Impact of the COVID-19 pandemic on the presentation of surgical conditions. Experience of Hospital de Clínicas in Uruguay

Background: COVID-19 was declared a global health emergency by WHO on March 11, 2020. As a result of the pandemic, patients’ visits to the emergency department have been affected and are reflected in the presence of complications associated with the course of the disease. Objectives: To evaluate the stage of the conditions requiring emergency surgery at the moment of consultation in the context of the pandemic. To analyze postoperative morbidity and mortality. To analyze if there were changes in the selection of the surgical approach. Material and methods: We conducted a single-center, retrospective and observational cohort study at the university center Hospital de Clínicas. Two study groups were generated to compare two populations over the same time interval (from March 13 to December 13), but differentiated by the presence of the COVID-19 pandemic and its influence. Results: The cohort was made up of 765 patients, 371 in group A and 394 in Group B. The presence of complications associated with the course of the disease and postoperative morbidity and mortality was higher in the group influenced by the pandemic (p = 0.0001 and p = 0.001, respectively). The laparoscopic approach was more common in group B (p = 0.006). Conclusions: In general, the percentage of emergency surgical conditions in Hospital de Clínicas of Uruguay was similar in both periods. The presence of complications associated with the course of the disease and postoperative morbidity and mortality was higher in the group influenced by the pandemic, as expected due to delays in consultations. © 2021 Argentine Association of Surgery.

Perceptions of general surgeons in training in the initial phase of COVID-19 pandemic

Objective: The aim of this study is to describe the perceptions of surgeons in training during the initial phase of the COVID-19 pandemic. Material and methods: A 51-question survey was conducted among physicians in training from a department of surgery in an Argentine hospital. Five domains were explored: institutional, healthcare, academic, domestic and emotional. Results: The survey was completed by 55 physicians (91.7%): 35 residents and 20 fellows. Among the respondents, 98.1% considered the information provided by the hospital and the department about the measures implemented in the COVID-19 stetting was sufficient. 98.1% considered that the instructions about personal protective equipment were satisfactory, but 38% reported difficulties to use them. 92.5% of the residents agreed with the system implemented for on-call shifts, 94.5% increased the time dedicated to academic activities, 75% considered the virtual class schedule implemented as very useful and 72.72% perceived that they had spaces to express their concerns. The supervision was considered adequate by 60%;81.81% were worried to lose manual dexterity;53% felt frustrated and 54% were afraid of infecting their family/partner. Conclusion: Understanding the perceptions of surgeons in training in the initial phase of the COVID-19 pandemic made it possible to detect opportunities for improvement and incorporate modifications to address the following phases, ensuring learning and prioritizing their physical and psychosocial well-being. © 2018 Department of Spanish Literature and Theory of Literature and Comparative Literature.Universidad de Valladolid. All rights reserved.

The big challenge of SARS-CoV-2 latency: testes as reservoir

In the efforts to explain COVID-19 pathophysiology, studies are being carried out on the correspondence between the expression of SARS-CoV-2 cell receptors and viral sequences. ACE2, CD147 and TMPRSS2 receptors expression could indicate poorly explored potential infection targets. For the genomic analysis of SARS-CoV-2 receptors, using BioGPS information was decided, which is a portal that centralizes genetic annotation resources, in combination with that of The Human Protein Atlas, the largest portal of human transcriptome and proteome data. We also reviewed the most recent articles on the subject. RNA and viral receptor proteins expression was observed in numerous anatomical sites, which partially coincides with the information reported in the literature. High expression in testicular cells markedly stood out, and it would be therefore important ruling out whether this anatomical site is a SARS-CoV-2 reservoir;otherwise, germ cell damage, as it is observed in infections with other RNA viruses, should be determined.

Cutaneous susceptibility to SARS-CoV-2 infection according to the expression of viral entry factors in the skin

Introduction: Reports of dermatological manifestations in patients with COVID-19 suggest a possible cutaneous tropism of SARS-CoV-2;however, the capacity of this virus to infect the skin is unknown.

Neurological manifestations in coronavirus disease 2019

Coronavirus disease 2019 (COVID-19), an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently hitting the world in the form of a pandemic. Given that some reports suggest that this infection can also occur with neurologic manifestations, this narrative review addresses the basic and clinical aspects concerning the nervous system involvement associated with this disease. More than one third of patients hospitalized for COVID-19 can present with both central and peripheral neurological manifestations. The former includes dizziness and headache, while the latter includes taste and smell disturbances. Other reported neurological manifestations are cerebrovascular disease and epileptic seizures. According to published reports, neurological disorders are not uncommon in COVID-19 and can sometimes represent the first manifestation of the disease;therefore, neurologists should consider this diagnostic possibility in their daily practice. Since maybe not all COVID-19 neurological manifestations are due to SARS-CoV-2 direct effects, it is important to monitor the rest of the clinical parameters such as, for example, oxygen saturation. Similarly, follow-up of patients is advisable, since whether neurological complications may develop lately is thus far unknown.

Proposal for the management of COVID-19-associated coagulopathy in children

SARS-CoV-2 infection (COVID-19) has become a pandemic with a high case fatality rate that mainly affects adults. Most severely ill adult patients develop a coagulopathy that was not described until recently, and which is currently considered a main cause of death. Everything indicates that a similar phenomenon also occurs in children with COVID-19. Anticoagulant treatment has become one of the therapeutic foundations for this infection;however, its implementation in children can be difficult since, until recently, it was not considered in the pediatric population. Evidence regarding the use of anticoagulants in COVID-19 is rapidly generated, changes constantly, it is often difficult to interpret, and can be contradictory. After an extensive review of the published literature, a proposal was generated that offers suggestions for anticoagulant treatment, considering available resources in Mexico.

Impact of mandatory preventive isolation on daily physical activity and weight of children in Colombia during the SARS-cov-2 pandemic

Introduction: In Colombia from March 24 to August 31, 2020, children and adolescents spent 162 days in total mandatory preventive isolation due to the Covid-19 pandemic. Objective: To know and evaluate their behavior of children and adolescents during this period of confinement in order to establish the consequences on the physical activity and weight gain. Methods: An open virtual survey was developed on the Google survey platform, addressed to parents with 5 questions: 1. How old is your child: 2. How many minutes of physical activity at home do you do? 3. How many minutes of screens (TV, computer, cell phone, video games, etc.) her or she watch per day? 4. How many hours does he or she sleep at night? 5. Has your child's body weight increased? How much? This survey was distributed in the databases of the Association of Sports Medicine and the Colombian Heart Foundation through social networks such as WhatsApp and emails. Results: 1,139 virtual surveys were conducted. It was found that during the mandatory isolation period: 75.2% of the children did not perform the minutes of physical activity recommended by the World Health Organization (WHO), that 82.8% exceeded the time of 60 minutes versus to electronic devices and that 44% weight gained. Conclusions: In periods of confinement, it is important to design educational strategies and processes that promote healthy lifestyles in children that can be preserved in the future in adults.

Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adults with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. Objective: to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection;b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

ANXIETY SYMPTOMS AND ASSOCIATED FACTORS AMONG HEALTH PROFESSIONALS DURING THE COVID-19 PANDEMIC

Objective: to identify anxiety symptoms and associated factors among health professionals during the COVID-19 pandemic. Method: a cross-sectional study carried out with 1,354 health professionals, whose socio-professional data and psychological and physical anxiety symptoms were collected via Google Forms between May 17th and May 21st, 2020, in northeastern Brazil, and analyzed using Pearson’s Chi-Square test and logistic regression. Results: there was an association between psychological symptoms and age (p=0.036) and female gender (p=0.015), as well as between physical symptoms and age (p=0.000), having provided care for patients with COVID-19 (p=0.003), if the professional presented COVID-19 symptoms (p=0.000), with social interaction with symptomatic people (p=0.028) and gender (p=0.000). Conclusion: the study may support a better understanding of the health professionals’ experience in relation to the COVID-19 pandemic for developing policies for the care of professionals, as well as encourage further studies, considering the urgency, uniqueness and magnitude of the situation experienced. © 2022, Universidade Federal do Parana. All rights reserved.

Proceedings from the scientific closing seminar of the project: "semi-presential technological support platform for urgent and priority dental care for the elderly in the context of the covid-19 pandemic in the chilean population"

It is with great pleasure that we present the proceedings of the closing seminar of the research project on Development of a digital platform of teledentistry for the elderly in the context of the COVID-19 pandemic, funded by the Contest for Rapid Allocation of Funds of the National Agency of Research and Development (ANID), Reference No. COVID0766, Chile. This project offers new knowledge aiming to improve the access to oral health by the elderly population through the development and deployment of a web-based teledentistry platform which operates in conjunction with a mobile dental clinic and a network of clinical referral centers during the COVID-19 pandemic. The study involved a network of five Chilean universities: Universidad de La Frontera (main beneficiary), Universidad de Chile, Universidad de Talca, Universidad de Antofagasta, Universidad San Sebastián, Concepción Campus. Besides, the project generated international connections with the faculties of dentistry of the following academic institutions: Universidad Santo Tomás de Bucaramanga, Colombia, Universidad de Antioquia, Colombia, and Universidad de Guadalajara, México. The closing seminar was conducted as a webinar between August 27 and August 28, 2021. © 2022, Universidad de Concepcion. All rights reserved.

Experience in a rehabilitation center for mastectomized women at the start of the COVID-19 pandemic

OBJECTIVE: Describe the experience lived in an interdisciplinary follow-up care center for mastectomized women at a public university in Sao Paulo during the beginning of the COVID-19 pandemic. METHOD: Experience report on the health care provided in the health center for mastectomized women. RESULTS: The care was provided three times a week by an interdisciplinary health team. The mentioned areas that cover the women care in the center: Physical, Psychological, Social Support and Health Education. CONCLUSIONS: The attention by an interdisciplinary team becomes prevalent in the care of mastectomized women, since cancer and its treatment produce various changes in women's lives in the short and long term, so follow-up and support must be biopsychosocial, covering all areas that may be affected, especially during the pandemic.

Reusing and/or reprocessing the N95 face respirator mask or equivalent: An integrative review

OBJECTIVE: to analyze the scientific evidence available on the different reprocessing methods and the necessary conditions for reuse of the N95 face respirator mask or equivalent. METHOD: an integrative literature review. The PICO strategy was used to elaborate the question. The search was conducted in four databases: PubMed, SciVerse Scopus, WebofScience and EMBASE, considering any period of time. RESULTS: a total of 32 studies were included from the 561 studies identified, and they were presented in two categories: "Conditions for reuse" and "Reprocessing the masks". Of the evaluated research studies, seven(21.8%) addressed the reuse of the N95 face respirator mask or equivalent and 25(78.1%) evaluated different reprocessing methods, namely: ultraviolet germicidal irradiation(14);hydrogen peroxide(8);vapor methods(14);using dry heat(5) and chemical methods(sodium hypochlorite[6], ethanol[4] and sodium chloride with sodium bicarbonate and dimethyldioxirane[1]). We emphasize that different methods were used in one same article. CONCLUSION: no evidence was found to support safe reprocessing of face respirator masks. In addition, reuse is contraindicated due to the risk of self-contamination and inadequate sealing.

Severity of acute cholecystitis in times of COVID-19: myth or reality?

Introduction. Acute cholecystitis is one of the most frequent causes of hospital admissions in the adult population and laparoscopic cholecystectomy is considered the gold standard for its management. Within the effects of the COVID-19 pandemic, an increase in the severity of presentation has been perceived in these patients. This study aims to compare the clinical and surgical presentation based on the different severity scales of acute cholecystitis before and during the COVID-19 pandemic. Methods. A retrospective cohort study was performed with patients undergoing laparoscopic cholecystectomy for acute cholecystitis between 2019 and 2020. A bivariate and Kaplan Meier analysis was performed with the time elapsed between onset of symptoms and admission to hospital, and between admission to hospital and performance of surgery. Results. A total of 302 patients underwent laparoscopic cholecystectomy for acute cholecystitis. The time of evolution of symptoms until admission was 83.3 hours (95% CI: 70.95-96.70) vs. of 104.75 hours (95% CI: 87.26-122.24) before and during the pandemic, respectively. The time between admission to the hospital and the surgical procedure was significantly shorter in the current pandemic period (70.93 vs. 42.29) (p=<0.001). The patients with greater severity (Parkland 5) was the same before and during pandemic (29%). Conclusion. Similar clinical and surgical severity is reported before and during the COVID 19 pandemic, probably secondary to the results of a significantly shorter entry time to the operating room during the pandemic, due to a greater availability of operating rooms for urgent surgical pathologies. © 2022, Asociacion Colombiana de Cirugia. All rights reserved.

Loneliness, Anxiety, Depression, and Adoption of the Role of Caregiver of Older Adults with Chronic Diseases during COVID-19

Objective: To determine the effect of loneliness, anxiety, and depression on adopting the role of caregiver of older adults with chronic conditions in a sample of Mexican caregivers during the COVID-19 pandemic. Materials and method: Predictive and correlational design. The study was conducted with 157 caregivers through the dyad characterization scale, the HADS scale, the UCLA scale, and the Caregiver role adoption scale. The analysis used descriptive and inferential statistics. Results: Most participants were female, with a mean care time of seven months. Mostly, the caregivers have anxiety as a clinical problem (27 %), doubtful depression (14.9 %), profound loneliness (66.2 %), and satisfactory adoption of the role (71.2 %). We found that the more significant the role of adoption, the lower the anxiety, depression, and loneliness levels (p <.05). The psychosocial factors, the age of the person cared for, the age of the informal caregiver, and the care time explained 36 % of the variance in role adoption (F = 13.12;p <.01), with loneliness as a predictive variable. Conclusion: The COVID-19 pandemic has impacted the caregivers’ mental health and caused profound loneliness, the latter being a predictor for adopting the role. © 2022, Universidad de La Sabana. All rights reserved.

COVID-19 coronavirus: More than just a lung disease: what it is and what we know about the link with the cardiovascular system

Infection due to SARS-CoV2 is a pandemic. It is believed that the first case occurred on 8 December 2019 in Hubei province in China, although it was later indicated that the first laboratory-confirmed case occurred on 1 December 2019 due to the presence of an outbreak of suspected pneumonia in 59 patients in a shellfish market in Wuhan. It not only caused a respiratory disease, it often compromised the cardiovascular system since it produces a myocardial lesion, myocarditis, and, less often, increased the decompensation of pre-established cardiovascular diseases. An attempt is made in this article to elucidate the cardiovascular component presented in the current literature, and to suggest some steps to follow in patients with these diseases in accordance with the current evidence.

Mechanical ventilator as a shared resource for the COVID-19 pandemic

COVID-19, the causative agent of which is a new type of coronavirus called SARS-CoV-2, has caused the most severe pandemic in the last 100 years. The condition is mainly respiratory, and up to 5% of patients develop critical illness, a situation that has put enormous pressure on the health systems of affected countries. A high demand for care has mainly been observed in intensive care units and critical care resources, which is why the need to redistribute resources in critical medicine emerged, with an emphasis on distributive justice, which establishes the provision of care to the largest number of people and saving the largest number of lives. One principle lies in allocating resources to patients with higher life expectancy. Mechanical ventilator has been assumed to be an indivisible asset;however, simultaneous mechanical ventilation to more than one patient with COVID-19 is technically possible. Ventilator sharing is not without risks, but the principles of beneficence, non-maleficence and justice prevail. According to distributive justice, being a divisible resource, mechanical ventilator can be shared;however, we should ask ourselves if this action is ethically correct.

COVID 19 comprehensive management in a regional hospital of northwestern Spain

Introduction: The COVID-19 pandemic has brought about a paradigm shift in healthcare.