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1.
Acta Phlebologica ; 22(3):79-83, 2021.
Article in English | EMBASE | ID: covidwho-1818990

ABSTRACT

BACKGROUND: This preliminary study aimed to evaluate the safety of radiofrequency (RF) thermoablation of the great saphenous vein (GSV) with immediate foam sclerotherapy of superficial tributary veins performed in the outpatient clinic (Hospital Department). Further, we also evaluated the cost reduction compared to the same procedure performed in the operating room. METHODS: Thirty patients were evaluated for RF thermoablation of the GSV. Foam sclerotherapy was performed with 1-3%sodium-tetra-decyl-sulphatefoam (Tessari’s method). We evaluated the possible risks of the procedure and methods to resolve them. We compared the costs of both procedures performed in the operating room and in the outpatient clinic. RESULTS: We had complete occlusion of the GSV in 28/30 patients (93.3%). Periodic check-up revealed a reflux through an anterior lateral saphenous vein in one patient and a long saphenous stump in another patient. There were no severe intraoperative complications. In two cases, it was necessary to convert the radiofrequency procedure into foam sclerotherapy (using the hollow probe as a long catheter in one case and using needle injection in the second case). In another case, it was necessary to perform surgical cannulation of the GSV. There were no severe postoperative complications. Moreover, the cost of the operating room procedure was € 1226.50, while that of the outpatient clinic procedure was € 1082.65 (cost reduction, 12.5%). CONCLUSIONS: This procedure is safe and sufficiently cost-effective to perform in an outpatient clinic and the operating room can hence be reserved for patients with more serious pathologies. These results should be validated in further studies with larger sample size.

2.
Acta Scientiae Veterinariae ; 50, 2022.
Article in English | EMBASE | ID: covidwho-1818984

ABSTRACT

Background: Diarrhea induced by infectious factors may lead to significant health problems in dogs. Canine parvovirus (CPV), canine coronavirus (CCV), canine distemper virus (CDV), Giardia spp., Escherichia coli (E. coli), and Salmonella spp. are the important infectious agents that may induce diarrhea in dogs. The present study aimed to investigate the effect of CPV, CCV, CDV, Giardia spp., E. coli, and Salmonella spp. infections on the change in serum calprotectin (Calp) concentration. Materials, Methods & Results: A total of 30 dogs were enrolled in the study. The study dogs were divided into 3 groups. Healthy animals as confirmed by clinical examination and animals negative for the specified pathogens were placed in Group 1. Animals infected by one or more agents, including CPV, CCV, CDV, and Giardia spp., but negative for E. coli or Salmonella spp. were placed in Group 2. Finally, animals positive for E. coli or Salmonella spp. and infected or not infected by one or more agents, including CPV, CCV, CDV, and Giardia spp., were placed in Group 3. Stool samples and rectal and conjunctival swab samples were collected to investigate the etiologic agents that induced diarrhea. Blood samples were collected through vena cephalica antebrachii for hematological and biochemical examinations. The samples were obtained via routine clinical examinations at the Prof. Dr. Servet Sekin outpatient clinic at Dicle University Veterinary Faculty. CPV, CCV, CDV, and Giardia spp. diagnoses were made based on immunochromatographic test kits. The bacteriological analysis of stool samples was used to diagnose E. coli and Salmonella spp. infection. Serum Calp concentrations were measured by Enzyme-Linked Immunosorbent Assay (ELISA). The analysis of swab and stool samples by immunochromatographic rapid diagnosis kits and microbiological methods showed that 5 animals were infected with CPV, 10 with CCV, 6 with CDV, 3 with Giardia spp., 12 with E. coli, and 2 with none of the specified agents. Total leukocyte count (WBC), lymphocyte (Lym - %), and granulocyte (Gra - %) values were higher in the diarrheal dogs when compared with the control group. In the biochemical examination of serum samples, total bilirubin (TBIL) and phosphorus (P) levels were higher and sodium (Na) levels were lower in Group 3 when compared to the control group (P = 0.025, 0.024, and 0.018, respectively). Total protein (TP) and albumin (Alb) values were lower in Group 2 compared to Groups 1 and 3 [P = 0.001 and 0.019 for TP, P = 0.000 and 0.01 for Alb, respectively]. There was a statistically significant difference in creatine kinase (CK) levels between Group 1 and Group 2 (P = 0.013). Serum Calp level was higher in the E. coli infected group (Group 3) compared to the other groups, no significant differences were noted between the groups (P > 0.05). Discussion: In conclusion, to the best of authors knowledge, this study is the first to evaluate serum Calp levels in dogs with diarrhea induced by viral, bacterial, and protozoan infections. The Calp level was higher in the sick dogs that were infected by at least one agent, including CPV, CCV, CDV, and Giardia spp., and were at the same time E. coli positive when compared with the control group and the group without E. coli infections. It was concluded that new studies could be useful to reveal the diagnostic importance of serum Calp concentration in dogs with diarrhea and that these results may contribute to future studies in this area.

3.
Journal of Clinical and Diagnostic Research ; 16(4):IC01-IC04, 2022.
Article in English | EMBASE | ID: covidwho-1818676

ABSTRACT

Introduction: Delhi, India’s capital, witnessed the first Coronavirus Disease 2019 (COVID-19) case on February 10, 2020, and subsequently three waves of the pandemic due to which the government had to impose lockdown starting March 25. It led to a decrease in patients seeking health care services for non emergency problems. Janakpuri Super Speciality Hospital (JSSH), a three hundred bedded autonomous institute under Delhi Government, also encountered a decrease in patient footfall. Aim: To identify the changes in trend in Outpatient Department (OPD) registrations and Inpatient Department (IPD) admissions during one year (January 1, 2020 to December 31, 2020) of COVID-19 pandemic in comparison to 2019 and also to analyse the collected data with the publicly available data on daily COVID-19 incidence in Delhi. Materials and Methods: A retrospective study was done by collecting data from the Janakpuri Super Speciality Hospital, Medical Record Department from 1st January 2019 to 31s December 2020, for daily OPD visits and IPD admissions. The collected data was analysed with the publicly available data on daily COVID-19 incidence in Delhi. Statistical analysis was performed using Microsoft Excel 2017. The non parametric exponential smoothening technique (dampening factor= 0.9) was applied over the dot plot graphs. Results: In 2020, compared to 2019, the daily OPD visits decreased by 37%. After an initial fall with March lockdown, there was a gradual increase in daily load. The OPD load peaked near middle of August 2020, The second big fall in OPD footfall occurred near second wave in September 2020, After that, OPD volume remained low till the 31st December 2020. Similarly, IPD admission volume peaked near the first wave in June 2020. The 2020 IPD admission volume also witnessed a massive decrease of 40.67% compared to 2019 and was maximum in gastroenterology admissions (65.63%). Conclusion: The study’s findings suggest that temporal associations between COVID-19 pandemic and hospital OPD and IPD admissions during 2020. The possibility of increased morbidity and mortality amongst non COVID-19 patients due to the unavailability of timely health care cannot be ruled out. The government should do capacity building to guide patients to identify the best doctor, clinic and hospital nearest to them in case of future pandemics.

4.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816933

ABSTRACT

Importance: Given concerns that cancer patients may be at increased risk of COVID-19 and may have more severe complications if infected, there have been profound changes to routine cancer care. We aimed to identify risk factors for developing COVID-19 among cancer patients. Methods: We conducted a retrospective cohort study of cancer patients tested for SARS-CoV-2 infection between March 1, 2020 and June 6, 2020 at NewYork-Presbyterian Hospital (NYPH)/Columbia University Irving Medical Center (CUIMC) in New York City. During this time period, all hospitalized patients (starting April 4, 2020) and all symptomatic cancer patients seen in the outpatient clinics were tested for COVID-19. Our primary outcome of interest was COVID-19 test results, defined as positive (SARS-CoV-2 detected on at least one test) or negative (not detected on any COVID-19 tests). Clinical data extraction included: age, sex, race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, Asian, other, unknown), body mass index (BMI), smoking status, time since cancer diagnosis, cancer type, current cancer status, most recent cancer treatment type within the past year, time since last cancer treatment prior to COVID-19 testing, and infusion center visit within the past year. Chi-squared tests and multivariable logistic regression were used to examine the association between demographic, clinical, tumor and treatment-related factors and COVID-19 test results while controlling for covariates. Results: A total of 1,174 cancer patients were tested for COVID-19 with 317 (27%) patients testing positive. Demographic characteristics of the study population included a median age of 67 years (range, 1-103), 55.1% female, and 35.7% non-Hispanic white, 32.5% Hispanic, 15.2% non-Hispanic black, and 4.0% Asian. About 27.2% had a recent cancer diagnosis, 56.7% had active disease, and 56.7% were on active cancer treatment within the past year. In multivariable analysis, older age and higher BMI were associated with COVID-19. Compared to non-Hispanic whites, black and Hispanic cancer patients were more likely to test positive for COVID-19 (odds ratio [OR]=2.21, 95% confidence interval [CI]=1.44-3.40 and OR=2.71, 95% CI=1.91-3.83, respectively). A recent cancer diagnosis, active disease, and active cancer treatment were not associated with COVID-19. Compared to cancer patients not on active treatment, those receiving chemotherapy were less likely to develop COVID-19 (OR=0.65, 95% CI=0.44-0.95). We observed excess deaths among cancer patients who tested positive vs. negative for COVID-19 (28.4% vs. 8.3%, p<0.001). Conclusions and Relevance: Consistent with the general population, we found that older age, minority race/ethnicity, and obesity were associated with COVID-19 among cancer patients. Surprisingly, patients on active treatment including chemotherapy were not at increased risk for COVID-19. Therefore, delays in cancer diagnosis and treatment during the COVID-19 pandemic should be minimized.

5.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816910

ABSTRACT

INTRODUCTION: COVID-19 has been declared as a pandemic by the World Health Organisation (WHO)in December 2019, as it spread globally and confirmed cases approach 5,000 000 patients and will exceed 365000 deaths on the 25 May 2020 across over 160 countries. Cancer patients are one of the most vulnerable groups in the current (COVID-19) pandemic. To date, the clinical characteristics of COVID-19-infected cancer patients remain widely not well understood. Patients and methods A retrospective study was conducted in Royal Wolverhampton NHS Trust for COVID-19 Cancer patients. Hospitalised cancer patients diagnosed with COVID-19 infection were identified between 30th March 2020 to 30th June 2020. Patients already have been diagnosed with cancer and had a laboratory-confirmed SARS-CoV-2 infection were enrolled. Clinical retrospective data were collected from hospital medical records, including demographic features, clinical features, laboratory findings, and chest radiograph and chest computed tomography (CT) images. Statistical analysis was done to assess the risk factors associated with severe events which required admission to an intensive care unit, the use of mechanical ventilation, or death Results Forty Cancer patients with Covid 19 infection during the period from 30th March 2020 to 30th June 2020 were enrolled. (52.6%) 22 of patients were females. Median age was 65 years .All patients were local residents of Wolverhampton. Among the cancer patients, Breast cancer was the most frequent type of cancer (n= 9;21.1%), followed by Gl cancers (n= 8;21%) and lymphoma (n = 6;15.8%).Twenty two patients (52.6%) were diagnosed with stage I-III cancer.18 patients (47.4%) were on active chemotherapy, 3 patients were on target therapy and 3 patients(7.9%) were on active immunotherapy. In addition to cancer, 31 (81.6%) patients had at least one or more coexisting chronic diseases. The most common clinical features on admission were fever (92.1%), dry cough (86.8%), and fatigue (92%);29 (76.3%) patients developed dyspnoea along with lymphopaenia (n = 32, 84.2%), high level C-reactive protein (n = 40, 100%), anaemia (n = 22, 57.9 %), and hypoproteinaemia (n = 21, 55.3%). The common chest computed tomography (CT) findings were ground-glass opacity (n = 13) and patchy consolidation (n= 4) .It is important to note that CT chest not done in 17 patients. A total of 19 patients had severe events and the mortality rate was (44.7%) .Median days of hospital admission was (12.5).It is noted that all patients with active immunotherapy had recovered despite disease progression. Conclusions: Cancer patients have deteriorating conditions and worse outcomes from the COVID-19 infection. It is recommended that cancer patients receiving antitumour therapies should have regular screening for COVID-19 infection and should avoid treatments causing immunosuppression or have dose reduction during COVID-19 Pandemic in second wave .Covid 19 has different response with patients on active immunotherapy need to be highlighted.

6.
Clinical Neurosurgery ; 67(SUPPL 1):54, 2020.
Article in English | EMBASE | ID: covidwho-1816184

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has substantially disrupted inpatient and outpatient neurosurgical care. METHODS: Patients who underwent a neurosurgical operation, inpatient consult, or outpatient appointment at Vanderbilt University Medical Center between March 23, 2019 and April 20, 2020 were identified. The March 23, 2020 Tennessee gubernatorial executive order was used to distinguish pre-and post-COVID cases. RESULTS: The total number of pre-and post-COVID cases was 4,152 and 195, respectively. Overall, a 45% reduction in median weekly operative case volume was demonstrated (82/week to 45/week;P=.001) after March 23. There was an observed downtrend in case volume in the weeks leading up to March 23. There was a 47% reduction for adult procedures (68/week to 36/week;P = .001) and 29% reduction for pediatrics (14/week to 10/week;P = .017). Among adult procedures, the most significant decreases were seen for spine surgeries (P = .008) and endovascular procedures (P = .036). Total weekly inpatient consults to adult neurosurgery decreased by 30% (97/week to 68/week;P <.001) with no significant change to pediatric consults. Adult and pediatric outpatient clinic visits decreased by 28% (552/week to 400/week;P = .021), with a 54% decrease for in-person encounters (551/week to 254/week;P = .001). Weekly Telehealth encounters increased from 0/week to 130/week. CONCLUSION: There was a significant reduction in pediatric and adult neurosurgical procedures, clinic visits, and adult inpatient consults during COVID-19. Telemedicine was increasingly used for assessment. Identifying neurosurgical procedures most impacted by COVID-19 delays may aid in the development of effective triage strategies for elective surgeries as they are reinstated.

7.
Journal of Pakistan Association of Dermatologists ; 32(1):117-122, 2022.
Article in English | EMBASE | ID: covidwho-1812772

ABSTRACT

Background Pityriasisrosea (PR) is an exanthematous disorder accompanied by systemic recurrence of HHV 6 and/ or 7. Objective To explain the link between levels of vitamin D and CXCL10 in persistent PR during COVID-19. Methods The study encompassed 25 patients (10 males and 15 females, age range: 10-40 years) with persistent PR more than 12 weeks and 25 control subjects (12 males and 13 females, age range: 11- 38 years) examined in the medical Excellence center, Dermatology Outpatient Clinic, National Research Center, Egypt between November 2020 and March 2021. Blood samples were collected from controls and persistent PR patients for more than 12 weeks, 15 days later after topmost clinical symptoms. Assessment of serum CXCL10 was done by ELISA kit. Vitamin D was determined using the chemi-luminescence technique. Results A student unpaired T- test was done at P<0.05 illustrating a significant increase in levels of CXCL10 while a significant decrease in levels of vitamin D in the sera of both male and female patients in comparison to control ones. Conclusion Our study provided evidence that circulating CXCL10 is elevated in persistent PR patients as well as in COVID-19 where PR is one of clinical symptoms of coronavirus. This highlights the immunological response in PR and contributes to a clear explanation of cutaneous defense mechanism. Vitamin D showed a significant reduction in persistent PR patients and has been shown to be safe and guard against acute respiratory infections as in COVID-19

8.
Wounds UK ; 18(1):34-41, 2022.
Article in English | EMBASE | ID: covidwho-1812598

ABSTRACT

Background: Understanding the burden of surgical site infection (SSI) requires comprehensive, reliable and comparable data. However, many hospitals do not routinely collect information on wound healing after the patient leaves hospital. Aim: To evaluate five post-discharge surveillance strategies that collect patient/carer reported outcomes on wound healing following adult and paediatric surgery. Method: Between March 2020 and February 2021, colleagues from five specialist hospitals in England collaborated to collect baseline and compliance data for the different methods of postdischarge surveillance. The five methods included were telephone follow-up;postal questionnaires;postal questionnaires and contacting non-responders by telephone to asking patients to install a postoperative app on their personal smartphone (Medopad, Huma) and using a SSI surveillance text link, which did not need to be installed (Isla, Islacare Ltd). Results: Overall, 1432 patients out of 2116 patients provided information about their wound after discharge. The group of patients who were asked to install an app on their smart device had the lowest return rate for information on their wound, while the system that used a text link and did not need to be installed had one of the highest return rates. Conclusion: Understanding baseline practice and evaluating different methods of discharge surveillance may help to drive improvement in this area. Our early findings suggest that in practice, a SSI surveillance approach using a text link and photos, such as Isla, which is used in hospital before discharge by staff and post-discharge by patients warrants further attention.

9.
International Journal of Cardiovascular Imaging ; 2022.
Article in English | EMBASE | ID: covidwho-1800348

ABSTRACT

In hospitalized COVID-19 patients, myocardial injury and echocardiographic abnormalities have been described. The present study investigates cardiac function in COVID-19 patients 6 weeks post-discharge and evaluates its relation to New York Heart Association (NYHA) class. Furthermore cardiac function post-discharge between the first and second wave COVID-19 patients was compared. We evaluated 146 patients at the outpatient clinic of the Leiden University Medical Centre. NYHA class of II or higher was reported by 53% of patients. Transthoracic echocardiography was used to assess cardiac function. Overall, in 27% of patients reduced left ventricular (LV) ejection fraction was observed and in 29% of patients LV global longitudinal strain was impaired (> − 16%). However no differences were observed in these parameters reflecting LV function between the first and second wave patients. Right ventricular (RV) dysfunction as assessed by tricuspid annular systolic planar excursion (< 17 mm) was present in 14% of patients, this was also not different between the first and second wave patients (15% vs. 12%;p = 0.63);similar results were found for RV fraction area change and RV strain. Reduced LV and RV function were not associated with NYHA class. In COVID-19 patients at 6 weeks post-discharge, mild abnormalities in cardiac function were found. However these were not related to NYHA class and there was no difference in cardiac function between the first and second wave patients. Long term symptoms post-COVID might therefore not be explained by mildly abnormal cardiac function.

10.
Respiratory Case Reports ; 11(1):19-24, 2022.
Article in English | EMBASE | ID: covidwho-1798778

ABSTRACT

COVID-19 coagulopathy has gained attention due to the strikingly high prevalence of deep vein thrombosis (DVT) and pulmonary embolism (PE). We describe here a case of bilateral PE preceded by mild COVID-19 contracted 4.5 months earlier in a male patient who presented to the outpatient clinic with exertional dyspnea. The patient had developed PE 9 years earlier, when no underlying genetic factor was detected. In the 4.5 months after contracting mild COVID-19, he presented four times with exertional dyspnea and a thorax computer tomography angiography (CTA) on two occasions and one perfusion scintigraphy revealed no embolism. Based on his high D-dimer values, his symptoms and his history of PE, he was placed on prolonged PE prophylaxis, which was stopped 33 days ago, and at that time, CTA revealed extensive bilateral PE. In conclusion, an unusually longer activation in COVID-19 coagulopathy may co-exist in patients with a history of previous PE, ongoing symptoms and increased D-dimer levels, irrespective of the COVID-19 severity.

11.
Journal of Clinical and Diagnostic Research ; 16(SUPPL 1):5-6, 2022.
Article in English | EMBASE | ID: covidwho-1798698

ABSTRACT

Sir William Osler said, To study the phenomena of disease without books is to sail an unchartered sea, while to study books without patients is not to go to sea at all. This quote is a bleak reminder of the state of clinical teaching after nearly two years of Covid disrupting the implementation of our curriculums across the country given the recent roll out of a Competency-based Curriculum. We cannot allow the undergraduate course to slip into a distant online mode for fear of losses of competences mandated to perform professional roles as physicians of first contact. The focus of this brief lecture is on Undergraduate Teaching-Learning in Clinical Medicine though post-graduate education is not necessarily exempt from these ideas. It will attempt to suggest possibilities given the existing context of the transformation towards the new Competency-based Curriculum and the facts of faculty-student ratios that challenge us. Assumptions must be stated at the beginning that faculty are not only motivated but also enthusiastic and interested in their task to educate their undergraduates to learn and the vice versa exists especially in dealing with students in their clinical phase of studentship. If the patient needs to return to the centre of our education, then moving very moment of teaching to the bedside, Outpatient clinic, Emergency and even Operation Theatre are the needs of the hour. Key elements towards achieving competences and outcomes require us to insist on small groups (usually not more than 15-20 per unit) and formative assessments ongoing throughout phases of teaching clinical medicine. To force multiply we need to include Senior Residents and Postgraduates (even the special Intern) into the pool of 'Faculty' and more importantly use every opportunity to provide experiences in the clinical settings mentioned above not restricted to 'nine to five work hours'. Outpatient (Ambulatory) clinic has great potential to teach small groups of clinical students assigned to shadow faculty and residents/interns working up patients in regular outpatient clinics even participating actively in the actual care and treatment of patients. Since clinical postings occur usually through three semesters leading up to final examinations, judicious involvement in 'work ups' documented in case notes or logbooks as students under supervision of faculty/residents makes fabulous learning. Initial postings begin with history and anthropometric measurements and growth charting leading to physical examination both General and Systems finally even deciding on differentials with investigation plan and writing then counselling regards prescriptions. All this is after it is present to the faculty/resident in the presence of the parents for confirmation or clarifications. Undergraduates enjoys a single patient work up by every student assigned to a faculty/resident is enjoyed by undergraduates simply because it is realistic. Of course, informing the patient or attender of the patient and appropriate allocation even of healthy or follow up patients for this exercise makes this a possibility. It is rare that such an informed patient or attender disallows such an exercise. Depending upon outpatient space, the clinical exercise may occur while sitting opposite the faculty/resident in the same consult room or in a nearby room to return to the faculty/resident's room for presentation in front of the parents. One may hasten the process by focusing on a one patient-one key learning system and various models have been described by John Dent and Ronald Harden classified on Student - Faculty ratios. As an example, in the case of Paediatrics, focusing on growth charting, practical immunisation, nutrition counselling, discussing most likely differentials, investigation approaches, form filling, rational therapeutic choices, optimal prescriptions, education and counselling may be chosen as learning points for different students seeing different patients. Initially, case notes of history and examination are allowed onto outpatient charts followed by assisting by investigation requests, discussing results when relevant and finally actually writing prescriptions to be scrutinised and signed off by faculty/residents. The obvious disadvantage is that it does slow down patient clearance but while students work up their patient's one can continue to clear other patients and every patient does not need to be handed over to students to work up. Their involvement in actual patient care makes great inspiration to learn more. Ambulatory settings also allow one to direct students to the immunisation room or pharmacy to observe and under supervision begin to even administer common vaccines while recognising components of the many prescriptions we dispense. We all know that to do is the best way to strengthen the learning experience. Teaching in the wards at the bedside of patients is also rather fulfilling and motivational for students to understand and want to learn the art and science of medicine. The bedside clinic has been the cornerstone of clinical education only to disintegrate as one 'Bakra' works up and presents the chosen allocated patient to the faculty while the remaining clinical batch of students passively stand by hopefully learning. Allocating patients or beds to individual students or a pair of students, the latter in early postings, with mandatory responsibility of working up and seeing 'their' patients every morning of the clinical posting with details entered in the logbook book is the first step. The faculty assigned for the bedside that day, does not reveal the patient to be discussed but may randomly pick up one of the patients asking the student(s) 'responsible' to present. This mandates that all students posted have to be up to date with history, examination, investigation results and treatment if not daily assessments and care plan. Another successful involving method is to walk up to the batch allocated patients from the parent unit after they have seen their patients for the day and conducting teaching rounds mimicking realistic patient service rounds. Each student or pair of students presents updates of their patients and discussions occur similar to one has on regular rounds. Differentials are argued, Investigation results analysed and Treatment options even choice of antibiotics with doses and duration justified. This clerkship exercise is an early extension of internship and we all know that most learning occurs during Internship at least in our times. Documentation may occur in student logbooks but one may make provisions that patient progress notes be clearly identified as student learning notes and documented as such. The student-doctor then needs to not only interact with patients, practice examining patients, documenting the same, to chase results and cross consults. Common non-medical issues faced in care and treatment are then experienced by students. It is only in the ward that feeding, introducing intravenous cannula, performing phlebotomy, medications administration, infusions, monitoring transfusions, transportation within hospital, changing diapers and even bed making is experienced. It is in the wards that opportunities to participate in procedures like LPs, biopsies, etc. occur making sure that documentation occurs in logbooks. To enable more excitement in learning, the mandating evening duties as observers from 6-8 pm assigned to report to duty residents/postgraduates as they deal with emergencies and regular work documenting what they observe during such duties. Observation in Operation Theatres or in areas where procedures occur only makes good learning if there is a structured system in place, where the teacher briefs the students preparing them for what they are to witness and observe followed by the actual witnessing of the procedure/intervention ending with debriefing of the steps involved and findings. The continuum of learning must continue into the postoperative period to complete the learning by student participation in post-operative rounds. In later postings, the occasional opportunity to scrub up to 'participate' in the intervent on adds to the inspiration to learn. In all these encounters, students must adhere to norms expected of professional behaviour And patient consent by the primary care provider essential. Patients if informed do understand the need and accept reasonable student interaction during their stay in medical college settings. Involving them in providing feedback of students who interviewed and examined them also makes great learning points right from dress code to demonstrating respect. This brief lecture shares ideas to recognise and optimise utilisation of possible teachable moments in clinical medicine thus opening up possibilities of many other ideas from participants.

12.
Pakistan Journal of Medical and Health Sciences ; 16(2):186-190, 2022.
Article in English | EMBASE | ID: covidwho-1798526

ABSTRACT

Aim: To ascertain the frequency of acceptance and rejection of covid-19 vaccination and the reasons behind their choices among pregnant and breast feeding women visiting outpatient department of a tertiary care setup. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Unit -1 for a period of one month. All women attending outpatient department during the study, fulfilling the inclusion criteria and willing to participate in the study were included after informed consent. A questionnaire designed to acquire general information about the study participant was filled by the researcher. Data was entered and analyzed using SPSS vr 21.0. Results: Out of 500 enrolled women, 249(49.8%) women were pregnant and 251(51.2%) were breast feeding. 171(34.2%) were vaccinated and 329(65.8%) were unvaccinated. There is a significant association between the concept regarding unavailability of significant data regarding safety during pregnancy and breast feeding or vaccine being harmful during pregnancy and breastfeeding for mother & baby and acceptance of vaccine (p-value < 0.001) Conclusion: Safety concerns regarding the vaccine for pregnant and breast-feeding mothers still hold them from getting vaccinated. Obstetricians and Gynaecologists of the country need to play a vital role in building up the confidence of this population over vaccination and should strongly recommend pregnant and breast feeding women following up in clinics to get vaccinated.

13.
Journal of Urological Surgery ; 9(1):57-62, 2022.
Article in English | EMBASE | ID: covidwho-1792137

ABSTRACT

Objective: This study aimed to present the impact of coronavirus disease-2019 pandemic on seeking treatment in patients with erectile dysfunction (ED) and compare the clinical characteristics, demographics, and laboratory analysis of patients with ED during and before the pandemic period. Materials and Methods: The clinical and demographic characteristics and laboratory analysis of patients with ED were compared between the time interval of March 9, 2020, to June 1, 2020, and the previous 3 months from the pandemics. The International Index of Erectile Function-5 questionnaire was used to assess ED and the results from two groups were compared. Results: A 76.4% decreased total number of outpatient clinics and a 70.9% decreased number of patients with ED was observed;however a significant increase was detected in the ratio of patients with ED to the total number of patients during the pandemic period (1.7% vs. 2.1%, p=0.008). The median age of patients was smaller in the pandemic period. Mild ED was significantly higher in the pandemic period and moderate ED was detected higher in the period before the pandemic. Conclusion: The admission rate of patients with ED has increased in the pandemic period. The patients presenting with ED during the pandemic period were younger, with milder ED symptoms.

14.
Pakistan Paediatric Journal ; 46(1):67-74, 2022.
Article in English | EMBASE | ID: covidwho-1790130

ABSTRACT

Objective: The current study intends to look at how COVID-19 pandemic affected parenting practices during COVID-19 in Pakistan and if the children were exposed to more abuse and neglect at home. Study Design: A quantitative design survey. Place and Duration of the Study: Data was collected from parents visiting outpatient departments (OPDs) in four hospitals of Lahore, Peshawar, and Karachi in three months from July to September 2020. Material and Methods: A quantitative design survey was used, and data (N=923) were collected using a self-administered COVID-19 Parenting Response Scale (α = 0.74). Results: The primary responsibility of taking care of children rested with mothers in most of the cases. Ratio of severe disciplinary practices like shouting, yelling, cursing, and slapping children was increased significantly during the lock down as the anger and frustration in the parents also mounted. This effect was more pronounced in families from lower socioeconomic groups as well as for those who suffered income loss during COVID-19. Conclusion: Financial and emotional stress caused by COVID-19 exacerbated the already difficult parenting practices. Ultimately children suffered more violence at the hands of parents. In Pakistani society there is little awareness on building one‟s capacity on good parenting and little availability of such trainings. There is a need to understand implications for good parenting and create awareness of positive parenting methods.

15.
Journal of Clinical and Diagnostic Research ; 16(3):LC26-LC32, 2022.
Article in English | EMBASE | ID: covidwho-1780260

ABSTRACT

Introduction: Coronavirus Disease 2019 (COVID-19) appropriate behaviour and vaccination are two critical defenses in the fight against this pandemic. As these need to be followed religiously, this preventive behaviour should be thoroughly investigated. Aim: To examine the COVID-19 vaccine behaviour amongst people attending tertiary care centre at Patiala, Punjab, India. Materials and Methods: A cross-sectional study was conducted on 200 individuals attending the Outpatient Department of Government Medical College at Patiala, Punjab, India, from 15th July to 22nd July 2021. Individuals were administered socio-demographic questionnaire, General Health Questionnaire-12Hindi version (GHQ-12), and COVID-19 vaccine related and COVID-19 appropriate behavior related questionnaire. Actual observation by the clinician regarding proper use of face masks, hand hygiene and social distancing was done and objectively scored on 0-10 for each item with a scale interval of 2. Analysis was conducted using IBM Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Only 40% individuals were vaccinated. After eligibility, there was a mean delay of 4.20±3.51 weeks (median: 4 weeks) and 13.40±3.33 weeks (median: 12 weeks) in the vaccinated and unvaccinated individuals. Out of 120, 86 unvaccinated participants planned to get vaccinated in future. Significantly lower scores were obtained for actually observed COVID-19 appropriate behaviour (proper mask usage, hand hygiene and social distancing) as noted by the clinician vs the scores as reported by the participants. Conclusion: There were few takers for the COVID-19 vaccine, even weeks after eligibility. The COVID-19 appropriate behaviour was largely not being followed properly and the false sense of following the same complicated issues further. With multiple waves of the pandemic one after the other, and booster doses of vaccination, there is still an urgent need to sensitise the population at the grass root level regarding the COVID-19 vaccine behaviour to fight this pandemic.

16.
Blood ; 138(SUPPL 1):4020, 2021.
Article in English | EMBASE | ID: covidwho-1770432

ABSTRACT

Background Yttrium-90 ibritumomab tiuxetan [(90)Y-IT;Zevalin] is a radio-immunoconjugate (RIC) which targets CD20. This study evaluates the utilization and cost-effectiveness of (90)Y-IT in the first line treatment for patients with previously untreated low-grade FL (UFL) and marginal zone lymphoma (UMZL) treated at our institution with (90)Y-IT. Methods We utilized the Advanced Text Explorer (ATE) and the Lymphoma SPORE databases to identify two groups of patients with UFL, WHO grade 1-2, and UMZL who received treatment with either (90)Y-IT or bendamustine plus rituximab (BR) at Mayo Clinic Cancer Center between January 2003 and December 2019. We excluded all patients who had >25% bone marrow involvement with lymphoma for the BR group as this was a requirement for (90)Y-IT treatment. Inverse propensity weighting was utilized to balance the groups for baseline patients and disease characteristics. We use progression-free survival (PFS) as a denominator for the cost effectiveness/utilization evaluation. We identified meaningful and retrospectively measurable outcomes to compare between the groups. we extracted the following data;number of clinic visits in the first year after therapy, emergency room visits, number of hospital admissions, number of hospitalization days, numbers of days on the floor and ICU, number of infections, number of neutropenic fever hospitalizations, number of C-difficile events, number of blood products transfusions, overall use of growth factors due to therapy induced neutropenia, average number of times a growth factor was used, and the number of therapeutic use days. We defined days of therapeutic use as the number of days a treatment was administered on. We also calculated the average cost of the induction treatment when utilizing either (90)Y-IT or BR. The therapeutic cost included only the cost of the medications/therapies and their administration. Results Our cohort consists of a total of 143 patients - 64% (92/143) received BR and 36% (51/143) received (90)Y-IT (see Table-1 for clinical characteristics).The median follow-up from the time of therapeutic administration for the (90)Y-IT group was 5.3 years (95% CI;4.2, 6.2) with one death and 4.7 years (95% CI;3.9, 4.9) for the BR group with 6 deaths. The ORR was 100% in (90)Y-IT group with 94% achieving complete response (CR) while ORR in the BR group was 98% with 95% achieving CR. Rituximab maintenance was utilized in 33% of BR patients compared to only 6% in patients who received (90)Y-IT, p=0.002. After utilizing inverse propensity weighting (Figure-1), 5 years PFS was 76% for the (90)Y-IT group and 75% for the BR group, p=0.63 (Figure-2). We evaluated the average treatment effect of (90)Y-IT compared to BR on utilization outcomes, Table-2. (90)Y-IT required an average of 4.5 clinic visits less within the first year after treatment compared to BR group, p<0.001. (90)Y-IT patients had an average of 10 days less of therapeutic use days compared to the BR group, p<0.001. Patienta had similar admission rates to the hospital in both groups. However, when patients were admitted to the hospital in the first year after treatment, those who received (90)Y-IT spent an average of 1.5 days less in the hospital compared to the BR group, p=0.046. The overall use of growth factors was 40% less in the (90)Y-IT group as compared to the BR group, p<0.001. The therapeutic cost of induction of (90)Y-IT was 54% less than that of 6 cycles of BR. Transformation to a high grade of lymphoma was seen in 4 patients in the BR group and 2 patients in the (90)Y-IT group. There was only one case of myelodysplastic syndrome in the BR group and none in the (90)Y-IT group. Conclusion Radio-immunoconjugate therapy with (90)Y-IT is a very convenient and cost-effective treatment for low-grade UFL and UMZL. This is especially important amidst the COVID-19 pandemic as it requires less contact with the health system with decreased number of therapeutic days, clinic visits, use of growth factors and number of hospitalization days. The cost of the therapeutic agents and heir administration was also significantly lower for the (90)Y-IT which could help reducing the burden on the health system. (Figure Presented).

17.
British Journal of Surgery ; 109(SUPPL 1):i53, 2022.
Article in English | EMBASE | ID: covidwho-1769161

ABSTRACT

Aim: The COVID-19 pandemic posed many challenges to healthcare system in the UK. Attempts were made to ensure the provision of treatment, continuity of care and follow-up of the patients. As a result, implementation of telephone consultations was started for most of the outpatient appointments. The aim of this study was to evaluate patient satisfaction and views on this alteration in service. Method: The first 150 patients who had breast clinic appointments delivered by telephone consultation at Ipswich hospital during the pandemic in early 2020 were retrospectively identified and sent a postal survey. The satisfaction levels were assessed through a degree of agreement with statements (four items), yes/no answers (two questions), and space for comments. Results: 142 survey responses were included (94.7% response rate). The majority of patients (n=130) were satisfied with the care they received. Even though almost half of the patients stated that they would like to be seen face-to-face in the hospital, only 10% (n=4) of them stated that they would not like a second phone consultation. Surprisingly,78% (n=117) of patients stated they would be happy for further breast clinic appointments to be carried out in the same way. Conclusions: Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic, achieving high satisfactory rate amongst patients. Our findings suggest that this tool has benefits in post pandemic healthcare delivery. Can telephone reviews be the future in outpatient clinic consultations?.

18.
British Journal of Surgery ; 109(SUPPL 1):i14, 2022.
Article in English | EMBASE | ID: covidwho-1769154

ABSTRACT

Aim: During the COVID-19 pandemic, many surveys have analysed the impact of the virus spreading on everyday medical practice, including neurosurgery. However, no one has examined the perceptions of neurosurgeons towards the pandemic, their life changes, and the strategies they implemented to deal with their patients in such a difficult time. Method: From April 2021 to May 2021, a modified Delphi method was used to construct, pilot, and refine the questionnaire. The first part focused on the evolution of global neurosurgical practice during the pandemic. This survey was distributed worldwide among 1000 neurosurgeons. The responses were then collected and critically analysed. Results: Outpatient department practices changed with a rapid rise in teleservices. 63.9% of respondents reported that they had changed their OT practices to emergency cases with occasional elective cases. 40.0% of respondents and 47.9% of their family members reported having suffered from COVID-19 at some time. 56.2% of the respondents reported having felt depressed in the last 1 year. 80.6% of the respondents found online webinars to be a good source of learning. 47.8% of respondents tried to improve their neurosurgical knowledge, while 31.6% spent extra time in research activities during the COVID-19 pandemic. Conclusions: Progressive increase in operative waiting lists, preferential use of telemedicine, reduction in the tendency to complete stoppage of physical clinic services and reduction in the administration and application of PPE kits were evident across the world. Respondents' age impacted how the clinical services and impacted mental health across the global neurosurgical fraternity.

19.
Journal fur Neurologie, Neurochirurgie und Psychiatrie ; 22(2):76-79, 2021.
Article in German | EMBASE | ID: covidwho-1766845

ABSTRACT

Introduction: The COVID-19 pandemic has become the most prominent event of 2020, posing major challenges to both society and politics. Many surgical departments had to be restructured with more or less vague recommendations to be prepared for the feared onslaught of COVID-patients. This work served to capture the daily routine of spine surgery during the Corona pandemic. Patients & Methods: An online questionnaire with 32 questions about professional and personal daily life was sent to members of neurosurgical and spine surgical societies in the DACH region during the initial lockdown. Results: Daily professional life was very similar for a large proportion of respondents. Outpatient clinics were reduced to a minimum and replaced by telemedical care. Intra-departmental meetings were greatly reduced and employees were divided into „split teams“. The operative program was organized very differently in the DACH region. 92% of respondents reported that semi-acute or acute procedures had been postponed, while 6% of respondents were only able to perform emergency surgeries. Conclusion: Despite the lack of guidelines and almost daily changing policy guidance, many departments in the DACH region demonstrated very similar courses of action to contain nosocomial infections and prepare for the onslaught of COVID-patients. The lack of resources (masks, gloves, etc.) led to a further restriction of the surgical program in order to be able to continue to provide the basic equipment for effective work of medical staff. In light of future medical crises, this problem should be addressed in the future and consequently better organized.

20.
Archives of Cardiovascular Diseases Supplements ; 14(1):117, 2022.
Article in English | EMBASE | ID: covidwho-1757022

ABSTRACT

Despite the upheavals in health care systems related to the onset of the COVID-19 pandemic, cardiac rehabilitation (CR) needs to continue for inpatients experiencing recent cardiac surgery or severe heart failure because CR improves patient outcomes, reduces readmissions and lowers long-term costs. Our aim is to share the strategies implemented in our facility to minimize the risk of COVID-19 transmission and thus ensure safe and efficient CR for the inpatients. We describe the guidelines that were applied in our cardiac rehabilitation unit (CRU) during the containment phase in France, from March 17 to May 11, 2020. We report the incidence of COVID-19 confirmed cases by RT-PCR testing among symptomatic inpatients and health care workers (HCWs) within the same timeframe. Our strategy was focused on isolation of all inpatients and protection of the professionals. The main measures were systematically placing admitted patients in a single room, generalizing the use of surgical masks for HCWs and inpatients, suspending day hospital activity. The CR program was based on individual exercise and education, plus collective activities involving 2 or 3 patients with respect of enhanced barrier measures. From March 17, to May 11, 2020, 97 patients have been hospitalized in the CRU. The average length of stay was 24 days. Five members of the health care staff (5/205, 2.4%) were suspected cases and all tested negative for COVID-19. Eighteen inpatients (18/97, 18%) tested for COVID-19 and 2 (2/18, 11%) tested positive. Patient No. 1 had a positive test 10 days after her admission to the CRU. Patient No. 2 tested positive on the day of his admission. Both had recent cardiac surgery. They were transferred back to the hospital. No secondary case was detected in the CRU. CR can be performed in a safe way for both inpatients and HCWs during the COVID-19 pandemic era. In our experience, strict isolating and protecting measures are efficient to avoid nosocomial SARS-CoV-2 spread in CRUs.

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