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1.
Ann Surg ; 274(6): e795-e796, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1522438
2.
J Minim Invasive Gynecol ; 28(12): 2047-2051, 2021 12.
Article in English | MEDLINE | ID: covidwho-1275500

ABSTRACT

STUDY OBJECTIVE: Coronavirus disease 2019 (COVID-19) infection poses significant risks during surgical interventions. We investigated the intraperitoneal presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients who are COVID-19 positive. DESIGN: A prospective group study. SETTING: Department of Obstetrics and Gynecology designated for patients with COVID-19, Central Clinical Hospital of the Ministry of Interior, Warsaw. PATIENTS: Overall, 65 pregnant women with COVID-19 infection underwent cesarian section. The diagnosis was confirmed either by positive antigen test or by positive reverse transcriptase-polymerase chain reaction assay performed within no more than 13 days before the operation. INTERVENTIONS: On the day of the operation, a nasopharyngeal swab was taken, and peritoneal fluid was collected at the beginning of the operation. Both the nasopharyngeal swab and peritoneal fluid samples were tested for SARS-CoV-2. MEASUREMENTS AND MAIN RESULTS: A total of 65 pregnant women with COVID-19 infection were enrolled in the study. The SARS-CoV-2 ribonucleic acid test by nasopharyngeal swab produced positive results in 34 patients. In this group as well as in 31 nonconfirmed patients, all peritoneal fluid samples tested negative for SARS-CoV-2 ribonucleic acid. CONCLUSION: These results suggest a low risk of COVID-19 transmission from the peritoneal cavity at the time of laparoscopy or laparotomy.


Subject(s)
COVID-19 , Ascitic Fluid , Female , Humans , Pregnancy , Pregnant Women , Prospective Studies , RNA, Viral/genetics , SARS-CoV-2
5.
Langenbecks Arch Surg ; 406(4): 1007-1014, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1118231

ABSTRACT

BACKGROUND: There are still concerns over the safety of laparoscopic surgery in coronavirus disease 2019 (COVID-19) patients due to the potential risk of viral transmission through surgical smoke/laparoscopic pneumoperitoneum. METHODS: We performed a systematic review of currently available literature to determine the presence of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in abdominal tissues or fluids and in surgical smoke. RESULTS: A total of 19 studies (15 case reports and 4 case series) comprising 29 COVID-19 patients were included. The viral RNA was positively identified in 11 patients (37.9%). The samples that tested positive include the peritoneal fluid, bile, ascitic fluid, peritoneal dialysate, duodenal wall, and appendix. Similar samples, together with the omentum and abdominal subcutaneous fat, tested negative in the other patients. Only one study investigated SARS-COV-2 RNA in surgical smoke generated during laparoscopy, reporting negative findings. CONCLUSIONS: There are conflicting results regarding the presence of SARS-COV-2 in abdominal tissues and fluids. No currently available evidence supports the hypothesis that SARS-COV-2 can be aerosolized and transmitted through surgical smoke. Larger studies are urgently needed to corroborate these findings.


Subject(s)
COVID-19/surgery , COVID-19/transmission , Laparoscopy/adverse effects , SARS-CoV-2/isolation & purification , Abdomen/virology , Ascitic Fluid/virology , COVID-19/diagnosis , Humans , RNA, Viral/isolation & purification , Smoke/analysis
6.
Ann Surg ; 272(3): e240-e242, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-1114935

ABSTRACT

BACKGROUND: The excretion pathomechanisms of SARS-CoV-2 are actually unknown. No certain data exist about viral load in the different body compartments and fluids during the different disease phases. MATERIAL AND METHODS: Specific real-time reverse transcriptase-polymerase chain reaction targeting 3 SARS-CoV-e genes were used to detect the presence of the virus. RESULTS: SARS-CoV-2 was detected in peritoneal fluid at a higher concentration than in respiratory tract. CONCLUSION: Detection of SARS-CoV-2 in peritoneal fluid has never been reported. The present article represents the very first positive result describing the presence of the virus in peritoneal fluid during an emergency surgical procedure in a COVID-19 sick patient. This article thus represents a warning for increasing the level of awareness and protection for surgeon especially in emergency surgical setting.


Subject(s)
Ascitic Fluid/virology , COVID-19 , SARS-CoV-2/isolation & purification , Aged , Humans , Male , Pneumonia, Viral/virology , Real-Time Polymerase Chain Reaction , Viral Load
7.
Eur Rev Med Pharmacol Sci ; 24(23): 12516-12521, 2020 12.
Article in English | MEDLINE | ID: covidwho-995010

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has significantly affected health care organizations globally. Many aspects of this disease, as well as the risks for patients treated with multiple drug regimens to control severe COVID-19, are unclear. During emergency surgery for SARS-CoV-2-positive patients, the risk of SARS-CoV-2 exposure and transmission to the surgical staff has yet to be determined. PATIENTS AND METHODS: In this report, we describe a SARS-CoV-2-positive patient with severe respiratory syndrome treated with multiple doses of IL-6 inhibitors who presented with a perforated duodenal ulcer and underwent emergency surgery. During and after surgery, we tested for SARS-CoV-2 at the ulcer site and in the peritoneal fluid. RESULTS: The history of the patient allows for two possible interpretations of the pathogenesis of the duodenal ulcer, which could have been a stress ulcer, or a gastrointestinal ulcer associated to the use of IL-6 inhibitors. We also noticed that the ulcer site and peritoneal fluid repeatedly tested negative for SARS-CoV-2. Therefore, we reviewed the pertinent literature on gastrointestinal bleeding in patients with COVID-19 and on SARS-CoV-2 detection in the peritoneal fluid of surgical patients and discussed possible prevention strategies for bleeding and the actual risk of infection for the surgical staff. CONCLUSIONS: The first implication of this case is that the relation between repeated administration of IL-6 inhibitors and upper gastrointestinal bleeding and perforation must be investigated, and that the threshold for administering prophylactic proton pump inhibitors therapy should be carefully considered for patients with severe COVID-19. The second implication is that further testing should be performed on the peritoneal fluid of COVID-19 patients undergoing emergency surgical procedures to clarify the discordant results for the presence of SARS-CoV-2 in the peritoneal cavity and the possible risk of transmission to the surgical staff.


Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Duodenal Ulcer/surgery , Peptic Ulcer Hemorrhage/surgery , Peptic Ulcer Perforation/surgery , Stress, Physiological , Aged , Ascitic Fluid/chemistry , Ascitic Fluid/virology , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Duodenal Ulcer/virology , Humans , Male , Peptic Ulcer Hemorrhage/virology , Peptic Ulcer Perforation/virology , RNA, Viral/analysis , SARS-CoV-2
12.
Blood Purif ; 50(3): 283-289, 2021.
Article in English | MEDLINE | ID: covidwho-817873

ABSTRACT

In December 2019, cases of acute respiratory illness of unknown origin were reported in Wuhan, China. The disease is caused by "severe acute respiratory syndrome coronavirus 2". After identifying severe lung damage, injury to other organs, such as the kidney, has been identified. Peritoneal dialysis is a renal replacement therapy (RRT) and is at least as effective as other extracorporeal therapy options, with significant cost-effective advantages. However, this strategy is rarely used for the management of acute kidney injury in severe lung disease. In this review, we explore PD as an RRT strategy that may be a key instrument in countries and hospitals with limited access to all RRTs.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/complications , Pandemics , Peritoneal Dialysis , SARS-CoV-2 , Acute Kidney Injury/etiology , Acute Lung Injury/etiology , Ascitic Fluid/virology , COVID-19/prevention & control , Catheterization/methods , Containment of Biohazards , Cytokines/metabolism , Developing Countries , Disease Management , Humans , Infection Control , Inflammation , Medical Waste Disposal , Prone Position , SARS-CoV-2/pathogenicity , Treatment Outcome
13.
Ann Ital Chir ; 91: 235-238, 2020.
Article in English | MEDLINE | ID: covidwho-739563

ABSTRACT

The present pandemic caused by the SARS COV-2 coronavirus is still ongoing, although it is registered a slowdown in the spread for new cases. The main environmental route of transmission of SARS-CoV-2 is through droplets and fomites or surfaces, but there is a potential risk of virus spread also in smaller aerosols during various medical procedures causing airborne transmission. To date, no information is available on the risk of contagion from the peritoneal fluid with which surgeons can come into contact during the abdominal surgery on COVID-19 patients. We have investigated the presence of SARS-CoV-2 RNA in the peritoneal cavity of patients affected by COVID-19, intraoperatively and postoperatively. KEY WORDS: Covid-19, Laparotomy, Surgery.


Subject(s)
Ascitic Fluid/virology , Betacoronavirus/isolation & purification , Coronavirus Infections/transmission , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intestinal Perforation/surgery , Laparotomy , Pandemics , Pneumonia, Viral/transmission , Sigmoid Diseases/surgery , Viremia/transmission , Aerosols , Aged, 80 and over , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Cross-Sectional Studies , Diverticulum/complications , Fatal Outcome , Female , Humans , Intestinal Perforation/blood , Intestinal Perforation/complications , Intestinal Perforation/virology , Intraoperative Period , Nasopharynx/virology , Pandemics/prevention & control , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Postoperative Period , Prospective Studies , RNA, Viral/isolation & purification , Risk , SARS-CoV-2 , Serum/virology , Sigmoid Diseases/blood , Sigmoid Diseases/complications , Sigmoid Diseases/virology , Viremia/virology
14.
Perit Dial Int ; 40(5): 499-503, 2020 09.
Article in English | MEDLINE | ID: covidwho-737735

ABSTRACT

The pandemic of respiratory disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is life-threatening in peritoneal dialysis (PD) patients. In PD patients with systemic viral infections, peritoneal effluent may be theoretically contaminated. We searched for the presence of SARS-CoV-2 genetic material by real-time reverse transcriptase-polymerase chain reaction assays in serial PD effluents of three PD infected patients. Nasopharyngeal swabs obtained at admission showed high viral load in all three patients, whereas none of the PD effluent specimen tested positive, even after dialysate concentration. Those results support at most a very low SARS-CoV-2 dissemination risk by the peritoneal effluent of PD patients. Imposing special disposal procedures, such as the instillation of hypochlorite in the drainage bags to prevent viral spread to health-care workers, are probably not required.


Subject(s)
Ascitic Fluid/virology , Coronavirus Infections/epidemiology , Kidney Failure, Chronic/therapy , Peritoneal Dialysis/methods , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Adult , COVID-19 , COVID-19 Testing , COVID-19 Vaccines , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Female , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Real-Time Polymerase Chain Reaction/methods , Sampling Studies , Sensitivity and Specificity , Severe Acute Respiratory Syndrome/diagnosis , Viral Load
16.
Surg Laparosc Endosc Percutan Tech ; 30(6): e43-e45, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-660517

ABSTRACT

BACKGROUND: The safety of laparoscopic surgery in SARS-CoV-2 positive patients remains unclear. The presence of the virus within peritoneal fluid and the peritoneal tissues is not known. We report an asymptomatic COVID-19 positive patient who underwent laparoscopic appendectomy with negative peritoneal sampling for SARS-CoV-2. MATERIALS AND METHODS: During a standard 3 port laparoscopic surgery samples peritoneal fluid, peritoneal brushings, and surgical smoke plum were collected. Specific real-time reverse transcriptase-polymerase chain reaction targeting SARS-CoV-2 were used to detect the presence of the virus in the samples. RESULTS: SARS-CoV-2 was not detected on multiple samples of the peritoneum in an asymptomatic patient. CONCLUSIONS: SARS-CoV-2 was not found in the peritoneum of a single patient with asymptomatic infection. Further studies comparing SARS-CoV-2 surgical candidates are needed to address safety concerns.


Subject(s)
Appendectomy/methods , Appendicitis/surgery , Ascitic Fluid/virology , Asymptomatic Diseases , COVID-19/diagnosis , Laparoscopy/methods , RNA, Viral/analysis , SARS-CoV-2/genetics , Diagnosis, Differential , Humans , Male , Pandemics , Young Adult
20.
Langenbecks Arch Surg ; 405(3): 353-355, 2020 May.
Article in English | MEDLINE | ID: covidwho-209487

ABSTRACT

PURPOSE: COVID-19 greatly affected millions and affected the way we practice with heightened posture in the way we treat surgical patients. Surgical consensus guidelines are recommending caution in the use of laparoscopy for the theoretical possibility of viral transmission from aerosolization of tissue and peritoneal fluid during surgery. However, there has yet to be proof of COVID-19 being present in peritoneal fluid, justifying the consensus statements. We aim to assess the presence of COVID-19 in peritoneal fluid. METHODS: We performed a laparoscopic appendicectomy for a COVID-19-infected patient with acute appendicitis. Peritoneal fluid and peritoneal washings were collected and sent for COVID-19 PCR. RESULTS: The peritoneal fluid sample collected on entry and at the end of the operation was negative for COVID-19 on PCR. The patient had an uneventful recovery from surgery. CONCLUSIONS: This case revealed that COVID-19 was not detected in peritoneal fluid and peritoneal washings in a patient infected with COVID-19. This study provides novel preliminary data in the investigation of COVID-19 transmission from laparoscopy-related aerosolization.


Subject(s)
Appendectomy/methods , Appendicitis/surgery , Ascitic Fluid/virology , Coronavirus Infections/diagnosis , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/diagnosis , Appendicitis/diagnosis , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , DNA, Viral/isolation & purification , False Negative Reactions , Follow-Up Studies , Humans , Laparoscopy/adverse effects , Laparoscopy/methods , Male , Occupational Health , Pandemics , Patient Safety , Peritoneal Lavage/methods , Real-Time Polymerase Chain Reaction/methods , Risk Assessment , Treatment Outcome , Young Adult
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