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1.
Aging (Albany NY) ; 12(15): 15771-15783, 2020 08 15.
Article in English | MEDLINE | ID: covidwho-721665

ABSTRACT

During the COVID-19 outbreak, some patients with COVID-19 pneumonia also suffered from acute abdomen requiring surgical treatment; however, there is no consensus for the treatment of such patients. In this study, we retrospectively reviewed 34 patients with acute abdomen who underwent emergency surgery during the COVID-19 outbreak. Among the 34 patients with acute abdomen, a total of six cases were found with COVID-19 pneumonia (clinical classification for COVID-19 pneumonia: all were the common type). On the premise of similar demographics between both groups, patients with COVID-19 pneumonia had worse indicators of liver and coagulation function. Compared with acute abdomen patients without COVID-19, patients with COVID-19 pneumonia had a longer hospital stay, but there were no significant differences in postsurgical complications (P = 0.58) or clinical outcomes (P = 0.56). In addition, an obvious resolution of lung inflammation after surgery was observed in five COVID-19 patients (83.3%). No new COVID-19 cases occurred during the patients' hospital stays. Therefore, for the common type of COVID-19 pneumonia, emergency surgery could not only improve the outcomes of COVID-19 pneumonia patients with acute abdomen, but also benefit the resolution of pulmonary inflammation.


Subject(s)
Abdomen, Acute , Coronavirus Infections , Emergency Treatment , Gastrointestinal Diseases , Pandemics , Pneumonia, Viral , Surgical Procedures, Operative , Abdomen, Acute/diagnosis , Abdomen, Acute/epidemiology , Abdomen, Acute/etiology , Abdomen, Acute/surgery , Aged , Betacoronavirus/isolation & purification , Blood Coagulation Tests/methods , China/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Emergency Treatment/methods , Emergency Treatment/statistics & numerical data , Female , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/physiopathology , Humans , Length of Stay/statistics & numerical data , Liver Function Tests/methods , Male , Middle Aged , Outcome and Process Assessment, Health Care , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/trends
2.
J Vasc Surg ; 72(3): 790-798, 2020 09.
Article in English | MEDLINE | ID: covidwho-701461

ABSTRACT

The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Thoracic Outlet Syndrome/diagnosis , Triage/standards , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Decompression, Surgical/standards , Elective Surgical Procedures/methods , Elective Surgical Procedures/standards , Emergency Treatment/methods , Emergency Treatment/standards , Humans , Infection Control/standards , Interdisciplinary Communication , Limb Salvage/methods , Limb Salvage/standards , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Telemedicine/standards , Thoracic Outlet Syndrome/etiology , Thoracic Outlet Syndrome/therapy , Thrombolytic Therapy/methods , Thrombolytic Therapy/standards , Time-to-Treatment/standards
4.
J Hand Surg Am ; 45(9): 869-875, 2020 09.
Article in English | MEDLINE | ID: covidwho-684289

ABSTRACT

The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19-infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms. Some of them may already have an ongoing, severe infection. The time-sensitive nature of some of these cases means that hand surgeons may need to operate urgently on patients who may be suspected of COVID-19 infections, often before confirmatory test results are available. General guidelines for perioperative care of the COVID-19-positive patient have been published. However, our practices differ from those of general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the perioperative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring the safety of the attending staff.


Subject(s)
Amputation, Traumatic/surgery , Betacoronavirus , Coronavirus Infections , Finger Injuries/surgery , Microsurgery/methods , Pandemics , Pneumonia, Viral , Reconstructive Surgical Procedures/methods , Adult , Emergency Treatment , Humans , Male
5.
Chin J Traumatol ; 23(4): 207-210, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-640869

ABSTRACT

Malaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations, which led to the enforcements of the Malaysian "Movement Control Order" to prohibit disease transmission. The overwhelming increasing amount of infections has led to a major strain on major healthcare services. This leads to shortages in hospital beds, ventilators and critical personnel protective equipment. This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases. The core highlights of these strategies enforced during this pandemic are: (1) surgery ward and clinic decongestions; (2) deferment of elective surgeries; (3) restructuring of medical personnel work force; (4) utilization of online applications for tele-communication; (5) operating room (OR) adjustments and patient screening; and (6) continuing medical education and updating practices in context to COVID-19. These adaptations were important for the continuation of emergency surgery services, preventing transmission of COVID-19 amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic. In addition, an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Wounds and Injuries/surgery , Coronavirus Infections/prevention & control , Elective Surgical Procedures , Emergency Treatment , Humans , Malaysia/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control
6.
Updates Surg ; 72(2): 297-304, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-612946

ABSTRACT

The sudden COVID-19 outbreak in Italy has challenged our health systems and doctors faced the challenge of treating a large number of critically ill patients in a short time interval. Acute care surgeons, although not directly involved in treating COVID-19 + patients, have often modified their daily activity to help in this crisis. We have designed the first Italian survey on the effect of COVID-19 outbreak on Acute Care Surgery activity and submitted it to emergency surgeons in all the country to evaluate the experiences, trends, attitudes and possible educational outcomes that this emergency brought to light. A total of 532 valid surveys were collected during the study period. Lombardy and Lazio had the major answer rate. 96% of responders noticed a decrease in surgical emergencies. The outbreak affected regions and hospitals in different ways depending on the local incidence of infection. Half of responders modified their approach to intra-abdominal infections towards a more conservative treatment. 43% of responders, mainly in the North, were shifted to assist non-surgical patients. There has been a direct but non-homogeneous involvement of emergency surgeons. Almost all hospitals have responded with specific pathways and training. Both emergency surgery and trauma activity have changed and generally decreased but the majority of surgeons have operated on suspected COVID-19 patients.


Subject(s)
Coronavirus Infections , Critical Care/statistics & numerical data , Emergency Treatment/statistics & numerical data , Pandemics , Pneumonia, Viral , Surgical Procedures, Operative/statistics & numerical data , Wounds and Injuries/surgery , Acute Disease , Disease Outbreaks , Health Care Surveys , Humans , Italy/epidemiology
7.
Prehosp Disaster Med ; 35(4): 451-453, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-546918

ABSTRACT

Coronavirus Disease 2019 (COVID-19), a new respiratory disease, is spreading globally. In France, Emergency Medical Service (EMS) teams are mobile medicalized resuscitation teams composed of emergency physician, nurse or anesthesiologist nurse, ambulance driver, and resident. Four types of clinical cases are presented here because they have led these EMS teams to change practices in their management of patients suspected of COVID-19 infection: cardiac arrest, hypoxia on an acute pneumonia, acute chronic obstructive pulmonary disease (COPD) exacerbation with respiratory and hemodynamic disorders, and upper function disorders in a patient in a long-term care facility. The last case raised the question of COVID-19 cases with atypical forms in elderly subjects. Providers were contaminated during the management of these patients. These cases highlighted the need to review the way these EMS teams are responding to the COVID-19 pandemic, in view of heightening potential for early identification of suspicious cases, and of reinforcing the application of staff protection equipment to limit risk of contamination.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Emergency Medical Services/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Aged , Betacoronavirus , Coronavirus Infections/epidemiology , Disaster Planning , Emergency Medical Services/standards , Emergency Treatment/standards , Female , France/epidemiology , Humans , Male , Pandemics , Personal Protective Equipment , Planning Techniques , Pneumonia, Viral/epidemiology
9.
Endocrine ; 68(3): 485-488, 2020 06.
Article in English | MEDLINE | ID: covidwho-526772

ABSTRACT

The ongoing spread of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health. As the coronavirus outbreak began spreading, hospitals were forced to relocate resources to treat the growing number of COVID-19 patients. As a consequence, doctors across the country canceled tens of thousands of nonurgent surgeries. However, recognizing that the COVID-19 situation may be highly variable and fluid in different communities across the country, elective surgery could be still allowed in some centers for patients included in the high-priority class. The majority of endocrine disorders requiring surgical treatment in patients identifiable as first-priority class, or needing hospitalization within 30 days, are generally represented by malignant thyroid tumors, hyperthyroidism, hyperparathyroidism, and some adrenal disorders. The need for urgent intervention is evaluated on a case-by-case basis according to the severity of the symptoms, the likelihood of progression, and global clinical judgment. On the basis of the above indications, during the last 4 weeks, we performed 18 planned surgical treatments in patients with thyroid cancer (total thyroidectomies, plus lymph node dissection if needed) or multinodular toxic goiter. In no case, postoperative ventilatory support was needed, and the average hospital stay was 3 days. The negative COVID-19 status for all the treated patients was appropriately evaluated beforehand. Nobody knows how long the current COVID-19 pandemic will be lasting. Certainly, we will be requested in the next future to incrementally offer surgical services for endocrine disorders that have been deferred for the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections , Endocrine Surgical Procedures , Endocrine System Diseases/surgery , Pandemics , Pneumonia, Viral , Adrenal Gland Diseases/surgery , Coronavirus Infections/epidemiology , Elective Surgical Procedures , Emergency Treatment , Humans , Hyperparathyroidism/surgery , Hyperthyroidism/surgery , Italy/epidemiology , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Prognosis , Severity of Illness Index , Thyroid Neoplasms/surgery
11.
J Obstet Gynaecol Can ; 42(8): 1017-1020, 2020 08.
Article in English | MEDLINE | ID: covidwho-436613

ABSTRACT

Health care team training and simulation-based education are important for preparing obstetrical services to meet the challenges of the COVID-19 pandemic. Priorities for training are identified in two key areas. First, the impact of infection prevention and control protocols on processes of care (e.g., appropriate and correct use of personal protective equipment, patient transport, preparation for emergency cesarean delivery with the potential for emergency intubation, management of simultaneous obstetric emergencies, delivery in alternate locations in the hospital, potential for increased decision-to-delivery intervals, and communication with patients). And second, the effects of COVID-19 pathophysiology on obstetrical patients (e.g., testing and diagnosis, best use of modified obstetric early warning systems, approach to maternal respiratory compromise, collaboration with critical care teams, and potential need for cardiopulmonary resuscitation). However, such training is more challenging during the COVID-19 pandemic because of the requirements for social distancing. This article outlines strategies (spatial, temporal, video-recording, video-conferencing, and virtual) to effectively engage in health care team training and simulation-based education while maintaining social distancing during the COVID-19 pandemic.


Subject(s)
Coronavirus Infections , Delivery, Obstetric , Infection Control/methods , Obstetrics , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Simulation Training , Staff Development/methods , Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Delivery, Obstetric/education , Delivery, Obstetric/methods , Emergency Treatment/methods , Female , Humans , Interdisciplinary Placement/methods , Obstetrics/education , Obstetrics/methods , Pandemics/prevention & control , Patient Simulation , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , Simulation Training/methods , Simulation Training/organization & administration
13.
Oral Oncol ; 107: 104784, 2020 08.
Article in English | MEDLINE | ID: covidwho-271026
15.
Can J Cardiol ; 36(7): 1148-1151, 2020 07.
Article in English | MEDLINE | ID: covidwho-245208

ABSTRACT

The traditional model of heart failure (HF) care in Canada, which relies upon a multidisciplinary team and clinic-based care processes, has been undermined as a result of the COVID-19 pandemic. As the pandemic continues, we will be challenged to improve or maintain the health status of those with HF by optimizing guideline-directed care despite physical distancing constraints and a reduction in the health care workforce. This will require development of new strategies specifically targeted at decreasing the risk of decompensation and resultant HF hospitalization. As such, we must quickly pivot to the adoption and application of novel technologies and revise usual care models, processes, and workflow. The unprecedented COVID-19 crisis has delivered the Canadian HF community a burning platform for the design and implementation of innovative approaches to support the vulnerable population we serve; born out of necessity, we now have the opportunity to explore innovative approaches that might inform the future of HF care delivery in Canada. Herein, we provide perspectives from leadership within the Canadian Heart Failure Society on how to optimize HF care during the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Health Services Accessibility/statistics & numerical data , Heart Failure/epidemiology , Heart Failure/therapy , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Adult , Aged , Canada , Coronavirus Infections/diagnosis , Emergency Treatment , Female , Heart Failure/diagnosis , Humans , Infection Control/organization & administration , Male , Middle Aged , Occupational Health , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Public Health , Safety Management/organization & administration
16.
J Endod ; 46(6): 730-735, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-169539

ABSTRACT

INTRODUCTION: In late 2019, an outbreak of a new coronavirus named severe acute respiratory syndrome coronavirus 2 was detected in Wuhan, China. A great percentage of patients with this disease developed symptoms of dry cough, malaise, and a high fever. During this time, several patients requiring assessment and treatment of endodontic emergencies were directed to the School and Hospital of Stomatology at Wuhan University, Wuhan, China. We examined the characteristics of these patients. METHODS: A total of 96 patients with a mean age of 42.24 ± 18.32 years visited the general and emergency department of the School and Hospital of Stomatology at Wuhan University because of endodontic emergencies during the peak period of February 22 to March 2, 2020. Patient information was collected and organized by date of visit, sex, age, and systemic disease history. Body temperature was measured and acquired for each patient, a coronavirus disease 2019 (COVID-19) epidemiologic investigation questionnaire was given to each patient, an endodontic diagnosis was determined for the offending tooth, and a verbal numerical rating scale (VNRS) was used to record pain levels. RESULTS: Of the total patient visits during this period, 50.26% of visits were for endodontic treatment. No patients had a fever (>37.2°C). One patient with a confirmed COVID-19 history was admitted after recovery. Three admitted patients had been exposed to confirmed or suspected COVID-19 patients. Twelve admitted patients (12.5%) with a mean age of 62.42 ± 13.77 years had a history of systemic diseases. The most common age group for endodontic emergencies was 45-64 years (30.21%), and patients of this group showed a significantly higher mean VNRS score compared with that of the 6- to 19-year age group and the 20- to 34-year age group (P < .05). The majority of endodontic emergency diagnoses were diseases of symptomatic irreversible pulpitis (53.10%). Patients who were diagnosed with symptomatic irreversible pulpitis, symptomatic apical periodontitis, and acute apical abscess showed a significantly higher mean VNRS score than that of other groups (P < .05). CONCLUSIONS: Endodontic emergencies, with symptomatic irreversible pulpitis being the most common, consist of a much higher proportion of dental emergencies in a COVID-19 high-risk area than normally. Vital pulp therapy can advantageously reduce treatment time, resulting in a reduced risk of infection for vital pulp cases. Rubber dams, personal protective equipment, and patient screening are of great importance during the COVID-19 outbreak in protecting clinicians.


Subject(s)
Coronavirus Infections/complications , Endodontics , Pneumonia, Viral/complications , Pulpitis/diagnosis , Adult , Aged , Betacoronavirus , China , Emergency Service, Hospital , Emergency Treatment , Female , Humans , Male , Middle Aged , Pandemics , Pulpitis/therapy , Young Adult
18.
Biosci Trends ; 14(3): 227-230, 2020 Jul 17.
Article in English | MEDLINE | ID: covidwho-116215

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 virus, is now generating a global epidemic, leading to a severe public health emergency. Until April 12, 2020 around 1,700,954 confirmed cases and 105,633 deaths have been reported all over the world. The World Health Organization (WHO) has declared COVID-19 as a Public Health Emergency of International Concern. Under this circumstance, surgical activities should be carefully evaluated to avoid excessive occupation of limited medical resources, and to reduce the possibility of hospital infection. China has achieved an inspiring achievement on epidemic control. Here, we reviewed available studies on surgical activities during the outbreak, in combination with our current experience, with the aim of providing feasible suggestions on surgical issues during the COVID-19 pandemic.


Subject(s)
Coronavirus Infections , Infection Control/methods , Pandemics , Pneumonia, Viral , Surgical Procedures, Operative , Betacoronavirus , Blood Safety , Elective Surgical Procedures , Emergency Treatment , Humans
19.
Biosci Trends ; 14(3): 222-226, 2020 Jul 17.
Article in English | MEDLINE | ID: covidwho-100190

ABSTRACT

The new coronavirus (COVID-19) has been characterized as a world pandemic by WHO since March 11, 2020. Although it is likely that COVID-19 transmission is primarily via droplets and close contact, airborne transmission and fecal-oral route remains a possibility. The medical staff working in the operating room, such as anesthesiologists, surgeons and nurses, are at high risk of exposure to virus due to closely contacting patients. The perioperative management is under great challenge while performing surgeries for patients suffering COVID-19, including emergency cesarean section, which is one of the most common surgeries under such circumstances. How to prevent medical staff from cross-infection is an issue of great concern. In this article, we give a practice of anesthesia scenario design for emergency cesarean section in a supposed standard patient suffering COVID-19, aimed to optimize the work flow and implement the protective details through simulation of a real operation scenario, which may be useful for training and clinical practice of anesthesia management for patients suffering COVID-19 or other fulminating infectious diseases.


Subject(s)
Anesthesia , Cesarean Section , Coronavirus Infections , Infection Control/methods , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Betacoronavirus , Emergency Treatment , Female , Humans , Pregnancy
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