ABSTRACT
Background The use of spinal anaesthesia (SA) for retrograde uretero-renoscopic surgery is considered to be not as effective as a general anaesthetic (GA) by urologists. However, there were significant concerns associated with GA both for the patient and the anaesthetic team at the height of the COVID-19 pandemic. Our unit was able to successfully transfer surgery to a purpose-built day facility that had extensive experience in delivering SA. This created the opportunity to assess the SA technique in uretero-renoscopy in a cohort of unselected patients. Objective To assess the feasibility of SA as a primary form of anaesthetic for retrograde endoluminal renal and ure-teric surgery. Results Over 4 months, 41 ureteroscopic procedures were performed. The conversion rate to GA (for inadequate analgesia) was 9.8%. Surgical outcome data were compared with an equivalent cohort of patients’ who underwent GA before the pandemic. Both groups had similar outcomes: day-case discharge rate (SA 84%, GA 86%) and surgical completion rate (SA 94%, GA 90%). However, there was a difference in postoperative readmission rate (SA 8%, GA 22%) favouring SA. Conclusions This observational study demonstrated that SA is a safe and effective form of anaesthesia for uretero-renoscopic surgery, delivering non-inferior outcomes to GA. This has implications for the immediate provision of care as COVID-19 continues and as an alternative anaesthetic option to suit patients post pandemic. A larger prospective observational study would be appropriate to clearly define the benefits of SA for ureteroscopy.
ABSTRACT
Background. Patients with hand eczema account for 30–40% of dermatological patients. With the pandemic of new coronavirus infection COVID-19 and the need for frequent antiseptics use, there has been a steady increase in hand eczema incidence. The dominant symptoms in exacerbating eczema are skin inflammation and itching, which requires effective and safe skincare that is effective and safe. Objective. To evaluate the efficacy of the therapy with synthetic tannin and polidocanol-based agents and modern emollients, the time of resolution and degree of severity of clinical symptoms of eczema in patients, as well as the time and duration of remission, safety and compliance with sodium hypochlorite hand antiseptic spray. Materials and methods. Thirty-four patients with exacerbation of hand eczema were examined. The study was conducted in two stages. At the stage 1, before the remission, the patients received synthetic tannin and polidocanol-based agents and modern emollients;at the stage 2, monotherapy with modern emollients was used. Patients used sodium hypochlorite spray as a hand sanitizer throughout the study period. Results. The NESCI score became zero in 33 (96%) patients after the complex treatment of hand eczema. The Dermatology Life Quality Index by the end of stage 2 decreased 6-fold compared to the beginning of the study. No exacerbation of the dermatosis was observed in any of the patients included in the study during the use of sodium hypochlorite hand spray. Conclusion. The complex therapy with synthetic tannin, polidocanol-based agents, and modern emollients in hand eczema helps to achieve stable medical remission, decreases the itching intensity, and improves the patients’ quality of life. The use of new hand sanitizers during the pandemic in patients with hand eczema did not result in dermatosis exacerbations.
ABSTRACT
Background: Vaccines represent an efficient means to control the pandemic of Coronavirus Disease 2019 (COVID-19). Two mRNA-based emergency vaccines have recently been licensed for mass administration: BNT162b2 and mRNA-1273 COVID-19 vaccine. Delayed hypersensitivity reactions these new vaccines can range widely from localized skin symptoms to disseminated exanthemas. Locally confined reactions can be caused by the active component or the excipients in the vaccine. Both mRNA vaccines contain polyethylene glycol (PEG) 2000 lipid conjugate as excipient. PEG and its derivatives with clinical cross-reactivity (polysorbates, laureth-9) are ubiquitous in many drugs. The mRNA-1273 COVID-19 vaccine also contains trometamol, an organic amine used extensively. Method: We reported a series of 14 patients referred to our Allergy Department with suspected delayed large local reactions (DLLR): erythematous and edematous plaques ≥10 cm in diameter accompanied by pain or pruritus, after the administration of BNT162b2 or mRNA-1273 COVID-19 vaccine between January to February 2021. We describe cutaneous manifestations,latency time, treatment and duration of the lesions. We performed patch test in the upper back with PEG 400 1% in petrolatum (pet), PEG 3350 10% pet, PEG 3350 in aqueous solution (aq), PEG 4000 10% pet, polysorbate 80 1% pet, polysorbate 80 10% pet, laureth-9/ sodium lauril sulphate 1%, trometamol 0.50% aq (only in mRNA-1273 vaccinated patients), with readings at day 2 and day 4. Results: We collected 14 patients: 13 received mRNA-1273 and only one BNT162b2 COVID-19 vaccine. Most patients (13/14) reacted to the first dose. 42.9% had detectable serum specific IgG antibodies against SARS-CoV-2 in the last 3 months. The mean size of DLLR was 11.9 ± 1.6 cm and the latency time was 4.4 ± 1.8 days. Ten patients (71.4%) not receive any treatment, and four (28.6%) received topical corticosteroids. The mean duration of the reactions was 4.75 ± 2.7 days when treated and 4.5 ± 0.60 days without treatment, with no significant differences (p = 0.79). All patients completed vaccination with the second dose and 69.2% developed DLLR again. PT were negative in the 100% cases Conclusion: We didn't found any sensitization to excipients in our 14 cases series. We thought that DLLR may occur due to a non-specific inflammatory response or represent the normal immune response to the vaccination, and in our experience, this should not be a contraindication to receive further doses of mRNA vaccines.
ABSTRACT
Background: Vaccination has become increasingly relevant to prevent the global pandemic from coronavirus disease 2019 (COVID-19). Two mRNA-based emergency vaccines have recently been licensed for mass administration: BNT162b2 and mRNA-1273 COVID-19 vaccine. Delayed vaccines hypersensitivity reactions can be caused by residual proteins, or most frequently by excipients. Both mRNA vaccines contain polyethylene glycol (PEG) 2000 lipid conjugate as excipient. PEG and its derivatives with clinical cross-reactivity (polysorbates, laureth-9) are ubiquitous in many drugs. mRNA-1273 COVID-19 vaccine also contains trometamol, an organic amine used extensively. Method: We collected the patients referred to our Allergy Department with systemic skin delayed reaction after the administration of BNT162b2 or mRNA-1273 COVID-19 vaccine between January to February 2021. We recorded age, sex, personal history of allergies and previous SARS-CoV-2 infection. We describe cutaneous manifestations, latency time, treatment, and duration. We performed patch test (PT) in the upper back with PEG 400 1% in petrolatum (pet), PEG 3350 10% pet, PEG 3350 in aqueous solution (aq), PEG 4000 10% pet, polysorbate 80 1% pet, polysorbate 80 10% pet, laureth-9/ sodium lauril sulphate 1%, trometamol 0.50% aq (only in mRNA-1273 vaccinated patients), with readings at day 2 and day 4. Results: The study population comprised 11 patients: 6 (54.5%) received BNT162b2 and the rest received mRNA-1273 COVID-19 vaccine. Most patients (10/11, 90.9%) reacted to the first dose. Almost half of them (5/11, 45.4%) had detectable serum specific IgG antibodies against SARS-CoV-2 in the last 3 months. The most frequent manifestation was generalized maculopapular exanthema (6/11, 54.5%), 2 flaking palms, 1 acute generalized exanthematous pustulosis (AGEP), 1 micropapular exanthema accompanied by a 7-centimeter blister, and 1 multiple fixed drug eruption (MFDE). PT were negative in the 100% cases. We contraindicate the second dose of the vaccine in patients with severe skin reactions (MFDE, AGEP) after the first dose (2/10, 20%). The remaining patients received the second dose, reappearing systemic skin lesions in 1/8 (12.5%), having a maculopapular exanthema again. Conclusion: In our experience, mild exanthemas should not be a contraindication to receive further doses of mRNA vaccines. However, we recommended an exhaustive allergy workout in all patients with systemic skin delayed reaction.