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COVID-19 is a severe immunosuppressive disease that can cause changes in the clinical course of autoimmune diseases. Autoimmune thyroiditis (AIT) is no exception. It is relevant to study the features of the clinical course of existing AIT in the post-COVID-19 period. The work aims to study the changes in the structure and function of the thyroid in patients with AIT with subclinical and manifest compensated hypothyroidism who had moderate COVID-19. A total of 123 patients aged 21-49 with AIT with subclinical hypothyroidism - 43 (group 1, 12 of whom had moderate COVID-19) and manifest hypothyroidism in the stage of medical compensation - 80 (group 2, 32 of whom had moderate COVID-19). The duration of AIT ranged from 4 to 13 years. In all cases, upon inclusion in the study and 2 and 6 months after it, changes in the structure of the thyroid gland were studied according to ultrasound data, as well as its functional capacity and the degree of compensation of hypothyroidism according to the thyroid-stimulating hormone indicator. In all patients with AIT, COVID-19 caused the progression of structural changes in the thyroid within one of two variants of the ultrasound picture of thyroiditis - hypoechoic heterogeneous or pseudo micronodular. The hormone-producing function also changed: in 7 out of 12 patients of group 1 of the main subgroup, hypothyroidism changed from subclinical to manifest hypothyroidism in the postoperative period, and in all patients of group 2 of the main subgroup, a further decrease in hormone synthesis was noted. In the post-COVID-19 period, patients with AIT undergo a progression of structural changes in the thyroid gland and a decrease in the synthesis of thyroid hormones.Copyright © 2023 The Authors.
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BACKGROUND: Many early signs of Surgical Site Infection (SSI) developed during the first thirty days after discharge remain inadequately recognized by patients. Hence, it is important to use interactive technologies for patient support in these times. It helps to diminish unnecessary exposure and in-person outpatient visits. Therefore, this study aims to develop a follow-up system for remote monitoring of SSIs in abdominal surgeries. MATERIAL AND METHODS: This pilot study was carried out in two phases including development and pilot test of the system. First, the main requirements of the system were extracted through a literature review and exploration of the specific needs of abdominal surgery patients in the post-discharge period. Next extracted data was validated according to the agreement level of 30 clinical experts by the Delphi method. After confirming the conceptual model and the primary prototype, the system was designed. In the pilot test phase, the usability of the system was qualitatively and quantitatively evaluated by the participation of patients and clinicians. RESULTS: The general architecture of the system consists of a mobile application as a patient portal and a web-based platform for patient remote monitoring and 30-day follow-up by the healthcare provider. Application has a wide range of functionalities including collecting surgery-related documents, and regular assessment of self-reported symptoms via systematic tele-visits based on predetermined indexes and wound images. The risk-based models embedded in the database included a minimum set with 13 rules derived from the incidence, frequency, and severity of SSI-related symptoms. Accordingly, alerts were generated and displayed via notifications and flagged items on clinicians' dashboards. In the pilot test phase, out of five scheduled tele-visits, 11 (of 13) patients (85%), completed at least two visits. The nurse-centered support was very helpful in the recovery stage. Finally, the result of a pilot usability evaluation showed users' satisfaction and willingness to use the system. CONCLUSION: Implementing a telemonitoring system is potentially feasible and acceptable. Applying this system as part of routine postoperative care management can provide positive effects and outcomes, especially in the era of coronavirus disease when more willingness to telecare service is considered.
Subject(s)
Mobile Applications , Telemedicine , Humans , Patient Discharge , Pilot Projects , Aftercare , Surgical Wound Infection/epidemiology , Surgical Wound Infection/prevention & controlABSTRACT
Postoperative respiratory failure is a significant cause of morbidity and mortality. Early identification of patients at moderate to high risk of postoperative respiratory failure is critical to effective prevention strategies. A multi-disciplinary team developed a robust process for the early identification of at-risk patients and the prevention of respiratory failure in the perioperative setting.
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Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, including coronary artery bypass grafting, which has great clinical and economic importance for the healthcare system. Despite the improvement of surgical tactics, anesthetic and care benefits, POAF incidence has been increasing over the past decade. The mechanisms of POAF are different. Chronic coronary artery disease and its frequent comorbidities such as arterial hypertension, obesity, diabetes mellitus and heart failure, - are associated with various structural and functional changes in the heart, contributing to electrical atrial remodeling. Today, such risk factors for POAF as age, enlarged left atrium, post heart valve surgery, and obesity are well known. A new coronovirus infection that occurred in the early postoperative period can also be a trigger for atrial fibrillation. Postoperative arrhythmias can worsen both hospital and long-term results of treatment, increase the length of the patient's stay in the hospital, and the risk of complications. This review updates the data on the pathogenesis, incidence and complications of POAF, taking into account the current epidemiological situation.Copyright © 2022 Authors. All rights reserved.
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Background: Iatrogenic coronary artery dissection during diagnostic or therapeutic catheterization is a rare and mortal complication that may result in a newly developed myocardial infarction. In this study, we aimed to share the results of CABG treatment of patients with iatrogenic coronary artery dissection after coronary angiography (CAG) in our clinic. Method(s): All patients who underwent CAG or percutaneous coronary intervention (PCI) in our hospital between January 2014 and December 2021 were analyzed retrospectively and patients who underwent CABG after iatrogenic coronary artery dissection were included in the study. The dissection classification was achived according to the National Heart, Lung and Blood Institute (NHLBI) classification. Result(s): During the eight years, CAG was applied to 20,398 patients and PCI to 9583 patients. Needed to treat CABG in iatrogenic coronary artery dissection developed in 17 of the patients (0.06%). LMCA was dissected in 6 (35.3%) patients and LAD in 6 (35.3%), CX in 2 (11.8%) and RCA dissection in 3 (17.6%). 3 patients (17.6%) had an intubation time longer than 48 hours. One of them has recently had a COVID infection. Another was suffering from pulmonary edema. The other patient died on the 4th postoperative day due to low cardiac output. The length of stay in the intensive care unit was 2 (min: 1 - max: 13) days. The hospital stay was 6 (min: 4 - max: 20) days. Conclusion(s): The development of a critical clinical condition prior to surgery is strongly associated with a higher probability of early and late postoperative death. For this reason, it is clear that the treatments applied at every stage of the pre-, per-, and postoperative period are the most important determinants of the results.Copyright © 2023, CKS.
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Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital condition, characterized by multiple venous malformations that may involve any organ system, most commonly the skin or the gastrointestinal tract. These lesions are often responsible for chronic blood loss and secondary anemia, and in rare situations may cause severe complications such as intussusception, volvulus, and intestinal infarction. Intussusception as a complication of BRBNS, although a known complication of the disease, has rarely been reported, especially in the Philippines. In the Philippine Society for Orphan Disorders, only 2 cases of BRBNS are currently included in the organization, including the patient presented in the case report. The treatment of BRBNS that involves the gastrointestinal tract depends on the extent of intestinal involvement and severity of the disease. The treatment aims to preserve the GI tract as much as possible due to the high recurrence in the disease. In this case report, we present a 13 year-old male with BRBNS with previous history of intussusception, successfully managed conservatively;however, upon recurrence, underwent exploratory laparotomy wherein a subcentimeter perforation in the antimesenteric border of the proximal ileum was noted, together with a gangrenous intussuscipiens, and multiple mulberry-like formations on the antimesenteric border of the small bowels. Histopathological findings of the resected bowels showed multiple cavernous hemangiomas consistent with BRBNS. The postoperative course of the patient was unremarkable.Copyright © 2023 The Authors
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Objective: Coronavirus disease-2019 (COVID-19), caused by a novel coronavirus, has become a worldwide pandemic. In order to control the global spread of this contagious disease, elective surgeries including cardiac and vascular procedures were postponed. In this article we present our experience during the initial phase of the pandemic in view of safety protocols. Material(s) and Method(s): The study included all elective, urgent, and emergent procedures that were performed from March 11, 2020 to June 30, 2021 at the department of cardiovascular surgery. Patients' demographics, preoperative COVID-19 (reverse transcription-polymerase chain reaction) test results, surgical procedures, complications and outcomes were prospectively collected. We also developed our own protocol to proceed with our surgical activity without delay. Result(s): A total of 86 cardiac and vascular procedures were performed during the study period. The median age was 64 years (range 23-79), 59 (69%) were males. There were 42 (48%) elective procedures, and 13 (15%) patients had emergency procedures. 57 (66%) patients underwent coronary artery bypass graft surgery. 10 (12%) patients underwent valvular procedures. Peripheral vascular surgeries were performed in 18 (21%) patients. The median length of stay in the hospital was 9 days (range 1-60). A positive COVID-19 test was identified in 4 patients, two of them were detected in the immediate postoperative period and died. In-hospital mortality was 9%. Conclusion(s): Cardiovascular procedures could be performed safely with a relatively low risk during the outbreak, particularly for elective patients with proper management and strict infection control and isolation protocols.Copyright © 2022 by Turkiye Klinikleri.
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Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.
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The COVID-19 pandemic strongly affected organ procurement and transplantation in France, despite the intense efforts of all participants in this domain. In 2020, the identification and procurement of deceased donors fell by 12% and 21% respectively, compared with the mean of the preceding 2 years. Similarly, the number of new registrations on the national waiting list declined by 12% and the number of transplants by 24%. The 3-month cumulative incidence of death or drop out for worsening condition of patients awaiting a liver transplant was significantly greater in 2020 compared to the previous 2 years. Continuous monitoring at the national level of early post-transplant outcomes showed no deterioration for any organ in 2020. At the end of 2020, less than 1% of transplant candidates and less than 1% of graft recipients - of any organ - had died of COVID-19.Copyright © 2021 The Author(s)
ABSTRACT
Immune changes arising against the background of COVID-19 can lead to the manifestation of autoimmune diseases and provoke the development of Crohn's disease. In the presented work, we describe two clinical cases of manifestation of Crohn's disease in children after suffering a novel coronavirus infection COVID-19. Moreover, the variant of manifestation in both cases was spilled purulent appendicular peritonitis. In the first case, the child underwent a traditional appendectomy and abdominal sanitation. However, the choice of traditional appendectomy in this version of the pathological process led to severe consequences for the patient (a complicated postoperative period and multiple surgical interventions), including for the formed intraperitoneal abscesses and intestinal fistula, which is most characteristic of Crohn's disease. Therefore, the patient was diagnosed with Crohn's disease only after numerous operations. Regarding the second case, the situation was completely different, despite the obvious manifestations of ARVI (sore throat, fever), which led to the belated diagnosis of appendicitis in this child. Laparoscopic appendectomy and simultaneous adequate abdominal sanitation made it possible to avoid repeated surgical interventions in this case. In both cases, patients at the diagnosis were sent to federal clinics to select specific therapy. In our opinion, it is worth paying close attention to pediatric patients with a novel coronavirus infection and abdominal pain syndrome since this may be onset of inflammatory bowel disease.Copyright © 2022, Dynasty Publishing House. All rights reserved.
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Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness; atrial fibrillation may be detected or managed for the first time during acute hospitalization for another condition. Atrial fibrillation after cardiothoracic surgery is a distinct type of acute atrial fibrillation. Acute atrial fibrillation is associated with high risk of long-term atrial fibrillation recurrence, warranting clinical attention during acute hospitalization and over long-term follow-up. A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation. Acute management requires a multipronged approach with interdisciplinary care collaboration, tailoring treatments to the patient's underlying substrate and acute condition. Key components of acute management include identification and treatment of triggers, selection and implementation of rate/rhythm control, and management of anticoagulation. Acute rate or rhythm control strategy should be individualized with consideration of the patient's capacity to tolerate rapid rates or atrioventricular dyssynchrony, and the patient's ability to tolerate the risk of the therapeutic strategy. Given the high risks of atrial fibrillation recurrence in patients with acute atrial fibrillation, clinical follow-up and heart rhythm monitoring are warranted. Long-term management is guided by patient substrate, with implications for intensity of heart rhythm monitoring, anticoagulation, and considerations for rhythm management strategies. Overall management of acute atrial fibrillation addresses substrates and triggers. The 3As of acute management are acute triggers, atrial fibrillation rate/rhythm management, and anticoagulation. The 2As and 2Ms of long-term management include monitoring of heart rhythm and modification of lifestyle and risk factors, in addition to considerations for atrial fibrillation rate/rhythm management and anticoagulation. Several gaps in knowledge related to acute atrial fibrillation exist and warrant future research.
Subject(s)
Atrial Fibrillation , Humans , Atrial Fibrillation/diagnosis , Atrial Fibrillation/epidemiology , Atrial Fibrillation/therapy , American Heart Association , Anti-Arrhythmia Agents/therapeutic use , Anticoagulants/therapeutic use , Anticoagulants/pharmacology , Hospitalization , Heart RateABSTRACT
The novel coronavirus (severe acute respiratory syndrome coronavirus;SARS-CoV-2) has spread out to most of the world with the World Health Organization (WHO) classifying it as a global pandemic. There exists very little information on the infectious course of COVID- 19 in immunocompromised individuals, including transplant recipients. We report a case of a young adult who tested positive for SARS-CoV-2 in the immediate post-operative period following renal transplantation.
ABSTRACT
Aim: There are data showing that the use of minimally invasive anesthesia methods (local anesthesia, nerve blocks) as an alternative to traditional anesthesia methods used in inguinal hernia repair surgery is safe and effective. During the COVID-19 pandemic, which affected the whole world, we aimed to evaluate the use of minimally invasive anesthesia methods in patients with inguinal bladder hernia, as well as their perioperative and postoperative results in our pilot study. Material(s) and Method(s): We evaluated the perioperative and postoperative data of five patients with inguinal bladder hernia, who underwent surgery with local anesthesia and ilioinguinal/iliohypogastric nerve blockade, four of which were performed during the COVID-19 pandemic. Result(s): It is possible to perform inguinal bladder hernia surgery with local anesthesia and ilioinguinal/iliohypogastric nerve block, including in secondary cases. Better hemodynamic stabilization in the intraoperative period reduces the need for narcotic analgesics by providing effective analgesia in the postoperative period, as well as reducing the risk of contamination in airway control. Discussion(s): Performing inguinal bladder hernia surgery using local anesthesia and ilioinguinal/iliohypogastric nerve block provides reliable and effective analgesia during the perioperative and postoperative periods.Copyright © 2023, Derman Medical Publishing. All rights reserved.
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Introduction: During the first year of coronavirus disease (COVID)-19 outbreak, kidney transplant programs were suspended in several countries in the World. Republic of Belarus did not suspend organ transplant program carefully weighed the risks and benefits of pursuing or postponing kidney transplantation. In cooperation with national-level efforts, our transplant program adopted universal donor and recipient screening using reverse transcriptase polymerase chain reaction for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) with or without chest CT scans before kidney transplantation. Thus, national kidney transplant activities in Republic of Belarus remained stable for both living and deceased donor transplantation compared with the same period during the previous year. The objective was to study the safety of kidney transplantation, the incidence of COVID-19 disease in kidney transplant patients and medical care providing for transplanted patients during this pandemic period. Method(s): A retrospective review of all patients who had received a kidney transplant at State Institution "Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology" in Minsk, Republic of Belarus was performed from January 2020 to November 2022. Result(s): Dynamics of kidney transplantations number, clinical data of recipients during 3 years Covid-19 pandemic compared with the previous year are presented in table 1. The rate of infection in early postoperative period was low: 1,1% (2020), 0,5% (2021) and 0% (November 2022). In case of SARS-CoV2 infection modifications of immunosuppression (IS) therapy were based on the clinical conditions. For asymptomatic patients "wait and see approach" was mostly used;a suspension of antimetabolites drugs was adopted in the majority of patients with symptomatic COVID-19 infections. For CNIs, withdrawal was the preferred choice in severely symptomatic patients. A discontinuation of all IS drugs was used only in severely symptomatic COVID-19 patients on invasive mechanical ventilation. Since 2022 we started to use remdesivir in recipients with symptomatic course of disease with positive results. [Formula presented] From the middle of 2021 we commenced specific vaccination among transplanted patients. Most widely available vaccines in Belarus were CoronaVac (Sinovac Life Sciences, Beijing, China) and Gam-COVID-Vac (Gamaleya Research Institute of Epidemiology and Microbiology, Russia). There were no revealed any adverse effects of vaccination among our group. Conclusion(s): In our experience, the current kidney transplant program seems viable and safe, even during periods of health emergencies. No conflict of interestCopyright © 2023
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The outbreak of coronavirus disease 2019 (COVID-19) affects the world. It is highly contagious and spreads quickly. COVID-19 severely increases the medical burden and interferes with our normal work. This article introduces our experience on treat oral cancer patients during the epidemic. The negative impact can be minimized through reasonable and orderly arrangement.Copyright © 2021 The Authors
ABSTRACT
Immune changes arising against the background of COVID-19 can lead to the manifestation of autoimmune diseases and provoke the development of Crohn's disease. In the presented work, we describe two clinical cases of manifestation of Crohn's disease in children after suffering a novel coronavirus infection COVID-19. Moreover, the variant of manifestation in both cases was spilled purulent appendicular peritonitis. In the first case, the child underwent a traditional appendectomy and abdominal sanitation. However, the choice of traditional appendectomy in this version of the pathological process led to severe consequences for the patient (a complicated postoperative period and multiple surgical interventions), including for the formed intraperitoneal abscesses and intestinal fistula, which is most characteristic of Crohn's disease. Therefore, the patient was diagnosed with Crohn's disease only after numerous operations. Regarding the second case, the situation was completely different, despite the obvious manifestations of ARVI (sore throat, fever), which led to the belated diagnosis of appendicitis in this child. Laparoscopic appendectomy and simultaneous adequate abdominal sanitation made it possible to avoid repeated surgical interventions in this case. In both cases, patients at the diagnosis were sent to federal clinics to select specific therapy. In our opinion, it is worth paying close attention to pediatric patients with a novel coronavirus infection and abdominal pain syndrome since this may be onset of inflammatory bowel disease.Copyright © 2022, Dynasty Publishing House. All rights reserved.
ABSTRACT
Immune changes arising against the background of COVID-19 can lead to the manifestation of autoimmune diseases and provoke the development of Crohn's disease. In the presented work, we describe two clinical cases of manifestation of Crohn's disease in children after suffering a novel coronavirus infection COVID-19. Moreover, the variant of manifestation in both cases was spilled purulent appendicular peritonitis. In the first case, the child underwent a traditional appendectomy and abdominal sanitation. However, the choice of traditional appendectomy in this version of the pathological process led to severe consequences for the patient (a complicated postoperative period and multiple surgical interventions), including for the formed intraperitoneal abscesses and intestinal fistula, which is most characteristic of Crohn's disease. Therefore, the patient was diagnosed with Crohn's disease only after numerous operations. Regarding the second case, the situation was completely different, despite the obvious manifestations of ARVI (sore throat, fever), which led to the belated diagnosis of appendicitis in this child. Laparoscopic appendectomy and simultaneous adequate abdominal sanitation made it possible to avoid repeated surgical interventions in this case. In both cases, patients at the diagnosis were sent to federal clinics to select specific therapy. In our opinion, it is worth paying close attention to pediatric patients with a novel coronavirus infection and abdominal pain syndrome since this may be onset of inflammatory bowel disease.Copyright © 2022, Dynasty Publishing House. All rights reserved.
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Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a syndrome that resembles to heparin-induced thrombocytopenia (HIT). Platelet factor 4 (PF-4) reacts to a vaccine component resulting formation of immune complex that stimulates an autoimmune reaction triggering platelet consumption causing thrombus formation and producing thrombotic events. When suspected is important to confirm for make a correct anticoagulation management to avoid complications related to unfractioned and low weight heparins use. In this report we describe a case of acute limb ischemia secondary to ChAdOx1 nCoV-19 vaccine (Astrazeneca, Cambridge, UK)Copyright © 2022
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Maintaining reduction of a calcaneal tuberosity avulsion fracture is challenged by the powerful force exerted upon the bone fragment by the Achilles tendon. Low-demand, elderly patients with osteoporotic bone usually undergo a low-energy mechanism when this fracture pattern occurs. Likely attributable to poor bone quality, the rate of early fixation failure has been documented to be as high as 40%. We present the cases of two 65-year-old female patients who each sustained a calcaneal tuberosity avulsion fracture. Both patients underwent a low-energy mechanism of injury and had a medical history of many comorbidities. The first patient underwent a partial calcaneal ostectomy and tenotomy after failing open reduction internal fixation (ORIF). The second patient primarily underwent a partial calcaneal ostectomy and tenotomy. Postoperatively, after the incision site was fairly healed, both patients could bear weight as tolerated. This method of excision and release may allow for decreased risk of skin compromise and return trips to the operating room for failed ORIF. In low-demand patients with low-energy calcaneal avulsion type fractures and osteoporotic bone, this technique may be the preferred surgical option.Copyright © 2022 The Author(s)