Personnel Protective Equipment for Healthcare Professionals During COVID-19 Pandemic

COVID-19 is highly contagious and transmission dynamics of COVID-19 are not yet fully elucidated. It is known that the ill person begins to become contagious before the symptoms of the disease begin. Also asymptomatic person who are infected but does not have symptoms and signs, can infect other individuals. The only way for health workers to protect themselves from COVID-19 is proper use of personal protective equipment and to ensure hand hygiene. COVID-19 is transmitted through close contact and large respiratory droplets and not transmitted by airborne. The surgical mask prevents the passage of respiratory droplets. However, during the aerosol producing procedures performed on the patient, small particles containing infectious particles are scattered to air in high amounts. Healthcare workers are more likely become infected during these procedures. It is recommended to wear respirator during these procedures. Use of masks or respirators must be in conjunction with other recommended PPE and appropriate hand hygiene.

A review of infection prevention and control guidelines for dental offices during the COVID-19 pandemic in mid-2020

Background: The COVID-19 pandemic was a challenge for all dental professionals who had to rapidly update infection prevention and control (IPAC) guidelines and protocols due to increased risk of SARS-CoV-2 transmission during common aerosol-generating procedures (AGPs), and a lack of consensus on how best to mitigate the risk of transmission in a dental office. Thus, the purpose of this descriptive study was to compare the variance in IPAC guidelines for dental offices that emerged, and to assess practice consistency from early to mid-2020. Methods: A comprehensive literature search was conducted from May 26 to July 8, 2020 for IPAC documentation specific to the dental office during the COVID-19 pandemic. Documents that met the inclusion criteria were independently reviewed. Data was extracted using a framework based on the following IPAC domains: pre-appointment, waiting room, personal protective equipment (PPE) selection, treatment room, and post-dismissal. Results: A total of 67 IPAC documents specific to dental offices were reviewed in this study. Included documents originated from 22 dental associations, 17 peer-reviewed articles, 13 dental regulators, 11 government bodies, two public health units, and two dental corporations. There was a great degree of variance with IPAC guidelines from the pre-appointment stage, during treatment, and post-treatment. Recommendations that emerged with some level of consistency involved pre-screening patients for COVID-19 symptoms (97%), staggering appointments (84%), social distancing, minimizing occupants in the waiting room, wearing a face shield over protective eyewear for AGPs (92%), and preprocedural rinses (84%). There was less consistency with recommendations for consolidating multiple appointments (36%), waiting room ventilation (46%), N95 masks (47%) versus FFP2/FFP3 masks (30%) use for AGPs, fit-testing respirators (37%), enclosing open operatories for AGPs (28%), prioritizing minimally invasive procedures (30%), and using third-party laundry companies (32%). Conclusions: The risk of SARS-CoV-2 transmission, lack of consensus on mode of spread, and need for rapid action resulted in a significant variation in most downstream IPAC interventions in the hierarchy of controls, including choice of PPE, treatment room, and post-dismissal domains. Upstream interventions, including pre-appointment and waiting room domains, were relatively consistent in practices in early to mid-2020.

Experience with 2D Exoscope System for Bilateral Simultaneous Cochlear Implant Surgery in the Era of the COVID-19 Pandemic.

We report the first case series utilizing the exoscope exclusively for bilateral simultaneous cochlear implant surgery and discuss the advantages, disadvantages, as well as surgical outcomes in the Covid-19 era. The VITOM® 2D is compatible with enhanced PPE and draping techniques which can improve safety while providing comparable surgical outcomes.

Droplet nuclei are generated during colonoscopy and are decreased by the use of carbon dioxide and water immersion technique.

OBJECTIVES: The COVID-19 pandemic has raised concerns on whether colonoscopies (CS) carry a transmission risk. The aim was to determine whether CS are aerosol-generating procedures. METHODS: This was a prospective observational trial including all patients undergoing CS at the Prince of Wales Hospital from 1 June to 31 July 2020. Three particle counters were placed 10 cm from each patient's anus and near the mouth of endoscopists and nurses. The particle counter recorded the number of particles of size 0.3, 0.5, 0.7, 1, 5, and 10 µm. Patient demographics, seniority of endoscopists, use of CO2 and water immersion technique, and air particle count (particles/cubic foot, dCF) were recorded. Multilevel modeling was used to test all the hypotheses with a post-hoc analysis. RESULTS: A total of 117 patients were recruited. During CS, the level of 5 µm and 10 µm were significantly higher than the baseline period (P = 0.002). Procedures performed by trainees had a higher level of aerosols when compared to specialists (0.3 µm, P < 0.001; 0.5 µm and 0.7 µm, P < 0.001). The use of CO2 and water immersion techniques had significantly lower aerosols generated when compared to air (CO2 : 0.3, 0.5, and 0.7 µm: P < 0.001; water immersion: 0.3 µm: P = 0.048; 0.7 µm: P = 0.03). There were no significant increases in any particle sizes during the procedure at the endoscopists' and nurses' mouth. However, 8/117 (6.83%) particle count tracings showed a simultaneous surge of all particle sizes at the patient's anus and endoscopists' and nurses' level during rectal extubation. CONCLUSION: Colonoscopy generates droplet nuclei especially during rectal extubation. The use of CO2 and water immersion techniques may mitigate these risks.

Healthcare workers' preparedness and response during COVID-19 pandemic

Background: Healthcare workers (HCWs) are most at risk of contracting SARS-CoV-2 and COVID-19 infection. Their preparedness, as a result of provision and access to personal protective equipment (PPE), training programmes and awareness and practices on infection prevention and control measures, is integral for the prevention of infectious disease transmission. Objective(s): This study was conducted to assess the preparedness and practices of HCWs during COVID-19 first wave outbreak in Brunei Darussalam. Method(s): A cross-sectional study using a pre-designed and self-administered web-based questionnaire was conducted among HCWs from government and private health sectors ranging from primary to tertiary health facilities in Brunei Darussalam. Data were analysed using descriptive statistics, and chi-square test was used for statistical significance. Result(s): A total of 511 HCWs participated in the study. Nurses (64%) and HCWs based at hospitals (66%) made up the majority of the study participants, with 74% having occupational exposure to COVID-19 cases. More than 99% of HCWs used respiratory PPE, and 94% used gloves. 74% had undergone respirator fit testing and 65% had received PPE awareness session within the last one year. Coverage in training programmes was found to be low among HCWs from private health facilities. Conclusion(s): Majority of HCWs who had received updated training programmes and therefore were better prepared came from government health facilities. HCWs from private health facilities lacked preparedness training programmes and as such, there needs to be improvement to enhance preparedness measures in light of the ongoing COVID-19 pandemic and for future infectious disease outbreaks. Copyright © The Author(s) 2021.

Assessment of Endodontic Emergency Care in a COVID-19 Pandemic

Objective: This study compared the aerosol-generating and non-aerosol-generating endodontic emergency procedures' success and assessed the outcome of endodontic treatments initiated before a pandemic but could not be completed in the targeted time. Material(s) and Method(s): Emergency treatments were performed according to symptoms of teeth. Treatment success or failure was determined according to patients whether not re-referral with untimely pain. Short-term outcome and complications arising from teeth, which endodontic treatments were prolonged were also recorded. A chi-square test was used in the statistical analysis, and p<0.05 was considered significant. Result(s): The aerosol-generating procedure group's success rate was 86.2%, while it was 70.0% in the non-aerosol generating procedure group (p=0.050). The short-term survival rate of teeth was 83.7% in patients whose endodontic treatment had been prolonged. Conclusion(s): Considering the pros and cons, each emergency patient should be evaluated case-by-case. Copyright ©Meandros Medical and Dental Journal, Published by Galenos Publishing House.

Updated Review about Liver Cirrhosis in the COVID-19 Era

Background: The clinical manifestations in patients with COVID-19 may be nonspecific, but most have fever, cough, followed by dyspnea, fatigue, or sputum production. approximately 14% to 53% of patients experience various degrees of liver damage, although most of these injuries are mild and transient, with a satisfactory prognosis in patients without prior liver disease. In contrast, COVID-19 in patients with pre-existing liver disease has been reported to result in higher hospitalization and mortality rates. Among these pre-existing liver diseases, cirrhosis is a chronic liver disease that involves the collapse of the structure of the liver and distortion of the vascular architecture. Cirrhosis is associated with inherent immune dysfunction and an altered gut-liver axis;patients with cirrhosis are particularly at elevated risk of infections and the associated complications. It remains uncertain whether immunocompromised patients with COVID-19 have a higher risk of adverse outcomes. Patients with cancer or solid organ transplant recipients may have an elevated risk of more severe COVID-19;whereas patients taking biologic therapies may not have a greater risk of developing severe COVID-19. No additional risk of death was observed in cancer patients receiving active treatment except in those undergoing chemotherapy. Whether patients with human immunodeficiency virus infection are at higher risk of mortality due to COVID-19 is unclear.Limited evidence has shown that the clinical manifestations in cirrhotic patients with COVID-19 are similar to those in the general population with COVID-19, with fever and cough remaining the most common symptoms, followed by shortness of breath and sputum production. Interestingly, whereas similar proportions of cirrhotic and noncirrhotic patients developed respiratory and cardiovascular symptoms, cirrhotic patients were less likely to develop gastrointestinal symptoms (e.g., diarrhea, nausea, vomiting). Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Modified Negative Pressure Enclosure During Tracheostomy in Patients With COVID-19.

COVID-19 also known as severe acute respiratory syndrome coronavirus 2 is the result of a highly transmissible coronavirus which can result in severe infection of the respiratory tract. The global pandemic which began in early 2020 has created a number of challenges for the medical community to contain the rate of transmission, especially to health care workers. A minority of the infected population will progress toward severe respiratory distress ultimately requiring mechanical ventilator assistance. Although preliminary data suggest a poor prognosis for those requiring ventilation support, there is a subgroup who will eventually be weaned off. As the pandemic evolves, this cohort of infected, chronically intubated and ventilated individuals will become more prevalent and may require tracheostomy to aid in recovery. Unfortunately, tracheostomy is an aerosol-generating procedure which poses high risks to all members within the operating room, as described by previous authors. There is an urgent need to explore and develop methods to maximize the safety of tracheostomy and other aerosol-generating procedures in order to reduce intraoperative transmission. In the present article, we present a modified technique for negative pressure enclosure in patients with COVID-19 who underwent tracheostomy.

THE COMPARISON OF AEROSOL EXPOSURES TO ENDOSCOPY PERSONNEL PERFORMING DIAGNOSTIC UPPER GASTROINTESTINAL ENDOSCOPY IN PATIENTS WITH AND WITHOUT HEAD BOX: A RANDOMIZED CONTROL TRIAL.

BACKGROUND AND AIMS: Esophagogastroduodenoscopy (EGD) has been identified as an aerosol-generating procedure (AGP) during the COVID-19 pandemic. The risk of AGP and benefits of utilizing protective measures have never been fully studied. METHODS: A randomized control, open label study in patients scheduled for diagnostic EGD between September and December 2021 was conducted. Patients were randomly assigned to either head box group or without head box group (control group). Particles were measured with 6-size particle counters at the nurse anesthetist and endoscopist position. Primary composite outcomes were the mean difference of aerosol particle levels during and before EGD at the nurse anesthetist face position and at the endoscopist face position. Secondary outcomes were factors increasing aerosol particle levels and safety of the head box. RESULTS: From 196 enrolled patients, 190 were analyzed. Baseline characteristics were not different between the two groups. The mean distance between endoscopist face and patient mouth was 67.2±4.9 cm. The mean differences of 0.3-, 0.5- and 1.0-micron particles during the procedure and at baseline before the procedure at nurse anesthetist position and the mean differences of 0.3-micron particles at the endoscopist position was found to have decreased in the head box group and increased in the control group (P<0.001, 0.001, 0.014 and P<0.001, respectively). Cough, burping, and body movement increased aerosol particles. No additional adverse events were observed in the head box group. CONCLUSIONS: EGD with the head box is safe and can reduce significant aerosolization to endoscopy personnel including nurse anesthetists and endoscopists. (ClinicalTrials.gov: NCT04981535).

Uptake of No- Biopsy Approach in Diagnosing Paediatric Coeliac Disease in a Regional Tertiary Centre

Background Coeliac disease (CD) is an immune mediated systemic disorder strongly associated with HLA DQ2 and DQ8 haplotypes.2 In 2012 The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) recommended serology based No-Biopsy Approach to the diagnosis of CD if I - Perifollicular Petechiae the following criteria are met1: Design/Methods A 6-year retrospective study of all children who attended coeliac clinic at The Great North Children Hospital, Newcastle. Data obtained using electronic patient records included TGA-IgA, EMA-IgA, symptoms at initial presentation and histopathological reports. HLA typing results were obtained from the Regional NHS blood and transplant laboratory. 346 children with CD were reviewed in the coeliac clinic from July 2013 to July 2019. Age range 0.9 - 16.5 years (median 9.5 years) and 54% female. Exclusion criteria include diagnosed outside study period or the UK, TGA-IgA at initial presentation unavailable for review. Results 66% of cases had TGA-IgA >=10xULN at initial presentation. 48% were diagnosed by serology based No-Biopsy Approach (figure1). Duodenal biopsies were performed in 82 cases. Biopsies were performed for type1 diabetes -8.5% and asymptomatic patients with first-degree relative with CD -8.5% (figure 1). EMA-IgA positivity was reported in 65/68 cases with symptoms attributed to CD in 62 cases in the cohort. A total of 13/62 cases had HLA risk alleles DQ2 and/or DQ8 performed (figure 2). Conclusion(s)*HLA screening uptake was 63%. The low uptake of HLA typing may have contributed to the increased number of cases undergoing duodenal biopsies.*Based on 2012 guidelines 19% of cases had duodenal biopsies for diagnosis of CD despite meeting the criteria for no biopsy approach.*Based on 2020 guidelines 96% of cases had duodenal biopsies for diagnosis of CD despite meeting the criteria for no biopsy approach.*The changes in the CD guidelines from 2012 to 2020 have resulted in an increase from 16% to 96% of cases that may have benefitted from no biopsy approach to the diagnosis of CD.*A unifying approach to the diagnosis of the CD will reduce the variability in investigations.*The current restrictions to Aerosol Generating Procedures due to SARS-CoV -2 pandemic will have a positive impact on establishing a No-Biopsy approach to the diagnosis of CD.

Assessment of Endodontic Emergency Care in a COVID-19 Pandemic

Objective: This study compared the aerosol-generating and non-aerosol-generating endodontic emergency procedures' success and assessed the outcome of endodontic treatments initiated before a pandemic but could not be completed in the targeted time. Material(s) and Method(s): Emergency treatments were performed according to symptoms of teeth. Treatment success or failure was determined according to patients whether not re-referral with untimely pain. Short-term outcome and complications arising from teeth, which endodontic treatments were prolonged were also recorded. A chi-square test was used in the statistical analysis, and p<0.05 was considered significant. Result(s): The aerosol-generating procedure group's success rate was 86.2%, while it was 70.0% in the non-aerosol generating procedure group (p=0.050). The short-term survival rate of teeth was 83.7% in patients whose endodontic treatment had been prolonged. Conclusion(s): Considering the pros and cons, each emergency patient should be evaluated case-by-case. Copyright ©Meandros Medical and Dental Journal, Published by Galenos Publishing House.

Evaluation of a Negative Pressure Aerosol Protection Box to Prevent Airborne Transmission of Sars-Cov-2 to Healthcare Providers in Pediatric Intensive Care

BACKGROUND AND AIM: High contagiousness of SARS-COV-2 is caused by bioaerosols' emission. Clinical situations involving tissue manipulation with high viral load called "aerosol-generating procedures" (AGP) may increase this risk of healthcare providers (HCPs) developing infectious diseases. Our aim was to investigate the impact of an aerosol protection box, the Splash-Guard Caregivers (SGGC), on the presence of viral particles after an AGP. METHOD(S): Prospective observational study conducted between April and June 2020, including the HCPs in charge of children admitted to a Pediatric Intensive Care Unit who tested positive for COVID-19. SGCG (https://rsr-qc.ca/ Splashguard-cg/) was not used systematically and room patients analyzed were divided in: SGCG+ and SGCP-. Virus detection was performed: on the air one meter from the patient's head, also on the air near each HCPs (wearable pumps) and at each HCPs forehead (swab) after an AGP. Samples were analyzed for SARS-COV-2 RNA by qPCR. RESULT(S): Eight batches of samples were performed in the single room of SARS-COV-2+ child: SGCG+ (n=3) and SGCG- (n=5), with five qPCR positive (10.2%) for SARSCOV- 2. Three (11.5%) among 26 analyses from the group SGCG-: in the air before the AGP (n=1), in the air near HCP's head (n=1), and in the HCP forehead swab (n=1). And, two (8.7%) in 23 analysis of SGCG+ group: in the HCP forehead swab (n=1) and in the air near HCP's head (n=1). None of the HCPs were infected by SARS-COV2. CONCLUSION(S): Our results document the presence of SARS-COV2 in infected children environment. The protection effect of SGCG needs additional research.

Pneumococcal Colonization Among Children 5 years of Age and Younger During SARS-CoV-2 Pandemic

Background. Children <=5 years of age have the highest rates of pneumococcal colonization and play an important role in the spread of pneumococcus. Our objective was to determine whether the public health measures (physical distancing, masking, and shelter-in-place orders) implemented to slow the spread of SARS-CoV-2 pandemic had an impact on pneumococcal colonization rates among children aged <=5 years with and without respiratory symptoms during the first year of SARS-CoV-2 pandemic (4/1/20 to 3/31/21). Methods. This is a single center retrospective cohort study. The study period was divided in 3 four-month periods to represent the initial period of strict adherence to public health measures (period 1: Apr-Jul), relaxation of some of these measures (period 2: Aug-Nov) and Northern hemisphere winter season (period 3: Dec-Mar). We used salvaged mid-turbinate samples obtained as part of routine care from patients without respiratory symptoms but screened for SARS-CoV-2 prior to surgery or aerosol generating procedures (asymptomatic) or from patients with respiratory symptoms tested for SARS-CoV-2 and/or other respiratory viruses (symptomatic). Samples were evaluated for pneumococcal colonization by real-time PCR using CDC lytA primers. Sample size was calculated based on the assumption of lower colonization rates in period 1 and gradual increase (10-15%) in the following study periods. Results. A total of 311 patients were included (185 asymptomatic and 126 symptomatic). Demographics, SARS-CoV-2 PCR and pneumococcal colonization results are shown in Table 1. Pneumococcal colonization rates for asymptomatic and symptomatic children were 14% and 22% (p=0.06), respectively. The odds of colonization of asymptomatic children were similar during period 2 (OR 0.96 [95%CI 0.34-2.67]) and period 3 (OR 0.53 [95%CI 0.17-1.62]), using period 1 as reference and after adjusting for age, sex, and SARS-COV-2 results. The odds of colonization of symptomatic children were also similar across the 3 study periods (period 2 OR 1.28 [95%CI 0.41-4.01] and period 3 OR 0.73 [95% CI 0.24-2.18]). Table 1. Characteristics of asymptomatic and symptomatic groups Conclusion. Pneumococcal colonization rates were not significantly impacted by public health measures implemented during the first year of the SARS-CoV-2 pandemic and did not correlate with SARS-CoV-2 positivity.

Covid-19 Risk in the Cardiac Catheterization Laboratory

Background: Infection Control Committees (IPC) have advised that droplet protocol protections are sufficient against COVID-19 unless Aerosol Generating Medical Procedures (AGMP) are being performed. AGMP do occur in the Cardiac Catheterization Lab (CCL) but are largely unpredictable. Recent analysis of superspreader events has provided evidence of significant aerosol spread. CO2 is exhaled by breathing subjects, and its measurement has been shown to be a reliable proxy for breathing activity, and thereby infectious risk, in indoor environments. Methods and Results: A portable CO2 monitor (AirQ AQ-200 or Aranet-4) was positioned at counter height in the periphery of CCL's during diagnostic & coronary interventional (Cath), transcatheter aortic valve implantations (TAVI) and Mitraclip (MC) procedures. Procedure start and stop times were recorded. CCL ventilation parameters were provided by hospital building engineers. Usual personnel numbers were attributed to each type of case (no allowance was made for the emergency need of additional personnel). Data were inputted into a publicly available well-mixed room model coded in Python (https://indoor-covid-safety.herokuapp.com/) to obtain a safe maximum CO2 level for case and catheterization lab parameters. Procedural mean values were than compared to the safe maximum. Data were obtained from 278 cases, 246 Cath (mean duration 50 min, range 23-155), 27 TAVI (65 min, range 35-287) and 5 MC (247 min, range 178-371). Using surgical masks with average fit and transmissibility data from the Wild variant, Cath CO2 measurements were within safe range 98.8% of the time, TAVI 92.6% and MC 0%. Under Omicron variant conditions, this decreased to 17.5% (Cath) and no TAVI/MC cases. For cath cases, case duration was an important determinate of safety, and a safe duration depended greatly on the variant in circulation. Increasing ventilation across a range of 6 ACH (air changes per hour) to 20 ACH led to marked improvement in risk from the Wild variant, but benefits were limited with the Delta and Omicron variants. Filtration had limited effect unless filters were MERV 15 or higher (HEPA). Conclusion(s): COVID-19 risk in the CCL is significant even in the absence of AGMP. Increased CCL ventilation and filtration can reduce this risk, but are limited by constant production of infectious aerosols. Risk can be further reduced by complimentary strategies such as aerosol-grade PPE for CCL staff, pre-procedural COVID-19 testing of patients, and postponement of elective procedures expected to last above a duration threshold during periods of high community disease activity. [Formula presented] [Formula presented] Copyright © 2022

EMS Operational Adaptations to the COVID-19 Pandemic

Study Objectives: The COVID-19 pandemic presented new and unique challenges to EMS agencies. In the absence of a unified strategy to address COVID-19, agencies across the country made changes to routine operations to ensure provider and patient safety while providing life-saving care. We conducted a survey of EMS agencies in the United States to assess adaptations made in response to COVID-19. Method(s): A convenience sample of EMS agency leaders were provided a link to an IRB-approved survey by e-mail and/or social network. Survey results from responding agencies were analyzed using Microsoft Excel software. Result(s): Twelve survey responses were received representing agencies across six states (TX, MO, PA, WA, VA, NC). All respondents began using dispatch screening questions to identify patients with a potential COVID-19 infection. EMS call volume at the peak of local infections was somewhat or significantly reduced in all but one responding agency. Fifty-eight percent, however, reported increased call duration. Thirty-three percent reported lower than average unit staffing. Due to supply shortages, two-thirds of respondents reported often or always reusing PPE intended for single use. Oxygen delivery via nasal cannula or non-rebreather mask was unchanged in ninety-two percent of agencies, while two-thirds of agencies changed equipment for bag-valve-mask ventilation (eg addition of HEPA filtration). Only two agencies continued to use nebulized medications under standard protocols, while five ceased administration of nebulized medications entirely. Three of the five agencies which stopped using nebulized medications and the one agency which ceased use of CPAP began performing intravenous or subcutaneous beta-agonist (eg Epinephrine or Terbutaline) administration for respiratory distress. Seventy-five percent of agencies modified non-invasive positive pressure ventilation procedures. Eighty-three percent of agencies reported making significant procedural changes for endotracheal intubation while only fifty-eight percent altered their use of supraglottic airway devices. Sixty-seven percent of agencies modified cardiopulmonary resuscitation procedures. US agencies indicated that they took additional precautions when performing airway procedures such as: halting or limiting certain aerosol-generating procedures (75%), limiting the number of individuals at the bedside (83%), and performing airway procedures in outdoor or well-ventilated areas (63%). Ninety-two percent of agencies began administering COVID-19 vaccinations. Conclusion(s): US EMS agencies around the country adapted their daily operations in response to COVID-19. The highly varied approaches highlight the lack of best practices or standard guidelines available for agencies to follow to mitigate safety concerns while maintaining the standard of care. Further investigation is needed to determine the clinical impact of these changes. No, authors do not have interests to disclose Copyright © 2022

Impact of COVID-19 Pandemic on Dental Practice: A Questionnaire Survey

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic had unprecedented health and economic consequences. Dentists encounter maximum aerosol production due to frequent use of ultrasonic and polishing devices or other surgical interventions, thus increasing the risk of nosocomial infections. The situation had caused drastic change in the clinical routines including modifications in infection control strategies, managing of minimally invasive procedures, reducing the patient visits and updating themselves to use telecommunication to cater to the need of patients. Aim(s): To evaluate the consequences and impact of COVID-19 pandemic by conducting an online survey using questionnaire amongst dentists as healthcare providers in the country of India. Material(s) and Method(s): This was a questionnaire-based, cross-sectional survey conducted using online platform in India with a sample size of 225 participants who were practicing dentists, either graduates or postgraduates, and agreed to give an informed consent. The questionnaire consisted of six segments: participants demographics, changes in clinical routine of the respective dentist, upgrading facilities in clinic, infection control measures, telecommunication and impact on financial aspect of the practitioner. Open-ended questions were also included giving an opportunity to the participant to share his or her perspective. Chi-square test of proportion was performed to assess the difference in proportion of the responses. A p-value <0.05 was considered statistically significant. Result(s): This study has shown that the pandemic has impacted negatively on financial status, patient flow and daily practice. Total 221 (98.2%) clinicians agree to the fact that, COVID-19 has affected their clinical routine, 203 (90.2%) clinician were aware of the aerosol generating procedures and 95 (42.2%) practitioners have installed devices for air purification. A 209 (92.8%) emphasise on the use of Personal Protective Equipment (PPE) kits and majority 84 (37.3%) were delaying elective procedures. About 184 (81.7%) have experienced decrease in number of patient flow and 104 (46.2%) practitioners agreed that their emotional and psychological wellbeing is affected due to drastic changes made in their practicing protocols due to COVID-19. Conclusion(s): The COVID-19 pandemic has affected the social, economic, physical as well as mental wellbeing of practioners all around the world. More or less the practice is hampered causing frustration and instability. Focusing the light on practicing dentists, they have seen to make significant changes in their zone of practice and have updated to the new normal version of practice. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

Development of an emergency airway response system for COVID-19 at a tertiary care hospital in resource limited country.

The ongoing coronavirus (COVID-19) infection causes severe respiratory dysfunction and has become an emergent issue for worldwide healthcare due to highly transmissible and contagious nature. Aerosol generating procedures such as tracheal intubation is of particularly high risk. This mandates some advice on processes and techniques required to protect staff and uniform approach during airway management. We hereby share our experience in development of an emergency response system to deal with COVID airway management at a frontline hospital which particularly consider the local demands and resources. This includes a change in working dynamics with 24/7 consultant coverage for emergent or urgent tracheal intubation of COVID patients at non-operating room locations. Other steps include prepackaging intubation baskets, availability of videolaryngoscope, standard personal protective equipment including powered air purifying respirator, and use of modified intubation checklist.

A Study to Assess the Effect of Planned Teaching on Knowledge and Beginning Skill Regarding "Hands Only-Cpr" among the General Public from Selected Area of Kankavli

Cardiac arrest is a condition where heart suddenly stops, and the person just dies. About 10% of the deaths in India is due to sudden cardiac arrest which is also the most common factor of death in the world. In this unusual time of the Covid-19 pandemic, there is concern about the risk of a public responder contracting Covid-19 from a person when providing CPR. The vast majority of cardiac arrests (over 80%) will be in the home setting and responders are likely to be friends or family. Knowing how to perform "hands-only CPR" can save a life. A cardiac patient's chance of becoming a long-term survivor are more than doubled if someone on the scene administers prompt CPR. Healthcare workers already are at the highest risk of acquiring SARS-CoV-2, According to the AHA, and administering CPR creates additional risks, CPR can involve a number of aerosol-generating procedures that include performing chest compressions, providing positive-pressure ventilation, and establishing an advanced airway through intubation. Resuscitation can require providers to work in close proximity to one another and the patient;and the urgency to resuscitate a patient in cardiac arrest can result in lapses in infection-controlprotocols. Copyright © 2022, Anka Publishers. All rights reserved.