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Presentation of a thymoma during pregnancy means that safe delivery becomes more challenging. We present a 33-year-old pregnant woman who was diagnosed with a large thymoma causing marked compression of the tracheobronchial tree and right atrium. After various multidisciplinary meetings she presented for elective caesarean section delivery at 31 weeks of gestation. A combined spinal-epidural anaesthesia was performed, along with colloid pre-and co-loading, and vasopressor support. The delivery was uneventful. The possibility of catastrophic complications was foreseen. Therefore, all requirements for the possibility of airway or haemodynamic collapse were planned carefully, including the possibility of emergent cardiopulmonary bypass.Copyright © 2023, College of Anaesthesiologists of Sri Lanka. All rights reserved.
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Objective: This study aims at comparing the patients with spinal trauma in the Coronavirus disease-2019 pandemic era and pre-pandemic era. Materials and Methods: Patient records for a 9-month period of pandemic (April 1, 2020 - December 31, 2020) and the same period of the previous year (April 1, 2019 - December 31, 2019) were retrospectively collected. These 2 periods were compared in terms of the total number of patients with spinal trauma, the type of injuries, the level of injuries in the spine, the treatment methods applied, and whether there was a neurological deficit. The first group was called as pandemic group (PG) and the latter as control group (CG). The differences between them were statistically examined. Results: The study sampled 278 patients (CG: 203 patients, PG: 75 patients). It was detected that the number of patients with spinal trauma in the PG dropped by 60% compared to the CG. The most frequent cause of spinal trauma for both groups was traffic accidents. No statistically significant difference was detected in terms of the type, level and severity of injuries, neurological examination findings and method of treatment (p>0.05). However, the rate of indoor or outdoor falls were significantly different between the two groups (p=0.002). Conclusion: It has been determined that the pandemic-induced social isolation and lockdown process is an important factor in the primordial prevention of spinal trauma. With the result obtained, we think that if adequate and correct measures are taken, the number of spinal traumas will continue to remain low in the post-pandemic period as well. © Copyright 2022 by the Turkish Spine Society/The Journal of Turkish Spinal Surgery published by Galenos Publishing House.
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Introduction: Effective spinal anaesthesia for caesarean delivery (CD) is assumed to cause bilateral sympathetic blockade with increased feet skin temperature due to vasodilatation [1]. There has been no published study of peripheral skin temperature measurements during spinal anaesthesia for CD. Our study investigated foot skin temperature changes as spinal anaesthesia was established. Method(s): A single centre, prospective observational study with ethics committee approval (IRAS No. 263967). With informed consent, 60 healthy parturients, 37-42 weeks' gestation with singleton pregnancy scheduled for category 4 CD with spinal anaesthesia were recruited. Standard spinal anaesthesia used 0.5% hyperbaric bupivacaine and diamorphine with IV Phenylephrine and fluids. Skin temperature was measured on the dorsum of both feet with Covidien Mon-a-Therm© skin thermistor sensors prior to intrathecal injection and every minute after until completion of surgery. Theatre room temperature and ambient temperature under surgical drapes were recorded. Two controls were recruited. Result(s): All participants had successful spinal anaesthesia. The Figure shows mean (95% CI) skin temperature changes of both feet of participants during spinal anaesthesia and for controls. The maximum rate of skin temperature increase occurred 5-12 minutes after spinal injection with temperature change plateauing after 30 mins. The mean temperature range was 5.54degreeC (min = 29.7degreeC;max = 35.2degreeC). Discussion(s): This study characterises for the first time the peripheral temperature changes in the feet that occur with sympathetic block after spinal anaesthesia in parturients. Increased bilateral foot skin temperatures occur within 10 minutes of spinal injection. This may be useful for determining successful spinal anaesthesia for CD in addition to other assessments [2]. The insights may be useful for assessing epidural analgesia. The study was supported by an OAA research grant. Data collected by ROAR group.Copyright © 2023 Elsevier Ltd
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Introduction: Diabetic peripheral neuropathy (DPN) is the most common neuropathic syndrome seen in patients with diabetes. Roughly 30% of the diabetes patient population1 experience painful DPN symptoms including bilateral stabbing or burning pain in addition to numbness in the feet and lower legs. Traditionally painful DPN symptoms have been treated with conventional medical management (CMM) including glycemic control, general risk factor management, as well as pharmaceutical agents. These treatment approaches are often unsuccessful in the long-term1. Spinal cord stimulation (SCS) has been demonstrated as an effective treatment for painful DPN of the lower extremities with multiple publications dating back to 1996 showing benefits of SCS for pain relief and improved Quality of Life (QoL) in DPN patients (Figure 1)2-18. Method(s): A systematic literature review of the robust body of evidence for SCS in the treatment of painful DPN was conducted. Publications were selected for inclusion by two independent reviewers using defined selection criteria. Additional relevant publications from outside the search dates were included. Result(s): SCS was first documented as an effective treatment for DPN in three single-arm studies published between 1996 and 20122,4,5, one of which was followed-up to thirty-six months18, and another to seven-years3. These studies paved the way for two RCTs published in 20146,7, one of which was followed-up to five-years in two publications8,10, and another7 was followed-up with analyses on QoL9 and an evaluation of the effects of burst SCS17. Two meta-analyses were published in 2020 and 202111,12. A post-hoc analysis of a multi-center single-arm study on high frequency (10kHz) SCS to treat DPN was published in 202013 and followed by an RCT published in 202114 with additional 1-year follow-up15,16. Collectively these studies demonstrate that SCS is an effective therapy for patients with painful DPN by reducing pain and increasing QoL for DPN patients (Figure 1). Conclusion(s): This review of a large body of evidence shows a decades-long history of the effectiveness of SCS for symptom relief in patients suffering from painful DPN. Future research on the effectiveness of new waveforms and novel methods of energy delivery to the spinal cord are needed. The study of outcomes in addition to pain relief is also needed, which may better illustrate the breadth of effects of SCS therapy on the underlying disease factors. Increasing awareness of the current evidence is essential to increasing therapy adoption by expanding payer support and influencing referring health care provider behavior. Disclosure: Eric Grigsby, MD: AE Mann Foundation: Consulting Fee: Self, Bioness Inc.: Consulting Fee: Self, Medallion Therapeutics: Consulting Fee: Self, Medtronic: Consulting Fee: Self, SPR Therapeutics: Consultant: Self, Tenex Health: Consultant: Self, Voyager Therapeutics: Consultant: Self, Xalud: Consulting Fee: Self, AE Mann Foundation: Consulting Fee: Self, Medallion Therapeutics: Consulting Fee: Self, Bioness Inc.: N/A: Self, Medallion Therapeutics: N/A: Self, SPR Therapeutics: N/A: Self, Abbott / St. Jude Medical: N/A: Self, Tenex: N/A: Self, Vertos: N/A: Self, Xalud: N/A: Self, AE Mann Foundation: Consulting Fee: Self, Bioness Inc.: Consulting Fee: Self, Medtronic, Inc.: N/A: Self, Collegium Pharmaceutical, Inc.: Trustee: Self, Flowonix Medical: Served on speakers' bureau: Self, Jazz Pharmaceuticals: Served on speakers' bureau: Self, Jazz Pharmaceuticals: Trustee: Self, Spinal Restoration, Inc.: Trustee: Self, Jazz Pharmaceuticals: N/A: Self, Alfred Mann Foundation: N/A: Self, Boston Scientific: N/A: Self, CNS Therapeutics: N/A: Self, Collegium Pharmaceutical, Inc.: N/A: Self, Flowonix Medical: N/A: Self, Jazz Pharmaceuticals: N/A: Self, Medtronic, Inc.: N/A: Self, Myoscience: N/A: Self, NeurAxon Inc.: N/A: Self, Spinal Restoration, Inc.: N/A: Self, St. Jude Medical, Inc.: N/A: Self, Abbott Laboratories: Consultant: Self, Alfred Mann Foundation: Consulting Fee: Self, Cervel Neurotech, Inc.: Consultant: Self, CNS Therapeutics: Consultant: Self, Covidien: Consultant: Self, Cumberland Pharmaceuticals, Inc.: Consultant: Self, Flowonix Medical: Consultant: Self, Jazz Pharmaceuticals: Consultant: Self, Mainstay Medical: Consultant: Self, Medtronic, Inc.: Consultant: Self, Myoscience: Consultant: Self, NeuroPhage Pharmaceuticals: Consultant: Self, Nevro Corp: Consultant: Self, Palyon: Consultant: Self, Spinal Modulation: Consultant: Self, SPR Therapeutics: Consultant: Self, St. Jude Medical, Inc.: Consultant: Self, Tenex Health, Inc.: Consultant: Self, VertiFlex Inc.: Consultant: Self, Vertos Medical, Inc.: Consultant: Self, Xalud Therapeutics, Inc.: Contracted Research: Self, Medtronic, Inc.: Served on speakers' bureau: Self, Flowonix Medical: Served on advisory board: Self, Medtronic, Inc.: N/A: Self, Jazz Pharmaceuticals: N/A: Self, Medtronic, Inc.: Ownership Interest: Own Stock, Stock Options, Future Stock Options: Self, Nevro Corp: Ownership Interest: Own Stock, Stock Options, Future Stock Options: Self, Rachel Slangen, PhD: None, Lisa Johanek, PhD: Medtronic: Salary/Employee: Self, Maddie LaRue, PHD: Medtronic: Employee:, Cecile de Vos, PhD: None, Melissa Murphy: Medtronic: Consulting Fee:, Relievant: Consulting Fee:Copyright © 2023
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Introduction: Peripartum women are at increased risk for severe illness with coronavirus disease (Covid-19) infection. Recent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies and its long-term effects.1-5 Objective: This case series aimed to observe the clinical course of peripartum women with confirmed Covid-19 admitted to a critical care unit in the North-west of England. Method(s): Since the start of the pandemic, all pregnant women with Covid-19 infection admitted to the critical care unit were monitored and followed up. Demographic profile, medical co-morbidities, treatment received, respiratory support and vaccination status were noted. Result(s): From March 2020 until February 2022, 8 women in our practice were shifted to the critical care unit post-partum in view of worsening work of breathing & increasing oxygen requirement after initial management in the delivery suite. All admissions were during the 3rd wave of the pandemic in the UK, between June to October 2021. 5 patients underwent Caesarean section under spinal anesthesia & 3 were shifted post normal vaginal delivery. Mean age in the study population was 33.25 years (SD +/- 3.99) and mean length of stay in the ICU was 6.62 days (SD +/- 3.99). Only one woman required intubation & mechanical ventilation for 10 days and the rest were managed on High Flow Nasal Cannula (HFNC) or Continuous Positive Airway Pressure (CPAP) hood and self-proning manoeuvres. 50% of the patients received Tocilizumab. All women were discharged home and there were no maternal deaths. Pre- admission none of the women were vaccinated, but on follow up 5 out of the 8 had completed their vaccination. All women were emotionally distraught due to being isolated from their family and new born. When reviewed at 12 weeks, one patient experienced post traumatic stress disorder (PTSD) and one had features of long Covid syndrome. On follow up, all new born babies were doing well. Conclusion(s): From the limited amount of data available, psychological stress was common to all patients. Being isolated from their new-born and family was the most difficult emotional aspect for the mothers in addition to finding it difficult to breathe and uncertainty about the future. Most mothers and new-born babies were discharged from the hospital without any serious complications. However, further observation and long term follow up is imperative. Use of guidelines in peripartum patients will aid in appropriate escalation of care. Key words: COVID-19, Pregnancy, Peri-partum, Long Covid syndrome.
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Objective: COVID-19 lockdowns in 2020 limited activities of daily life. Data on the impact on healthcare systems is ambiguous. So far no data has been published for pediatric neurosurgery in Germany. We present the results of a big data approach. Method(s): We obtained anonymous data from the nationwide database of hospital statistics (German Federal Statistical Office, www. desta tis. de) in August 2022. For the age group <18 years in 2016- 2020, the following diagnoses (ICD-10 code) were analysed: Intracranial injury (S06), malignant (C71), benign (D33) and unspecified (D43) neoplasia, abuse (T74), violent attack (Y09) and, for comparison, forearm fracture (S52). The following operations (OPS code) were chosen: Operation of the central nervous system (CNS, 5-01- 05), excision of intracranial lesion (5-015), shunt insertion (5-023), shunt revision (5-024), plastic operations of the spinal cord (5-036) and, for comparison, overall number of operations (OPS-5), spondylodesis (5-836) and functional neurosurgery (5-028) at all ages. Result(s): The number of operations declined from 17.23 million in 2019 to 15.82 million in 2020 (8.2%). CNS operations declined by 5%. Shunt insertion declined by 8.1%, revision by 5.1% and spinal cord operations by 6.6%, whereas excisions of intracranial lesions increased by 1.7%. Spondylodesis and functional operations both decreased by 11.9%. The hospitalisations for intracranial neoplasia declined by 8.8% compared to previous years. The number of inpatients with intracranial injury declined by 16%. Violent attack was also documented less often (-13.2%), but child abuse increased by 3.3%. Forearm fractures declined by 5.6%. Conclusion(s): The COVID-19 lockdown in 2020 lead to reduction of operations. Neuro-oncological operations were not affected. Intracranial injury even declined by 16%, reflecting limited activities and mobility. An increase in documented child abuse by 3.3% compared to the average of previous years was observed. These results help understand the impact of pandemics and political decisions and guide future decision-making.
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Riluzole is a sodium-glutamate antagonist that attenuates neurodegeneration in amyotrophic lateral sclerosis (ALS). It has shown favorable results in promoting recovery in pre-clinical models of traumatic spinal cord injury (tSCI) and in early phase clinical trials. This study aimed to evaluate the efficacy and safety of riluzole in acute cervical tSCI. An international, multi-center, prospective, randomized, double-blinded, placebo-controlled, adaptive, Phase III trial (NCT01597518) was undertaken. Patients with American Spinal Injury Association Impairment Scale (AIS) A-C, cervical (C4-C8) tSCI, and <12 h from injury were randomized to receive either riluzole, at an oral dose of 100 mg twice per day (BID) for the first 24 h followed by 50 mg BID for the following 13 days, or placebo. The primary efficacy end-point was change in Upper Extremity Motor (UEM) scores at 180 days. The primary efficacy analyses were conducted on an intention to treat (ITT) and completed cases (CC) basis. The study was powered at a planned enrolment of 351 patients. The trial began in October 2013 and was halted by the sponsor on May 2020 (and terminated in April 2021) in the face of the global COVID-19 pandemic. One hundred ninety-three patients (54.9% of the pre-planned enrolment) were randomized with a follow-up rate of 82.7% at 180 days. At 180 days, in the CC population the riluzole-treated patients compared with placebo had a mean gain of 1.76 UEM scores (95% confidence interval: -2.54-6.06) and 2.86 total motor scores (CI: -6.79-12.52). No drug-related serious adverse events were associated with the use of riluzole. Additional pre-planned sensitivity analyses revealed that in the AIS C population, riluzole was associated with significant improvement in total motor scores (estimate: standard error [SE] 8.0; CI 1.5-14.4) and upper extremity motor scores (SE 13.8; CI 3.1-24.5) at 6 months. AIS B patients had higher reported independence, measured by the Spinal Cord Independence Measure score (45.3 vs. 27.3; d: 18.0 CI: -1.7-38.0) and change in mental health scores, measured by the Short Form 36 mental health domain (2.01 vs. -11.58; d: 13.2 CI: 1.2-24.8) at 180 days. AIS A patients who received riluzole had a higher average gain in neurological levels at 6 months compared with placebo (mean 0.50 levels gained vs. 0.12 in placebo; d: 0.38, CI: -0.2-0.9). The primary analysis did not achieve the predetermined end-point of efficacy for riluzole, likely related to insufficient power. However, on pre-planned secondary analyses, all subgroups of cervical SCI subjects (AIS grades A, B and C) treated with riluzole showed significant gains in functional recovery. The results of this trial may warrant further investigation to extend these findings. Moreover, guideline development groups may wish to assess the possible clinical relevance of the secondary outcome analyses, in light of the fact that SCI is an uncommon orphan disorder without an accepted neuroprotective treatment.
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INTRODUCTION: The COVID-19 pandemic has imposed an additional pressure on health systems worldwide. Patients with neurogenic detrusor overactivity (NDO) were especially vulnerable to inadequate care. This study aims to evaluate the impact of the suspension of NDO treatment with Botulinum Toxin (BONT-A) due to the COVID-19 pandemic. METHODS: Cross-sectional study of patients with spinal cord injury and NDO, who underwent BONT-A treatment in 2018 or 2019 and, whose administration programed for 2020 or 2021 was suspended. The study protocol was divided into two parts. Phase 1 consisted of data collection from the clinical processes and in phase 2 a standardized telephone questionnaire was applied. Information was collected at 3 time points: (1) before the last BONT-A treatment, (2) after the last BONT-A treatment and (3) at the time of the telephone call. Statistical analysis used the McNemar and the Wilcoxon test with a p-value ⩽ 0.05 as level of significance. RESULTS: 21 patients with mean age of 42.0 years and disease duration of 16.9 years were included. On average patients were undergoing treatment with BONT-A for 7.6 years and mean inter-treatment frequency was 2.3 years. Mean time since the last BONT-A administration was 2.3 years and mean reported BONT-A effect duration was 11.9 months. A significant increase in the percentage of patients with involuntary urinary loss (p = 0.004) and urgency (p = 0.031) was found. A significant decrease in mean catheterization interval from 4.5 to 3.6 h (p = 0.002) and an increase in daily oxybutynin dosage from 8.5 to 12.1 mg (p = 0.002) was also found. DISCUSSION: The COVID-19 pandemic originated clinical worsening of patients undergoing regular BONT-A treatment for NDO. These patients presented a significant increase in involuntary urinary loss, urgency and medication dosage and a decrease in catheterization interval. Thus, interruption of intravesical BONT-A treatment severely affected these patients and needs to be avoided.
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Background: Loss of upper extremity function after tetraplegia results in significant disability. Emerging evidence from pilot studies suggests that functional electrical stimulation (FES) therapy may enhance recovery of upper extremity function after tetraplegia. The aim of this trial was to determine the effectiveness of FES therapy delivered by the Myndmove stimulator in people with tetraplegia. Methods: A multi-center, single-blind, parallel-group, two-arm, randomized controlled trial was conducted comparing FES to conventional therapy in adults (≥18 years) with C4-C7 traumatic incomplete tetraplegia between 4 and 96 months post-injury, and with a baseline spinal cord injury independence measure III -self-care (SCIM III-SC) score of ≤10. Participants were enrolled at four SCI-specialized neurorehabilitation centers in the U.S. and Canada. Participants were stratified by center and randomized in a 1:1 ratio to receive either 40 sessions of FES or conventional therapy targeting upper extremities over a 14-week period. Blinded assessors measured SCIM III, Toronto Rehabilitation Institute Hand Function Test, and Graded Redefined Assessment of Strength, Sensibility, and Prehension at baseline, after 20th session, after 40th session or 14 weeks after 1st session, and at 24 weeks after 1st session. The primary outcome measure was change in SCIM III-SC from baseline to end of the treatment. Based on the primary outcome measure, a sample size of 60 was calculated. Seventeen participants' progress in the study was interrupted due to the COVID-19 lockdown. The protocol was modified for these participants to allow them to complete the study. Results: Between June 2019 to August 2021, 51 participants were randomized to FES (n = 27) and conventional therapy (n = 24). Both groups gained a mean of 2 points in SCIM-SC scores at the end of treatment, which was a clinically meaningful change. However, there was no statistically significant difference between the groups on any outcomes. Conclusion: Forty sessions of FES therapy delivered by the MyndMove stimulator are as effective as conventional therapy in producing meaningful functional improvements that persist after therapy is completed. Limitations of this study include the impact of COVID-19 limiting the ability to recruit the target sample size and per-protocol execution of the study in one-third of the participants. Registration: This trial is registered at www.ClinicalTrials.gov, NCT03439319.
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INTRODUCTION: Maintaining timely and safe delivery of major elective surgery during the COVID-19 pandemic is essential to manage cancer and time-critical surgical conditions. Our NHS Trust established a COVID-secure elective site with a level 2 Post Anaesthetic Care Unit (PACU) facility. Patients requiring level 3 Intensive Care Unit admission were transferred to a non-COVID-secure site. We investigated the relationship between perioperative anaesthetic care and outcomes. MATERIALS AND METHODS: All consecutive patients undergoing major surgery at the COVID-secure site between June and November 2020 were included. Patient demographics, operative interventions and 30-day outcomes were recorded. Multivariate logistic regression was used to determine the odds ratio of outcomes according to PACU length of stay and the use of spinal or epidural anaesthesia, with age, sex, malignancy status and American Society of Anesthesiologists grade as independent co-variables. RESULTS: There were 280 patients. PACU length of stay >23h was associated with increased 30-day complications. Epidural anaesthesia was associated with PACU length of stay >23h, increased total length of stay, increase hospital transfer and 30-day complications. Two patients acquired nosocomial COVID-19 following hospital transfer. DISCUSSION: Establishing a separate COVID-secure site has facilitated delivery of major elective surgery during the COVID-19 pandemic. Choice of perioperative anaesthesia and utilisation of PACU appear likely to affect the risk of adverse outcomes.
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BACKGROUND: Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures. Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons. Aerosolized particles containing infectious coronavirus are typically 0.5-8.0 µm. AIM: To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer (OPS). METHODS: We quantified airborne particle counts during five posterior spinal instrumentation and fusions (9/22/2020-10/15/2020) using an OPS near the surgical field. Data were analyzed by 3 particle size groups: 0.3-0.5 µm/m3, 1.0-5.0 µm/m3, and 10.0 µm/m3. We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress. A spike was defined as a > 3 standard deviation increase from average baseline levels. RESULTS: Upon univariate analysis, bovie (P < 0.0001), high speed pneumatic burring (P = 0.009), and ultrasonic bone scalpel (P = 0.002) were associated with increased 0.3-0.5 µm/m3 particle counts relative to baseline. Bovie (P < 0.0001) and burring (P < 0.0001) were also associated with increased 1-5 µm/m3 and 10 µm/m3 particle counts. Pedicle drilling was not associated with increased particle counts in any of the size ranges measured. Our logistic regression model demonstrated that bovie (OR = 10.2, P < 0.001), burring (OR = 10.9, P < 0.001), and bone scalpel (OR = 5.9, P < 0.001) had higher odds of a spike in 0.3-0.5 µm/m3 particle counts. Bovie (OR = 2.6, P < 0.001), burring (OR = 5.8, P < 0.001), and bone scalpel (OR = 4.3, P = 0.005) had higher odds of a spike in 1-5 µm/m3 particle counts. Bovie (OR = 0.3, P < 0.001) and drilling (OR = 0.2, P = 0.011) had significantly lower odds of a spike in 10 µm/m3 particle counts relative to baseline. CONCLUSION: Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range. Further research is warranted to determine if such particles have the potential to contain infectious viruses. Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.
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The number of spinal cord injury (SCI) patients is gradually increasing in India. But due to the unavailability of rehabilitation facilities at the grass root level and most of the patient's financial status, institution-based SCI rehabilitation is still not feasible for many of SCI patients. Tele-rehabilitation can help to rehabilitate the SCI patients to a satisfactory extent where providing hospital-based rehabilitation is not possible. During the COVID-19 pandemic, tele-rehabilitation showed its true potential already. Poverty, lack of education, and lack of technical knowledge of the patients can be a major barrier to its implication. However, with the government's support, suitable manpower, and will to serve, we can deliver tele-rehabilitation services for SCI patients in the remotest and poorest areas of India.
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Objective: To describe the self-reported impact of the COVID-19 pandemic on the lives of persons with spinal cord injury (SCI). Design: Cross sectional study. Participants: There were a total of 382 adult participants with traumatic SCI of at least one-year duration, all of whom were identified through a state-based surveillance registry in the Southeastern United States. The majority of participants were male (68.4%) and 72% were ambulatory. The average age at the time of the study was 57.7. Main Outcome Measures: Participants completed a self-report assessment (SRA) online or by mail on the impact of COVID-19 on quality-of-life, ability to get daily necessities, and access to healthcare. Results: Over half of the participants (58.9%) reported a negative impact of the pandemic in at least one of five life areas, with community participation being the primary area affected (51.4%). A small portion of individuals had trouble obtaining necessities, with approximately 12% reporting difficulties getting enough or quality food and 8.2% reporting difficulty getting prescription medications. However, 25% reported delaying healthcare procedures because of fear of catching COVID-19. Among those requiring personal assistance, 32% reported a decrease in quality of care and 51.9% relied more on family to assist with their care. Conclusions: The COVID-19 pandemic had multiple negative impacts. Of particular importance were reduced access to healthcare and declines in quality and stability of attendant care, with greater reliance on family. Fear of contracting COVID-19 when accessing routine medical procedures needs to be addressed in future outbreaks.
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Background/Aims Rheumatology referrals classified as non-urgent/routine are commonly non-inflammatory conditions or medically non-urgent and can have significant waiting times for appointments. These waits were further escalated by the COVID-19 pandemic. Early intervention for noninflammatory conditions can be crucial to good outcomes and long wait-times can have significant adverse impacts while appropriate care pathways are determined. Recent UK GIRFT recommendations include using non-medical health professional expertise in assessment and management pathways to support right place, right time, right care. This study evaluated effectiveness, impacts and patient experiences of Advanced Practice Physiotherapist (APP) and Advanced Practice Nurse (APN) Triage and Assessment Clinics for routine new referrals. Methods The non-urgent/routine referral waiting list was e-triaged by a Rheumatology APP and APN supported by clinical record searches. Patients were contacted by telephone to update on clinical status and appointment requirements determined. Triage criteria were applied to determine new referrals suitable for APP and APN Rheumatology clinics, which included low likelihood of inflammatory disease or new referrals for known diagnosis/stable conditions. Clinics were undertaken with collocated Consultant clinical supervision. Assessment findings were discussed and management agreed, or seen if needed. With waiting list attrition, clinics were expanded to include Consultantdetermined stable condition reviews and follow-up reviews for nonsuspected inflammatory disease. Results At 01 July 2021, 214 new routine referrals were waiting a Consultant appointment (n=103 over 2yrs). Since service initiation, clinic outcomes to date include: 69% (n=243/358) new routine referrals discharged to GP or directed to right pathway with information, advice and self-management resources;8% (n=29) escalated to urgent;3% (11/358) with medical complexity remained on Consultant waitlist. Most common presentations seen included: Osteoarthritis (general or hand);Back and other spinal pain;Fibromyalgia;Persistent Fatigue and Widespread Pain;JHS/hEDS;Positive ANA without clinical features;Musculoskeletal conditions- other. To date, no patients have been re-referred and 329 new patient and 89 follow-up Consultant direct consultations have been spared. There is currently no wait-time for non-urgent/routine appointments. Patient experience feedback on the service has offered a 100% recommendation to continue and expressed highly positive experiences with the MDT approach. Patients value the breadth of expertise and care support, and the timely, thorough and professional service provided. Conclusion Rheumatology non-urgent/routine new referrals with low probability of underlying autoimmune conditions may be effectively and efficiently managed in a collaborative model using an advanced practice physiotherapist and nurse. This innovation has expanded a traditionally medical pathway to an MDT model utilising value-adding nonmedical expertise in service delivery. It has enhanced interdisciplinary learning and is a valued, collaborative approach to patient care. The initiative provides support to GIRFT recommendations of using an MDT skill-set to support improved patient access, service efficiencies and earlier intervention.
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Objective: The objective of this study was to evaluate how the coronavirus disease 2019 pandemic affected the profile of patients admitted to the electromyography (EMG) laboratory and the types of neurophysiologic evaluations. Method(s): We included patients who were admitted to our EMG laboratory in the first 6 months of the pandemic period (Period 1) and the same 6 months of the previous year (Period 2). In view of changes in health-care strategies, lockdown, and disease awareness during the pandemic, each group was divided into 3-month periods (early and late). Demographic and clinical characteristics and electrophysiologic data were evaluated retrospectively and compared between the groups. Result(s): In Period 1, there were 1872 studies of 1829 patients, and in Period 2, there were 625 studies of 607 patients. Electrodiagnoses for cranial neuropathies were more frequent during the pandemic when compared with before the pandemic (P = 0.018). The subgroup analysis revealed that the ratio of segmental anterior horn involvement decreased in the early pandemic period (P = 0.003), myopathies decreased in the late pandemic period (P = 0.001), and cranial neuropathies increased in the late pandemic period (P = 0.005) compared with the same periods in the previous year. Conclusion(s): During the pandemic, there have been changes in clinical practice approaches in the electrophysiology laboratory. More cranial neuropathies seemed to be diagnosed in the EMG laboratory during the pandemic, including new-onset facial neuropathies, which was the most significant finding of our study.Copyright © 2023 AVES. All rights reserved.
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The COVID-19 pandemic has generated a lot of interest among doctors as well as scientists around the world. Studies on the impact of the Covid-19 pandemic, including in people with post SCI sufferance, are ongoing, aiming to understand the pathophysiological mechanisms of SARS-CoV2 in target tissues, to optimize related methods of diagnosis and treatment in both, initial and later phases of the disease - e.g.: "long Covid" status - and thus, to make a substantial contribution to the quality of life improvement of the affected patients. After using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (acronym PRISMA) method to quest for afferent knowledge, it resulted a quite small number (12) of articles, most of them indirectly approaching this topic. Therefore, is important to deepen this niche - which is scarcely approached - in order to find new therapeutic approaches able to combat COVID-19-associated to SCI manifestations - like, for instance, to check whether the principle of intermittent hypoxia treatment is effective and worth to be included in the rehabilitation treatment protocols - as neither an indubitable effective drug or vaccine, or respectively, cure for SCI, has been provided so far.
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Purpose: To evaluate the safety of spinal anesthesia in pregnant women who underwent cesarean section during the Covid-19 pandemia and were immunized with the BNT162b2 vaccine. Methods: Historical cohort study that included three groups: non-vaccinated pregnant with no history of acute or previous Covid-19 [NV (n = 70)], vaccinated with one dose [1D (n = 65)] or two doses of BNT162b2 [2D (n = 45)], who underwent cesarean section with spinal anesthesia. Variables with normal distribution were analyzed with ANOVA. When one or more groups had non-normal distribution, the Kruskal-Wallis test was used. For categorical variables, the chi-square test or Kruskal-Wallis test was performed. When any variable had a frequency of less than five, the two-tailed Fisher's exact test with the Freeman-Halton extension was used. The significance level considered was p < .05. Results: Apparently there is no interaction between BNT162b2 and the drugs most commonly used in spinal anesthesia for cesarean delivery. Conclusion: Performing spinal anesthesia in patients immunized with BNT162b2 does not seem to result in significant differences in outcomes compared to those not vaccinated. Apparently there is no need to change the standards of performing spinal anesthesia in patients vaccinated with the BNT162b2 vaccine.
ABSTRACT
The study of food products to determine the level of creatine in them is an actual task, taking into account the need for this substance for patients with Covid'19 and spinal muscular atrophy. The purpose of our research is to develop a mobile information system for determining the level of creatine in food products. The developed method for determining the level of creatine in food products by the user and the method for determining the level of creatine in food products using a mobile information system provide the user with the opportunity to quickly, conveniently, cheaply and effectively assess the presence and level of creatine in any food products, on the basis of which to build a rational diet from the point vision of body saturation with creatine. The proposed mobile information system for determining the level of creatine in food products provides convenience, low-cost, celerity, miniaturization and automation for measurement of concentration of creatine in any food products. The conclusion obtained from the system regarding the presence and level of creatine in this or that food product is useful and extremely important when preparing the diet of patients, especially patients with Covid'19 and/or spinal muscular atrophy. The proposed approach and mobile information system for determining the level of creatine in food products can be used not only for drawing up the diet of patients, especially patients with Covid'19 and/or spinal muscular atrophy, from the point vision of body saturation with creatine, but also for example, to check the quality of meat products. © 2023 Copyright for this paper by its authors.