Thromboembolic complications in patients with acute surgical pathology with coronavirus infection of COVID-19

Background. Coronavirus disease (COVID-19) is a highly contagious infection, the etiological factor of which is the SARS-CoV2 virus. In COVID-19, hemostasis disorders vary widely: from latent hypercoagulation, which occurs only on the basis of laboratory tests, to severe clinical manifestations in the form of cerebral, coronary arterial or venous thrombosis complicated by pulmonary embolism. The purpose was to study of clinical manifestations of hemostasis disorders according to laboratory studies. Materials and methods. The observation data of 96 patients who were treated for surgical pathology and in whom COVID-19 was detected are presented. Patients were hospitalized in the intensive care unit, thrombotic complications were detected in 37 %. Both venous (64 %) and arterial (36 %) thrombosis occurred. Results. According to a survey of patients with a confirmed diagnosis of COVID-19, pulmonary embolism was detected in 11.4 %, deep vein thrombo-sis and catheter-associated thrombosis in 1.2 %, ischemic stroke in 1.3 % of patients. The cumulative frequency of thrombosis was 28 %. Attention should be paid to the complexity of the diagnosis of thrombotic complications in patients who underwent artificial lung ventilation. possible thrombotic complications, regardless of clinical manifestations. Conclusions. Preference should be given to low molecular weight heparins in a standard prophylactic dose, an alternative to which are direct oral anticoagulants used in surgical protocols to prevent postoperative thrombosis. The duration of post-hospital thromboprophylaxis is determined individually taking into account the risk factors of thrombosis until the normalization of D-dimer and fibrinogen, but not less than 2 weeks after discharge. © 2022. The Authors. This is an open access article under the terms of the Creative Commons Attribution 4.0 International License, CC BY, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.

Assessment of the course of coagulopathies in patients with surgical pathology on the background of COVID-19

Background. Coronavirus disease (COVID-19) is a highly contagious infection, the etiological factor of which is the SARS-CoV-2. In COVID-19, hemostasis disorders vary widely: from latent hypercoagulation, which is detected only by the results of laboratory tests, to severe clinical manifestations in the form of cerebral, coronary arterial or venous thrombosis complicated by pulmonary embolism. The purpose: to study clinical manifestations of hemostasis disorders according to laboratory studies. Materials and methods. The observation data of 89 patients who were treated for surgical pathology associated with COVID-19 are presented. All individuals were hospitalized in the intensive care unit, thrombotic complications were detected in 37 % of them. Both venous (64 %) and arterial (36 %) thrombosis occurred. Hemorrhagic complications were found in 15.7 % of patients. Results. According to a survey of people with a confirmed diagnosis of COVID-19, pulmonary embolism was detected in 11.4 %, deep vein thrombosis and catheter-associated thrombosis — in 1.2 %, ischemic stroke — in 1.3 % of patients. The cumulative frequency of thrombosis was 28 %. Attention should be paid to the comple xity of the diagnosis of thrombotic complications in patients who underwent artificial lung ventilation. The overall cumulative incidence of thrombosis on days 7, 14 and 21 of hospitalization was 12, 28 and 36 %, respectively, while the frequency of thrombotic complications with clinical manifestations was only 7, 14 and 21 %, which is almost 2 times less common. This once again suggests the need to examine all patients with COVID-19 for possible thrombotic complications, regardless of clinical manifestations. Conclusions. Patients should receive continuous thromboprophylaxis after discharge from a hospital. Preference should be given to low molecular weight heparins in a standard prophylactic dose, an alternative to which are direct oral anticoagulants used in surgical protocols to prevent postoperative thrombosis. The duration of post-hospital thromboprophylaxis is determined individually taking into account the risk factors of thrombosis until the normalization of D-dimer and fibrinogen, but not less than 2 weeks after discharge. © 2022. The Authors.

Study of coronary artery bypass grafting admission in Covid-19 era: A bicentric study

The Covid-19 pandemic that began in December 2019 and is still underway in 2022 has changed many habits and protocols in different economic industries including healthcare. In the specific case, the change in protocols and management of work activities also affected the health sector. Among the sectors in which the pandemic has influenced the flow of events is the cardiology sector. In the specific case, the present work will present how coronary bypass interventions have been influenced in their different aspects by the Covid-19 pandemic. The work will be based on a comparison between the 2019 data in the period prior to the pandemic and in 2020 in the post-pandemic period for two major public hospitals in the Campania region: The university hospital of Salerno (Italy) "San Giovanni di Dio and Ruggi D'Aragona"and AORN "A. Cardarelli "of Naples (Italy). Both the structures considered have an Emergency Department and First Aid Acceptance for surgical pathologies. © 2022 ACM.

Features of early postoperative period in children with gastrointestinal syndrome against the background of COVID-19

Objective. To study the features of the development and course of gastrointestinal syndrome against the background of COVID-19 in preschool-aged children hospitalized in the Pediatric Surgery Department with acute abdominal pain. Patients and methods. The study was performed on the basis of the Departments of Pediatric Surgery, Anesthesiology and Resuscitation at Smolensk Regional Clinical Hospital between September 1, 2021, and December 30, 2021. Using continuous sampling, we analyzed clinical data of 29 children aged 4 to 7 years with acute abdominal pain against the background of COVID-19. The course of COVID-19 in children who were discharged from the Pediatric Surgery Department after exclusion of acute surgical pathology was studied in dynamics. Results. The disease manifested itself as an acute diffuse abdominal pain and hyperthermia in 100% of children;65% of children had vomiting, and 56.25% of them had diarrhea. Seven (24%) children required diagnostic laparoscopy, of whom 5 children had no surgical pathology and 2 were diagnosed with adhesions. Laparoscopy revealed mesadenitis in all patients. Conclusion. Acute surgical pathology and gastrointestinal syndrome against the background of COVID-19 have similar manifestations during the acute period in children. Surgical interventions performed against the background of COVID-19 in the acute period provoke complications and prolong the recovery period. © 2022, Dynasty Publishing House. All rights reserved.

[Coronavirus infection and risk of postoperative venous thromboembolic events]. / Koronavirusnaya infektsiya i risk posleoperatsionnykh venoznykh tromboembolicheskikh sobytii u khirurgicheskikh bol'nykh.

OBJECTIVE: To determine whether patients with perioperative or previous coronavirus infection (CVI) have a greater risk of venous thromboembolic events (VTE). MATERIAL AND METHODS: A multiple-center regional prospective retrospective cohort study included elective and emergency patients who underwent surgery in November 2020. The primary endpoint was VTE (PE/DVT) within 30 days after surgery. CVI was stratified as perioperative (7 days before surgery - 30 days after surgery), recent (1-6 weeks before surgery) and remote (≥7 weeks before surgery) infection. There was no information about prevention or preoperative anticoagulation at baseline data collection. RESULTS: Incidence of postoperative VTE was 1.5% (10/650) in patients without CVI, 33.3% (3/9) in patients with perioperative CVI, 18.1% (2/11) in patients with recent CVI and 8.3% (1/12) in patients with remote CVI. After adjusting the confounders, patients with perioperative and recent CVI remained at a higher risk of VTE. In general, VTEs were independently associated with 30-day mortality. In patients with CVI, mortality rate among ones without VTE was 21.7% (5/23), with VTE - 44.4% (4/9). CONCLUSION: Patients with perioperative CVI have a higher risk of postoperative VTE compared to those without CVI and patients with previous CVI and no residual symptoms. Mortality in this group is also higher than in other cohorts.

A retrospective comparison of first and second opinion histopathology with patient outcomes in veterinary oncology cases (2011-2019).

Mandatory second opinion histopathology is common practice in human surgical pathology. It is intended to confirm the original diagnosis or identify clinically significant discrepancies, which could alter the course of disease, cost of treatment, patient management or prognosis. This retrospective analysis aimed to evaluate agreement between first and second opinion histopathology cases, examine their correlation with natural history of disease and investigate the rationale for pursuing this test. Medical records from 2011 to 2019 were reviewed, identifying 109 cases where second opinion histopathology was sought. Reasons for seeking second opinion and clinical disease course were also reviewed to determine whether case progression favoured first or second opinion findings in cases of diagnostic disagreement. Diagnostic disagreement was found in 49.5% of cases. Complete diagnostic disagreement (a change in degree of malignancy or tumour type) occurred in 15.6% cases and partial disagreement (a change in tumour subtype, grade, margins and mitotic count) occurred in 33.9%. Major disagreement (a change in diagnosis resulting in alteration of treatment recommendations) occurred in 38.5% of cases. The most common reasons for seeking second opinion were an atypical/poorly differentiated tumour (31.2%; 34/109) or a discordant clinical picture (24.8%; 27/109). Among cases with any form of disagreement, natural history of disease favoured second opinion findings in 33.3%. The first opinion was favoured over the second in a single case. These findings reinforce previous literature supporting a role for second opinion histopathology in optimizing therapy and predicting outcomes in veterinary oncology, particularly in cases where diagnosis is in question based on the overall clinical picture.

Practice of Academic Surgical Pathology During the COVID-19 Pandemic.

OBJECTIVES: To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on our service, pre-, and postgraduate education and discuss the measures taken to ensure continued provision of quality service as well as education during the mandatory lockdown. METHODS: Measures taken to protect staff from infection and minimize virus transmission within the department as well as measures taken to allow smooth provision of quality service and uninterrupted pre- and postgraduate education were analyzed. Data were collected regarding case volumes (histology, cytology, and frozen sections) and case complexity during the lockdown and analyzed. RESULTS: Staggered rota was introduced for all staff. Strict social distancing measures were implemented. Staff was extensively counseled regarding the importance of protective measures. Pre- and postgraduate education, which was temporarily suspended, was quickly resumed using online teaching ensuring continuation of academic activities. The volume of cases decreased during the lockdown but complexity increased even more. CONCLUSIONS: Immediate and effective measures were taken to protect staff from infection and ensure smooth provision of quality services. Measures were quickly taken to ensure resumption of pre- and postgraduate academic activities. The volume of cases decreased but complexity increased. There is fear among faculty and staff regarding the future.

Impact of COVID-19 lockdown measures on oncological surgical activity: Analysis of the surgical pathology caseload of a tertiary referral hospital in Northwestern Italy.

BACKGROUND AND OBJECTIVES: Italy was severely affected by the severe acute respiratory syndrome coronavirus 2 pandemic. Our Institution, Piedmont's largest tertiary referral center, was designated as a non-COVID-19 hospital and activities were reorganized to prioritize critical services like oncological care. The aim of this study was to investigate the efficacy in preserving the oncological surgical practice at our Institution during the most critical months of the COVID-19 epidemic by analyzing the surgical pathology activity. METHODS: The number of oncological surgical resections submitted to histopathological examination from 9th March 2020 to 8th May 2020 were collected as well staging/grading data and compared with the previous three pre-COVID-19 years (2017-2019). RESULTS: Overall, no decrease was observed for most tumor sites (5/9) while breast resections showed the largest drop (109 vs. 160; -31.9%), although a full recovery was already noticed during the second half of the period. Conversely, the selected control benchmarks showed a sharp decrease (-80.4%). Distribution of pathological TNM stages (or tumor grades for central nervous system tumors) showed no significant differences during the lockdown compared with previous years (p > .05). CONCLUSIONS: The present data suggest the possibility of preserving this cornerstone oncological activity during an evolving public health emergency thanks to a prompt workflow reorganization.

The Anatomic Pathology laboratory adjustments in the era of COVID-19 pandemic: The experience of a laboratory in a Portuguese central hospital.

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the world over the past weeks, with already 8,25 million infections and 445,000 deaths worldwide, leading to an unprecedented international global effort to contain the virus and prevent its spread. The emergence of novel respiratory viruses such as the SARS-CoV-2 creates dramatic challenges to the healthcare services, including surgical pathology laboratories, despite their extensive daily experience in dealing with biological and chemical hazards. Here, we cover important aspects on the knowledge on COVID-19 gathered during the first six months of the pandemic and address relevant issues on human biological sample handling in the Anatomic Pathology laboratory in the context of COVID-19 global threat. In addition, we detail our strategy to minimize the risk of contamination upon exposure to the different biological products received in the laboratory, which can be of general interest to other laboratories worldwide. Our approach has enabled a safe work environment for laboratory staff, while ensuring the maintenance of high quality standards of the work performed. In times of uncertainty and given the lack of specific guidelines directed at Anatomic Pathology services to better deal with the global COVID-19 public-health emergency, it is essential to share with the community rigorous methodologies that will enable us to better cope with probable novel waves of COVID-19 infection and other viruses that will possibly arise in the near future.