Liver and Biliary Tract Disease in Patients with Coronavirus disease-2019 Infection.

Coronavirus disease-2019 (COVID-19) had become a global pandemic since March 2020. Although, the most common presentation is of pulmonary involvement, hepatic abnormalities can be encountered in up to 50% of infected individuals, which may be associated with disease severity, and the mechanism of liver injury is thought to be multifactorial. Guidelines for management in patients with chronic liver disease during COVID-19 era are being regularly updated. Patients with chronic liver disease and cirrhosis, including liver transplant candidates and liver transplant recipients are strongly recommended to receive SARS-CoV-2 vaccination because it can reduce rate of COVID-19 infection, COVID-19-related hospitalization, and mortality.

Decreased hospitalizations and deaths from community-acquired pneumonia coincided with rising public awareness of personal precautions before the governmental containment and closure policy: A nationwide observational study in Japan (preprint)

Background The effectiveness of population-wide compliance to personal precautions (mask-wearing and hand hygiene) in preventing community-acquired pneumonia has been unknown. In Japan, different types of non-pharmaceutical interventions from personal precautions to containment and closure policies (CACPs, e.g. stay-at-home requests) were sequentially introduced from late January to April 2020, allowing for separate analysis of the effects of personal precautions from other more stringent interventions. We quantified the reduction in community-acquired pneumonia cases and deaths and assessed if it coincided with the timing of increased public awareness of personal precautions before CACPs were implemented. Methods A quasi-experimental interrupted time series design was applied to non-COVID-19 pneumonia hospitalization and 30-day death data from April 2015 to August 2020 across Japan to identify any trend changes between February and April 2020. We also performed a comparative analysis of pyelonephritis and biliary tract infections to account for possible changes in the baseline medical attendance. These trend changes were then compared to multiple indicators of public awareness and behaviors related to personal precautions, including keyword usage in mass media coverage and sales of masks and hand hygiene products. Findings Hospitalizations and 30-day deaths from non-COVID-19 pneumonia dropped by 24.3% (95% CI 14.8 to 32.8, p < 0.001) and 16.1% (95% CI 5.5 to 25.5, p < 0.005) respectively in February 2020, before the implementation of CACPs, whereas pyelonephritis and biliary tract infections did not suggest a detectable change. These changes coincided with increases in indicators related to personal precautions rather than those related to contact behavior changes. Interpretation Community-acquired pneumonia could be reduced by population-wide compliance to moderate precautionary measures, such as wearing masks and hand hygiene. Funding JSPS KAKENHI Grant Number 22K17329 and JSPS Overseas Research Fellowships. Research in context Evidence before this study The impact of personal precautions on community-acquired respiratory disease has been studied mainly for influenza and coronavirus infections, but no studies have evaluated the number of hospitalizations or 30-day deaths from overall non-COVID-19 pneumonia. We searched PubMed and medRxiv until May 3, 2022, for studies on the impact of personal precautions on community-acquired pneumonia using the following terms in the title and abstract: ((personal precaution*) OR (mask*) OR (non-pharmac*) OR (nonpharmac*)) AND (pneumonia). Before November 2019, when COVID-19 first emerged, no study was found that evaluated the impact of personal precautions such as masks on all-cause community-acquired pneumonia. After the emergence of COVID-19, there have been several reports of the relationship between non-pharmaceutical interventions (NPIs) and a decrease in non-COVID-19 pneumonia, but all reports evaluated the impact of general NPIs that aggregated different types of interventions, including personal precautions, physical distancing, and movement restrictions, and no studies were found that evaluated the impact on overall non-COVID-19 pneumonia from personal precautions alone. Added value of this study Our study found a reduction in hospitalizations and deaths from non-COVID-19 community-acquired pneumonia in Japan, especially those among the elderly population, had been detectable before the implementation of physical distancing policy and movement restrictions including stay-at-home requests. This reduction coincided with an increase in multiple indicators of public awareness of personal precautions, suggesting the potential benefit of population-level compliance to personal precautions (mask wearing and hand hygiene) against community-acquired pneumonia. Implications of all available evidence Maintaining a certain level of personal precautions in the population, e.g. by mask recommendations, may provide a positive public health impact even in the post-COVID era via reduced incidence of a spectrum of infectious diseases: most importantly, pneumonia as a major cause of death in the elderly. Since personal precautions are more sustainable than stringent restrictions such as lockdowns and could largely coexist with normal economic activities, long-term recommendations for personal precautions, at least in certain parts of the society, may warrant further discussion.

The successful management of Thirty-six hepatopancreatobiliary surgeries under the intensive protective arrangements during the COVID-19 pandemic.

ackground: During the pandemic of COVID-19, the overwhelm of infected patients created an exponential surge for ICU and ward beds. As a result, a major proportion of elective surgeries was postponed. However, various emergency and urgent procedures were allowed. Due to the mortality complications of hepatopancreatobiliary issues, we decided to afford urgent procedures under intensive protective arrangements. Method and results: In our ward (liver transplant), 4 ICU beds and 16 ward beds were allocated to non-COVID-19 patients. A total of 36 hepatopancreatobiliary procedures were managed for one month. All the surgeries were afforded under personal protective equipment and other intensive protective arrangements for personnel and patients. During 6 weeks following the surgery, all patients were followed up through telemedicine and no new case of COVID-19 was detected. Conclusion: In general, it appears that intensive protections could significantly reduce the number of COVID-19 incidence among patients with co-morbidities who undergo invasive procedures.

Perspectives from Italy during the COVID-19 pandemic: nationwide survey-based focus on minimally invasive HPB surgery.

The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable.