydrocortisone (200 mg) as well as an oral challenge with deflazacort (30 mg) under surveillance in the intensive care unit. Result(s): Patch tests were negative and intravenous hydrocortisone challenge went positive after 48 hours with the same previous skin reaction. Our patient showed a good tolerance to deflazacort. Conclusion(s): Choosing an alternative corticosteroid is pivotal to the patient's safety and also decreases the worry of developing an allergic reaction. This evaluation becomes especially important in high-risk groups where steroids are a life-saving treatment. Baeck et al. classified corticosteroids according to their chemical structure, improving treatment options and recommendations that can be prescribed. Nevertheless, discordance continues to be observed between the results of patch tests and the patient's tolerance to various commercial preparations. In order to provide alternative treatments, it is advisable to perform exposure tests with corticosteroids from a group other than the one the patient is sensitized to. Deflazacort could be an alternative in emergency cases. (Figure Presented).
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Background: There was no evidence about how COVID-19 can affect the neuroimmunological situation in patients who use immunosuppressive or immunomodulatory medications at the beginning of the COVID-19 pandemic in June 2020. Many concerns have arisen among clinicians regarding the management of Multiple Sclerosis (MS) secondary to different limitations applied during this period including the closure of clinics, quarantine, and difficulty for face-to-face communication. Considering this, the potential use of social media in patient-physician communication has been addressed in this study. Material(s) and Method(s): In a cross-sectional study, potential effect of available social media technologies on the communication between patients with MS and MS fellowships at the time of the COVID-19 outbreak in Iran in 2020 has been evaluated. Two questionnaires were designed, one for patients and another for MS fellowships. Data were gathered and results were analyzed by SPSS 23.0 software. Result(s): Of 1700 patients, 408 answered the questionnaire wholly. Most of them used mobile for their medical connection (77.4%). Patients with Relapsing-Remitting had more connections with their doctors (p=0.045). Although MS patients preferred to visit their doctors in person and have face-to-face contact, COVID-19 infectious MS fellowships used social media technologies to solve most patients' problems, answer their questions, and help them stop worrying, and only visited emergency patients in MS clinics by following disease control strategy. Conclusion(s): Social media could help patients and neurologists to solve most problems without in-person visits during the COVID-19 pandemic.Copyright © 2022
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Background: UMHATEM N.I. Pirogov" Sofia, is one of the largest and busiest hospitals for emergency medical care in Bulgaria. It is the legal successor of the former Institute of Emergency Medicine N.I. Pirogov", and it can be said that at the moment it is the only diagnostic-therapeutic, prophylactic and scientific-educational structure of this type within the Bulgarian healthcare system. The concept of adequate functioning and development of this type of hospital does not consider structuring an Infectious Diseases diagnostic-treatment unit. This reality makes necessary the formation of a radically different organization for the admission and treatment of patients in the hospital, both for those with symptoms of Covid 19 and for all other emergency patients. The organization created in this way must absolutely guarantee safety for both streams of patients. In the conditions of a pandemic, in case of a real threat to public health, the main task of triage in the Emergency Department is to establish indications for urgent hospitalization, or to refuse it in the absence of indications. The characteristic course of the disease, the prolonged treatment, the manifestations within the so-called post-Covid syndrome", require serious planning not only of the diagnostic-treatment and rehabilitation period, but also adequate monitoring in the first months after the patient's discharge. Within the national reorganization measures, during the determined periods, the main changes concerning the MED (Multi-profile emergency department) of Pirogov are implemented, with an emphasis on the formation of a specialized triage for the diagnosis and clinical evaluation of patients with a coronavirus infection. The main goal is the adequate diagnosis, treatment and follow-up of patients with coronavirus infection who have passed through the organized Covid-triage in a period of extreme pressure on the emergency structures and on the hospital system in the country as a whole. Objective(s): For a MED, which at the time of declaring an epidemic situation does not have a concept for the diagnosis and treatment of infectious diseases, to systematize the main urgently implemented organizational and structural changes, which turned out to be absolutely necessary to meet a newly emerging epidemiologically significant infectious disease. Aim(s): To systematize the organizational changes imposed by the situation and urgently implemented in the MED (multi-profile emergency department). To systematize the structural changes imposed by the situation and urgently implemented in the work of the MED. To analyze the organizational and structural changes carried out in this way and to differentiate the main difficulties caused by the regulations existing at the time of the announcement of the epidemic situationCopyright © Pantileeva D et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery);recent (1-6 weeks before surgery);previous (>=7 weeks before surgery);or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2;2.2% (50/2317) in patients with peri-operative SARS-CoV-2;1.6% (15/953) in patients with recent SARS-CoV-2;and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.Copyright © 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might have originated from the recombination of a Pangolin-CoV-like virus with a Bat-CoV-RaTG13-like virus and then transmitted to a human at Wuhan city of China. On February 11, 2020, the WHO announced a name for the new coronavirus disease as COVID-19. Finally, the WHO declared the novel coron-avirus outbreak a global pandemic on March 11, 2020. Within a few months, SARS-CoV-2 had spread across the world to 220 countries, areas or territories. The main objective of this work is to review the existing knowledge about COVID-19, its updated status, available treatment procedures and future challenges. The available literature based on the COVID-19 was thoroughly reviewed and concise, evidence-based information was explored for the public interest. Various authentic databases like PubMed, Scopus, and Google Scholar together with the official sites of some Govt. Organizations were carefully searched for all relevant information about the current status of COVID-19, including the published research on coronavirus. More than 68 million people are already infected, including around 20% severely ill, with almost 1.5 million casualties due to this virus which is expected to infect approximately 70% population worldwide. Currently, maximum confirmed cases and death are reported in the USA. The epicentre of the pandemic was initially shifted from China to Europe, then to the USA, Brazil and now India. In between, the understanding of pathogenesis and mode of transmission has been developed;repurposing drugs are being validated and the development of a new vaccine is underway. The study concludes that there is no established treatment available for COVID-19, although 26 clinical and 139 preclinical trials are un-derway to develop vaccines globally. Although three vaccines are at the advanced stage of develop-ment, their efficacy and adverse effects are yet to be validated and recorded. Recently, the Pfizer vaccine has been started for vaccination in emergency cases in England and Bahrain, and the United States of America will start it soon. Meanwhile, prevention, rigorous global containment and quarantine efforts are practiced worldwide to control its spread.Copyright © 2021 Bentham Science Publishers.
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Objective: Although COVID-19 in childhood is often asymptomatic or has a more benign course, the safety of healthcare workers should be the primary goal because of the risk of contamination. In our study, we aimed to investigate the asymptomatic COVID-19 PCR positivity and its effect on the development of complications in emergency and non-deferred surgery cases that will help both the patient, the operating room and the health care workers. Material(s) and Method(s): This is a prospective study that was performed in patients under 18 years of age who were operated on due to emergency and urgent cases in the Ankara City Children's Hospital, which was serving as an anti-pandemic hospital. The patients were evaluated from May 1 to October 1, 2020. Of the 458 patients, 433 patients who met the criteria were included in the study. COVID-19 Nasopharyngeal swab (PCR) samples were taken from all patients along with preoperative examinations. Result(s): Of the 433 cases included in the study, 155 (33.5%) were girls and 278 (66.5%) were boys. It was determined that emergency cases constituted 389 (89.8%) of all cases. The most common emergency pathologies according to age groups were intestinal obstruction or atresia in the neonatal period, foreign body aspirations of the respiratory tract in the preschool period, and acute appendicitis in the school age. Nasal swab PCR results were positive in only four patients, this rate was found to be 0.9% in the entire study group, and postoperative complications and transmission to healthcare workers were detected at none. Conclusion(s): In this prospective study, low COVID-19 PCR positivity (0.9% prevalence) was detected in asymptomatic children scheduled for emergency or non-deferred surgery, and we believe that it will shed light on the planning of safe procedure practices.Copyright © 2021 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
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Objective: Although COVID-19 in childhood is often asymptomatic or has a more benign course, the safety of healthcare workers should be the primary goal because of the risk of contamination. In our study, we aimed to investigate the asymptomatic COVID-19 PCR positivity and its effect on the development of complications in emergency and non-deferred surgery cases that will help both the patient, the operating room and the health care workers. Material and Methods: This is a prospective study that was performed in patients under 18 years of age who were operated on due to emergency and urgent cases in the Ankara City Children's Hospital, which was serving as an anti-pandemic hospital. The patients were evaluated from May 1 to October 1, 2020. Of the 458 patients, 433 patients who met the criteria were included in the study. COVID-19 Nasopharyngeal swab (PCR) samples were taken from all patients along with preoperative examinations. Results: Of the 433 cases included in the study, 155 (33.5%) were girls and 278 (66.5%) were boys. It was determined that emergency cases constituted 389 (89.8%) of all cases. The most common emergency pathologies according to age groups were intestinal obstruction or atresia in the neonatal period, foreign body aspirations of the respiratory tract in the preschool period, and acute appendicitis in the school age. Nasal swab PCR results were positive in only four patients, this rate was found to be 0.9% in the entire study group, and postoperative complications and transmission to healthcare workers were detected at none. Conclusion: In this prospective study, low COVID-19 PCR positivity (0.9% prevalence) was detected in asymptomatic children scheduled for emergency or non-deferred surgery, and we believe that it will shed light on the planning of safe procedure practices.
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Objective: Although COVID-19 in childhood is often asymptomatic or has a more benign course, the safety of healthcare workers should be the primary goal because of the risk of contamination. In our study, we aimed to investigate the asymptomatic COVID-19 PCR positivity and its effect on the development of complications in emergency and non-deferred surgery cases that will help both the patient, the operating room and the health care workers. Material(s) and Method(s): This is a prospective study that was performed in patients under 18 years of age who were operated on due to emergency and urgent cases in the Ankara City Children's Hospital, which was serving as an anti-pandemic hospital. The patients were evaluated from May 1 to October 1, 2020. Of the 458 patients, 433 patients who met the criteria were included in the study. COVID-19 Nasopharyngeal swab (PCR) samples were taken from all patients along with preoperative examinations. Result(s): Of the 433 cases included in the study, 155 (33.5%) were girls and 278 (66.5%) were boys. It was determined that emergency cases constituted 389 (89.8%) of all cases. The most common emergency pathologies according to age groups were intestinal obstruction or atresia in the neonatal period, foreign body aspirations of the respiratory tract in the preschool period, and acute appendicitis in the school age. Nasal swab PCR results were positive in only four patients, this rate was found to be 0.9% in the entire study group, and postoperative complications and transmission to healthcare workers were detected at none. Conclusion(s): In this prospective study, low COVID-19 PCR positivity (0.9% prevalence) was detected in asymptomatic children scheduled for emergency or non-deferred surgery, and we believe that it will shed light on the planning of safe procedure practices. Copyright © 2021 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
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Objective: This study compared the aerosol-generating and non-aerosol-generating endodontic emergency procedures' success and assessed the outcome of endodontic treatments initiated before a pandemic but could not be completed in the targeted time. Material(s) and Method(s): Emergency treatments were performed according to symptoms of teeth. Treatment success or failure was determined according to patients whether not re-referral with untimely pain. Short-term outcome and complications arising from teeth, which endodontic treatments were prolonged were also recorded. A chi-square test was used in the statistical analysis, and p<0.05 was considered significant. Result(s): The aerosol-generating procedure group's success rate was 86.2%, while it was 70.0% in the non-aerosol generating procedure group (p=0.050). The short-term survival rate of teeth was 83.7% in patients whose endodontic treatment had been prolonged. Conclusion(s): Considering the pros and cons, each emergency patient should be evaluated case-by-case. Copyright ©Meandros Medical and Dental Journal, Published by Galenos Publishing House.
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Objective: This study compared the aerosol-generating and non-aerosol-generating endodontic emergency procedures' success and assessed the outcome of endodontic treatments initiated before a pandemic but could not be completed in the targeted time. Material(s) and Method(s): Emergency treatments were performed according to symptoms of teeth. Treatment success or failure was determined according to patients whether not re-referral with untimely pain. Short-term outcome and complications arising from teeth, which endodontic treatments were prolonged were also recorded. A chi-square test was used in the statistical analysis, and p<0.05 was considered significant. Result(s): The aerosol-generating procedure group's success rate was 86.2%, while it was 70.0% in the non-aerosol generating procedure group (p=0.050). The short-term survival rate of teeth was 83.7% in patients whose endodontic treatment had been prolonged. Conclusion(s): Considering the pros and cons, each emergency patient should be evaluated case-by-case. Copyright ©Meandros Medical and Dental Journal, Published by Galenos Publishing House.
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BACKGROUND CONTEXT: The coronavirus-19 (COVID-19) pandemic has altered the standard of care for spine surgery in many ways. However, there is a lack of literature evaluating the potential changes in surgical outcomes and perioperative factors for spine procedures performed during the pandemic. In particular, no large database study evaluating the impact of the COVID-19 pandemic on spine surgery outcomes has been published. PURPOSE: To evaluate the impact of the COVID-19 pandemic on perioperative factors and postoperative outcomes of lumbar fusion procedures. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Patients who underwent primary, elective lumbar fusionbetween 2019 and 2020. OUTCOME MEASURES: Thirty-day readmission, reoperation, morbidity, complications, operative time, non-home discharge disposition, length of hospital stay, total RVUs and RVUs per minute. METHOD(S): The ACS-NSQIP database was queried for all patients who underwent primary lumbar fusion in 2019 and 2020. Exclusion criteria included cervical or thoracic fusion, arthroplasty, non-elective, emergency cases, deformity procedures, malignancy, preoperative sepsis, wound infection and missing perioperative variables. Patients were grouped into cohorts based on 2019 or 2020 operation year. Multivariate logistic and Poisson regression models were utilized to evaluate the impact of 2020 operative year on postoperative outcomes. RESULT(S): A total of 27,446 patients were included in the analysis (12,473 cases in 2020). For the 2020 cohort, non-white race (24.9% vs 23.4%, p=0.004), functional dependence (1.8% vs 1.4%, p=0.022), congestive heart failure (0.5% vs 0.3%, p=0.015), and ASA class =3 (53.5% vs 52.2%, p=0.037) were more common. Lumbar fusions performed in 2020 were also associated with longer mean operative time (209.3+/-99.3 vs. 205.9+/-98.6 minutes, p=0.005) and higher mean fusion levels (1.45+/-0.69 vs 1.41+/-0.65, p 0.05). However, operation year 2020 independently predicted morbidity (OR 1.087 [95% CI 1.007-1.172], p=0.032), pneumonia (1.407 [1.039-1.906], p=0.027), DVT (1.508 [1.106-2.056], p=0.009) and sepsis (1.537 [1.101-2.146], p=0.012). In terms of perioperative variables, operation year 2020 predicted greater operative time (1.012 [1.001-1.013], p=0.046), non-home discharge (0.690 [0.642-0.743], p<0.001), and total RVUs (1.044 [1.004-1.083], p=0.033). CONCLUSION(S): Lumbar fusion procedures performed amidst the COVID-19 pandemic were associated with poorer outcomes, including higher rates of morbidity, pneumonia, DVT and sepsis. In addition, surgeries performed in 2020 were associated with longer operative times and less frequent non-home discharge disposition. FDA DEVICE/DRUG STATUS: This does not discuss or include any applicable devices or drugs. Copyright © 2022
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Aim: Minimally invasive cancer surgery is the becoming the standard of care in colorectal oncology. With the growing interest in the use of tailored approach to improve the outcomes, colorectal oncology demands sub-specialised care. Method(s): This is a description of establishment of a dedicated colo-rectal oncology unit at a newly built tertiary care centre in the country, Tata Memorial Centre (Varanasi) with special emphasis on the introduction of laparoscopy for standard and extended colo-rectal surgery. Result(s): Over a period of 4 months, from February 2021 to May 2021, 35 colo-rectal surgeries have been done with 5 emergency cases and the remaining in elective setting. Operative procedures included -10 colectomies, 5 stoma/ostomy creations, 7 rectal resections in standard TME plane, 2 total pelvic exenterations, 11 extended rectal resections. 22 of these 35 surgeries (62.8%) were done using laparoscopic approach. Laparoscopy has been used across all procedures, specifically 5 colectomies, 7 standard TME rectal surgeries, 5 extended rectal resections and 1 total pelvic exenteration. Clavein dindo Grade 3 or higher morbidity was seen in 5.7% cases. Joint clinic session dedicated to colorectal oncology is conducted to provide a tailor-made individualized care to appropriate patients. Conclusion(s): Use of minimally invasive approach in colorectal oncology along with a sub specialized unit is the need of the hour to improve the outcomes in this cohort of patients.
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Aim: Gastrointestinal (GI) symptoms have been reported with coronavirus disease (COVID-19), but our understanding of their clinical significance is limited and this can be a safety concern for surgeons as patients might present with GI symptoms only. Method(s): A prospectively maintained database of emergency patients was reviewed between 20/03/2020 and 20/04/2020 (Cohort A) and 05/01/2021-26/ 01/2021. (Cohort B) All of them had a positive Polymerase Chain Reaction (PCR) COVID-19 test. We evaluated the prevalence of GI symptoms and their association with the severity of COVID-19 and looked at the prevalence of symptoms in different ethnicities. Chi-squared test in R software environment was used to analyse the data. Result(s): Cohort A consisted of 189 patients (100 male) 14 had nausea, 18 vomiting, 39 diarrhoea and 9 abdominal pain. 17 had ITU admissions and 68 died. Cohort B consisted of 348 patients (185 male) 50 had nausea, 46 vomiting, diarrhoea 84 and 23 had abdominal pain. 30 had ITU admissions and 75 died. In this cohort the COVID-19 Alpha Variant was making up nearly 100% of cases. Nausea was more common in Cohort B 50/348 (P = 0.01641) There was no difference in vomiting (18/189 Cohort A P = 0.198898), diarrhoea (39/189 Cohort A, P = 0.3385) and abdominal pain (9/189 Cohort A P = 0.379). There was no difference in GI symptoms for the severe and non-severe cases in Cohort A (P = 0.150813) but they were more prevalent in the non-severe group of Cohort B (P = 0.008). There was no diifference between ethnic groups in terms of GI symptoms (Cohort A 35 Black patients,17 Asian, 102 White and 35 Other Ethnicities, Cohort B 40 Black, 33 Asian, 174 White and 101 Other Ethnicities). Conclusion(s): Acute GI symptoms associated with COVID-19 are highly prevalent and were seen more often in non-severe cases of Cohort B. The SARS-CoV- 2 Alpha Variant was endemic in our region and the UK vaccination programme was being rolled out at the time of our study. More research is required to establish the significance of these factors.
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Aim: SARS-CoV- 2 has been associated with an increased rate of venous thromboembolism (VTE) in critically ill patients (1-4). Since surgical patients are already at higher risk of VTE than general populations, this study aimed to determine if patients with perioperative or previous SARS-CoV- 2 were at further risk of VTE. Method(s): International, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patient from all surgical specialties were included. The primary outcome measure was VTE (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV- 2 diagnosis was defined as perioperative (7-days before to 30-days after surgery), recent (1-6 weeks before surgery), and previous (37 weeks before surgery). Result(s): The postoperative VTE rate was 0.5% (666/123,591) in patients without SARS-CoV- 2 diagnosis, 2.2% (50/2,317) in patients with perioperative SARS-CoV- 2, 1.6% (15/953) in patients with recent SARS-CoV- 2, and 1.0% (11/1,148) in patients with previous SARS-CoV- 2. After adjustment for confounding factors, patients with perioperative (adjusted odds ratio 1.48, 95% confidence interval 1.08-2.03) and recent SARS-CoV- 2 (OR 1.94, 1.15-3.29) remained at higher risk of VTE, with a borderline finding in previous SARS-CoV- 2 (OR 1.65, 0.90-3.02). Overall, VTE was independently associated with 30-day mortality (OR 5.39, 4.33-6.70). In SARS-CoV- 2 infected patients, mortality without VTE was 7.4% (319/4,342) and with VTE was 40.8% (31/76). Conclusion(s): Patients undergoing surgery with a perioperative or recent SARS-CoV- 2 diagnosis are at increased risk of VTE compared to non-infected surgical patients.
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Introduction/Aims: The impact of COVID on elective operating is well documented and far-reaching. What has not been reviewed is the impact on trauma surgery. The indications for the surgical treatment of zyggomatic fractures are primarily aesthetic, with only a small percentage of patients with this injury having significant functional problems Material(s) and Method(s): Operative records between April 2015 and December 2021 held in the theatre database of Swansea Hospital were exported to Excel and processed using Winstat. Results/Statistics: Over the time studied the mean zygoma fractures treated per year was 41 (SD 20.6, max 61, minimum 11). The two years since COVID 2020 and 2021 had 11 and 16 cases requiring operative intervention. These were significantly different to that observed in any of the preceding years. [Formula presented] Conclusions/Clinical Relevance: Early in COVID there was a contraindication to general anaethesia for anything but emergency cases. Zygomatic surgery did not qualify as an emergency during this initial phase and the frequency of facial trauma was also reduced because of lockdown. When lockdown ceased in Wales, facial trauma in Swansea (as indicated by operated mandibular fractures) returned almost to normal. However, a combination of limited access to semi-elective theatre and a change in approach by clinicians and patients to the management of cheekbone fractures has completely altered the approach in the Swansea Unit. The impact of this change on training and patient care will be discussed. Copyright © 2022