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1.
Curr Oncol ; 27(5): e512-e515, 2020 10.
Article in English | MEDLINE | ID: covidwho-1024676

ABSTRACT

Sarcoma treatment during the covid-19 pandemic is a new challenge. This patient population is often immunocompromised and potentially more susceptible to viral complications. Government guidelines highlight the need to minimize patient exposure to unnecessary hospital visits. However, those guidelines lack practical recommendations on ways to manage triage and diagnosis expressly for new cancer patients. Furthermore, there are no reports on the efficiency of the guidelines. One of the main issues in treating musculoskeletal tumours is the complexity and variability of presentation. We offer a triage model, used in a quaternary-referral musculoskeletal oncology centre, that allows us to maintain an open pathway for referral of new patients while minimizing exposure risks. A multidisciplinary approach and analysis of existing investigations allow for a pre-clinic evaluation. The model identifies 3 groups of patients: ■ Patients with suspected high-grade malignancy, or benign cases with aggressive features, both in need of further evaluation in the clinic and prompt treatment■ Patients with low-grade malignancy, and benign cases whose treatment is not urgent, that are managed during the pandemic by telemedicine, with reassurance and information about their illness■ Patients who can be managed by their local medical professionals In comparison to a pre-pandemic period, that approach resulted in a higher ratio of malignant-to-benign conditions for new patients seen in the clinic (3:4 vs. 1:3 respectively), thus using available resources more efficiently and prioritizing patients with suspected high-grade malignancy. We believe that this triage system could be applied in other surgical oncology fields during a pandemic.


Subject(s)
Betacoronavirus/isolation & purification , Bone Neoplasms/therapy , Coronavirus Infections/complications , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Soft Tissue Neoplasms/therapy , Telemedicine/methods , Triage/standards , Bone Neoplasms/virology , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Disease Management , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Risk Management , Soft Tissue Neoplasms/virology
2.
Curr Oncol ; 27(5): e501-e511, 2020 10.
Article in English | MEDLINE | ID: covidwho-1024675

ABSTRACT

Objective: We aimed to review data about delaying strategies for the management of hepatobiliary cancers requiring surgery during the covid-19 pandemic. Background: Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guidance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible. Methods: An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma. Results: Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutaneous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed. Conclusions: There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case.


Subject(s)
Coronavirus Infections/complications , Hepatectomy/statistics & numerical data , Infection Control/methods , Liver Neoplasms/surgery , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Surgeons/standards , Time-to-Treatment/statistics & numerical data , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Humans , Liver Neoplasms/virology , Pandemics , Patient Care Management , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology
3.
Medicina (Kaunas) ; 56(12)2020 Dec 19.
Article in English | MEDLINE | ID: covidwho-1024607

ABSTRACT

The interplay between coronavirus disease 2019 (COVID-19) and pulmonary hypertension (PH) in children is unknown. Adults with PH are at potential risk for severe complications and high mortality due to associated comorbidities. It is difficult to extrapolate the outcomes of COVID-19 in adults to pediatric PH patients. Overall, a small number of COVID-19 cases is reported in patients with preexisting PH. Several factors may be responsible for the low incidence of COVID-19 in children with PH. Pulmonary hypertension is a rare disease, testing is not universal, and patients may have followed more rigorously the Center for Disease Control's guidelines recommended for personal protection with mask-wearing, social distancing, and hand sanitization through ongoing health education. The small number of COVID-19 cases in patients with preexisting PH does not support that PH is protective for COVID-19. However, medications used to treat PH may have some protection against COVID-19. This review discusses the pathophysiology of PH occurring with COVID-19, differences between children and adults with COVID-19, strategies for management of preexisting PH in children during the ongoing pandemic, and its impact within the field of PH.


Subject(s)
/complications , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/physiopathology , /epidemiology , Child , Humans , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/therapy , Incidence , Pandemics
4.
AJNR Am J Neuroradiol ; 41(9): 1703-1706, 2020 09.
Article in English | MEDLINE | ID: covidwho-1024494

ABSTRACT

Patients with coronavirus disease 2019 (COVID-19) may have symptoms of anosmia or partial loss of the sense of smell, often accompanied by changes in taste. We report 5 cases (3 with anosmia) of adult patients with COVID-19 in whom injury to the olfactory bulbs was interpreted as microbleeding or abnormal enhancement on MR imaging. The patients had persistent headache (n = 4) or motor deficits (n = 1). This olfactory bulb injury may be the mechanism by which the Severe Acute Respiratory Syndrome coronavirus 2 causes olfactory dysfunction.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Olfaction Disorders/etiology , Olfactory Bulb/diagnostic imaging , Pneumonia, Viral/complications , Coronavirus Infections/diagnostic imaging , Humans , Magnetic Resonance Imaging , Olfaction Disorders/diagnostic imaging , Olfactory Bulb/injuries , Pandemics , Pneumonia, Viral/diagnostic imaging , Smell , Taste
5.
AJNR Am J Neuroradiol ; 41(9): 1707-1711, 2020 09.
Article in English | MEDLINE | ID: covidwho-1024489

ABSTRACT

We report a case of bifacial weakness with paresthesia, a recognized Guillain-Barré syndrome subtype characterized by rapidly progressive facial weakness and paresthesia without ataxia or other cranial neuropathies, which was temporally associated with antecedent coronavirus 2019 (COVID-19). This case highlights a potentially novel but critically important neurologic association of the COVID-19 disease process. Herein, we detail the clinicoradiologic work-up and diagnosis, clinical course, and multidisciplinary medical management of this patient with COVID-19. This case is illustrative of the increasingly recognized but potentially underreported neurologic manifestations of COVID-19, which must be considered and further investigated in this pandemic disease.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Facial Paralysis/etiology , Guillain-Barre Syndrome/complications , Paresthesia/etiology , Pneumonia, Viral/complications , Humans , Male , Pandemics , Young Adult
6.
Recenti Prog Med ; 111(4): 184-185, 2020 04.
Article in Italian | MEDLINE | ID: covidwho-1024442

ABSTRACT

A position statement published by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) is fostering a vibrant debate, crossed by deep fears. These are recommendations addressed to ICU doctors who must decide whether to implement intensive treatments for patients who need them to survive. Specifically, the reference is to the patients to whom the CoViD-19 epidemic has compromised respiratory capacity. We still do not have clear what positive criteria can help make clinical decisions in contexts of insufficient resources that force us to make choices.


Subject(s)
Coronavirus Infections , Decision Making , Health Resources , Pandemics , Pneumonia, Viral , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/therapy , Decision Making/ethics , Health Resources/supply & distribution , Hospitals, Group Practice , Humans , Informed Consent , Patient Rights , Physicians , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Severity of Illness Index
7.
Can J Surg ; 63(22): S2-S4, 2020 05 01.
Article in English | MEDLINE | ID: covidwho-1024420

ABSTRACT

Summary: During the coronavirus disease 2019 (COVID-19) pandemic, delaying lifesaving cancer surgeries must be done with extreme caution and thoughtfulness. Modelling indicates that delays in high-risk cancer surgeries beyond 6 weeks could affect long-term outcomes for thousands of Canadians. Consequently, it is possible that postponing cancer surgery without consideration of its implications could cost more lives than can be saved by diverting all surgical resources to COVID-19. This article provides general guidance on supporting curative surgical treatment where appropriate and with available resources.


Subject(s)
Coronavirus Infections , Critical Care , Neoplasms/surgery , Pandemics , Pneumonia, Viral , Surgical Procedures, Operative , Betacoronavirus , Canada/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Decision Making , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Time Factors
9.
Nephron ; 144(5): 245-247, 2020.
Article in English | MEDLINE | ID: covidwho-1024277

ABSTRACT

Since December 2019, the epidemic of coronavirus disease 2019 (COVID-19) has spread very rapidly in China and worldwide. In this article, we report on a 75-year-old man infected with 2019 novel coronavirus who has end-stage kidney disease (ESKD). COVID-19 patients with ESKD need isolation dialysis, but most of them cannot be handled in time due to limited continuous renal replacement therapy (CRRT) machines. CRRT provided benefits for this patient by removing potentially damaging toxins and stabilizing his metabolic and hemodynamic status. With the control of uremia and fluid status, this patient ended up with an uneventful post-CRRT course, absence of clinical symptoms, and negative PCR tests. Greater efforts are needed to decrease the mortality of COVID-19-infected ESKD patients.


Subject(s)
Coronavirus Infections/complications , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Pneumonia, Viral/complications , Renal Dialysis , Aged , Betacoronavirus , Humans , Kidney Failure, Chronic/virology , Male , Pandemics
10.
Emerg Med J ; 37(9): 565-566, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1024248

ABSTRACT

We report the experience of prone ventilation in selected patients treated with helmet non-invasive ventilation (NIV) continuous positive airway pressure (CPAP) for acute respiratory failure in COVID-19 pneumonia. Preliminary results showed an improvement in the PaO2 value and PaO2/FiO2 ratio after 1 hour of prone ventilation. No variation of the lung ultrasound pattern before and after prone ventilation has been detected. At the time of writing, we attempted proning with helmet NIV CPAP in 10 patients. In 4 out of 10 patients, the attempt failed due to lack of compliance of the patient, scarce pain control even with ongoing treatment and refusal by the patient to prone positioning.


Subject(s)
Continuous Positive Airway Pressure/methods , Coronavirus Infections , Noninvasive Ventilation/methods , Pandemics , Pneumonia, Viral , Prone Position , Respiratory Insufficiency , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Italy/epidemiology , Male , Oxygen Consumption , Oxygen Inhalation Therapy/methods , Patient Positioning , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Treatment Outcome
19.
Br Dent J ; 229(6): 363-370, 2020 09.
Article in English | MEDLINE | ID: covidwho-1023873

ABSTRACT

The management of odontogenic infections has improved over recent decades, but further improvements are still required. The ongoing education of GDPs and their dental teams on this issue continues to be important, especially during the current COVID-19 pandemic, where remote triage poses additional difficulties and challenges.Odontogenic infections can lead to sepsis, a potentially life-threatening condition caused by the body's immune system responding in an abnormal way. This can lead to tissue damage, organ failure and death. A patient with non-odontogenic-related infection could also present with sepsis at a dental practice. Early recognition and prompt management of sepsis improves outcomes. GDPs and their dental teams should be trained in the recognition and management of sepsis. Age-specific sepsis decision support tools have been developed by the UK Sepsis Trust to help dental staff recognise and manage patients with suspected sepsis.The aim of this article is to provide an update on the management of odontogenic infections and sepsis.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Sepsis , Tooth Diseases , Betacoronavirus , Humans , Infections/complications , Sepsis/diagnosis , Sepsis/therapy
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