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J Neurosurg ; : 1-11, 2022 Sep 16.
Article in English | MEDLINE | ID: covidwho-2039641


OBJECTIVE: The outbreak of COVID-19 and the sudden increase in the number of patients requiring mechanical ventilation significantly affected the management of neurooncological patients. Hospitals were forced to reallocate already scarce human resources to maximize intensive care unit (ICU) capacities, resulting in a significant postponement of elective procedures for patients with brain and spinal tumors, who traditionally require elective postoperative surveillance on ICU or intermediate care wards. This study aimed to characterize those patients in whom postoperative monitoring is required by analyzing early postoperative complications and associated risk factors. METHODS: All patients included in the analysis experienced benign or malignant cerebral or intradural tumors and underwent surgery between September 2017 and May 2019 at University Hospital Münster, Germany. Patient data were generated from a semiautomatic, prospectively designed database. The occurrence of adverse events within 24 hours and 30 days postoperatively-including unplanned reoperation, postoperative hemorrhage, CSF leakage, and pulmonary embolism-was chosen as the primary outcome measure. Furthermore, reasons and risk factors that led to a prolonged stay on the ICU were investigated. By performing multivariable logistic regression modeling, a risk score for early postoperative adverse events was calculated by assigning points based on beta coefficients. RESULTS: Eight hundred eleven patients were included in the study. Eleven patients (1.4%) had an early adverse event within 24 hours, which was either an unplanned reoperation (0.9%, n = 7) or a pulmonary embolism (0.5%, n = 4) within 24 hours. To predict the incidence of early postoperative complications, a score was developed including the number of secondary diagnoses, BMI, and incision closure time, termed the SOS score. According to this score, 0.3% of the patients were at low risk, 2.5% at intermediate risk, and 12% at high risk (p < 0.001). CONCLUSIONS: Postoperative surveillance in cranial and spinal tumor neurosurgery might only be required in a distinct patient collective. In this study, the authors present a new score allowing efficient prediction of the likelihood of early adverse events in patients undergoing neurooncological procedures, thus helping to stratify the necessity for ICU or intermediate care unit beds. Nevertheless, validation of the score in a multicenter prospective setting is needed.

Journal of the Formosan Medical Association ; 121(9):1617-1621, 2022.
Article in English | Scopus | ID: covidwho-2015654
Journal of Clinical Periodontology ; 49:348, 2022.
Article in English | EMBASE | ID: covidwho-1956767


Background: Recent scientific evidence states that a subset of COVID-19 patients have a risk of increased bleeding tendency. This case report presents a 38-year-old woman with periodontitis, generalized stage III, grade C with an abnormal post-operative blood clot formation, who tested positive for COVID-19 5 days after a standard periodontal surgery. Description of the procedure: After initial periodontal treatment and re-evaluation, we proceeded to the surgical phase including: 1. regenerative procedure with EMD 15 2. regenerative procedure with EMD 44 3. open flap debridement 13-23 4. shortened flap 34-37. Outcomes: Periodontal surgical procedures (1) and (2) proceeded without any complications and were considered standard. On day 1 after the third periodontal surgery (3), the patient was called for post-operative control. The patient had no complaints.On day 2 post-operative, the patient reported by email excess of bleeding in the oral cavity from the operated area, simultaneously with fever and loss of taste. A photo taken by the patient confirmed the abnormal blood clot. On day 3, in compliance with COVID-19 protocols, the patient was seen urgently in our clinic while her COVID-19 symptoms had started to decline. During the appointment, the bleeding tendency was less acute than the day before. Further suturing for precaution was decided. The same day the patient received a COVID-19 PCR test. On day 4 post-operative, the report of the PCR test was confirmatory for COVID-19 and the patient reported no further complaints of intraoral bleeding. Conclusions: After considering the normal response of the initial treatment and the well documented good post-operative healing pattern of the periodontal tissues for this patient, we concluded that the abnormal bleeding tendency was associated with an active phase of COVID-19. Clinicians should be aware that during the first days after a periodontal surgery patients could have bleeding complications due to an active phase of COVID-19. subset-of-covid-19-patients-have-increased-bleeding-risk.