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2.
Cell ; 184(24): 5932-5949.e15, 2021 11 24.
Article in English | MEDLINE | ID: covidwho-1549679

ABSTRACT

Anosmia, the loss of smell, is a common and often the sole symptom of COVID-19. The onset of the sequence of pathobiological events leading to olfactory dysfunction remains obscure. Here, we have developed a postmortem bedside surgical procedure to harvest endoscopically samples of respiratory and olfactory mucosae and whole olfactory bulbs. Our cohort of 85 cases included COVID-19 patients who died a few days after infection with SARS-CoV-2, enabling us to catch the virus while it was still replicating. We found that sustentacular cells are the major target cell type in the olfactory mucosa. We failed to find evidence for infection of olfactory sensory neurons, and the parenchyma of the olfactory bulb is spared as well. Thus, SARS-CoV-2 does not appear to be a neurotropic virus. We postulate that transient insufficient support from sustentacular cells triggers transient olfactory dysfunction in COVID-19. Olfactory sensory neurons would become affected without getting infected.


Subject(s)
Autopsy/methods , COVID-19/mortality , COVID-19/virology , Olfactory Bulb/virology , Olfactory Mucosa/virology , Respiratory Mucosa/virology , Aged , Anosmia , COVID-19/physiopathology , Endoscopy/methods , Female , Glucuronosyltransferase/biosynthesis , Humans , Immunohistochemistry , In Situ Hybridization , Male , Microscopy, Fluorescence , Middle Aged , Olfaction Disorders , Olfactory Receptor Neurons/metabolism , Respiratory System , SARS-CoV-2 , Smell
4.
Indian J Gastroenterol ; 40(4): 410-419, 2021 08.
Article in English | MEDLINE | ID: covidwho-1338283

ABSTRACT

BACKGROUND AND OBJECTIVES: During Corona Virus Disease-19 (COVID-19) pandemic, it has been estimated that approximately 10% of health care professionals (HCPs) have been diagnosed contacting  COVID-19. Aerosol-generating procedures have led to change in safety practices among HCPs. We thus evaluated the efficacy of the endoscopic safety measures among HCPs posted in the endoscopy unit. METHODS: In this retrospective analysis, all endoscopic procedures performed over a period of 4 months, from 1 April to 31 July 2020 were included. We noted indications and number of COVID-positive procedures as well as comprehensive screening of HCPs posted in our endoscopy unit. The aim of the study was to evaluate the incidence and outcome of COVID-19 among HCPs. RESULTS: Three thousand four hundred and sixty procedures were included in the analysis. Indications were divided as urgent (n = 190, 5.49%), semi-urgent (n = 553, 16%) and non-urgent group (n = 2717, 78.52%). Thirty-four procedures (0.98%) were done on diagnosed COVID-19 patients. The most common indications were gastrointestinal bleed (n = 12/34, 35.30%) followed by biliary sepsis (n = 9/34, 26.5%). Among the HCPs, the incidence of symptomatic COVID-19 was 6.58% (n = 5/76). All HCPs recovered with excellent outcomes. A comprehensive screening showed 7.90% (n = 6/76) HCPs having Immunoglobulin G (IgG) antibody in their sera. CONCLUSION: Addition of safety measures in endoscopy leads to low risk of transmission among HCPs.


Subject(s)
COVID-19/prevention & control , Endoscopy/methods , Health Personnel , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Diseases/prevention & control , Occupational Health , Adolescent , Adult , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Female , Humans , Incidence , India , Infection Control/instrumentation , Infection Control/standards , Male , Middle Aged , Occupational Diseases/diagnosis , Occupational Diseases/epidemiology , Occupational Health/standards , Personal Protective Equipment , Retrospective Studies , Tertiary Care Centers , Young Adult
5.
Arab J Gastroenterol ; 22(2): 170-173, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1258299

ABSTRACT

BACKGROUND AND STUDY AIMS: The COVID-19 outbreak has reorganized surgical team conditions regarding endoscopy. The number of interventions has been reduced, the number of healthcare professionals must be limited, and both the patients and physicians are more protected than ever. PATIENTS AND METHODS: In the highest peak of contagion in Colombia, endoscopy, colonoscopy, and esophagogastroduodenoscopy were performed using a low-cost disposable device. A total of 1388 procedures were performed. Every patient was assessed for symptoms via a telephone call, at the health center, and after the procedure, following specific attention routes. RESULTS: After procedure follow-up, no positive cases of COVID-19 were noted. CONCLUSION: The methodology reduced the risk of infection during the COVID-19 pandemic.


Subject(s)
COVID-19 , Endoscopy , Telemedicine , COVID-19/prevention & control , Colombia , Disposable Equipment , Endoscopy/instrumentation , Endoscopy/methods , Humans , Pandemics
6.
Ann Otol Rhinol Laryngol ; 130(11): 1245-1253, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1140414

ABSTRACT

OBJECTIVES: Define aerosol and droplet risks associated with routine otolaryngology clinic procedures during the COVID-19 era. METHODS: Clinical procedures were simulated in cadaveric heads whose oral and nasal cavities were coated with fluorescent tracer (vitamin B2) and breathing was manually simulated through retrograde intubation. A cascade impactor placed adjacent to the nares collected generated particles with aerodynamic diameters ≤14.1 µm. The 3D printed models and syringes were used to simulate middle and external ear suctioning as well as open suctioning, respectively. Provider's personal protective equipment (PPE) and procedural field contamination were also recorded for all trials using vitamin B2 fluorescent tracer. RESULTS: The positive controls of nebulized vitamin B2 produced aerosol particles ≤3.30 µm and endonasal drilling of a 3D model generated particles ≤14.1 µm. As compared with positive controls, aerosols and small droplets with aerodynamic diameter ≤14.1 µm were not detected during rigid nasal endoscopy, flexible fiberoptic laryngoscopy, and rigid nasal suction of cadavers with simulated breathing. There was minimal to no field contamination in all 3 scenarios. Middle and external ear suctioning and open container suctioning did not result in any detectable droplet contamination. The clinic suction unit contained all fluorescent material without surrounding environmental contamination. CONCLUSION: While patients' coughing and sneezing may create a baseline risk for providers, this study demonstrates that nasal endoscopy, flexible laryngoscopy, and suctioning inherently do not pose an additional risk in terms of aerosol and small droplet generation. An overarching generalization cannot be made about endoscopy or suctioning being an aerosol generating procedure. LEVEL OF EVIDENCE: 3.


Subject(s)
Aerosols/adverse effects , COVID-19 , Disease Transmission, Infectious/prevention & control , Endoscopy , Otolaryngology , Risk Adjustment/methods , Suction , COVID-19/prevention & control , COVID-19/transmission , Cadaver , Endoscopy/adverse effects , Endoscopy/instrumentation , Endoscopy/methods , Humans , Otolaryngology/methods , Otolaryngology/standards , Outcome Assessment, Health Care , Personal Protective Equipment/classification , Personal Protective Equipment/virology , Research Design , Risk Assessment/methods , SARS-CoV-2 , Suction/adverse effects , Suction/instrumentation , Suction/methods
7.
Khirurgiia (Mosk) ; (12): 16-21, 2020.
Article in Russian | MEDLINE | ID: covidwho-969483

ABSTRACT

OBJECTIVE: To summarize an experience of endoscopy-assisted dilatational tracheostomies in patients with COVID-19. MATERIAL AND METHODS: There were 31 endoscopy-assisted dilatational tracheostomies in patients with COVID-19 for the period from April 17 to June 10, 2020 (11 women and 19 men). Mean age of patients was 66.7 years (range 48-87). Tracheostomy was performed using Ciaglia (22) and Griggs (9) techniques. All procedures were carried out at the intensive care unit in elective fashion. RESULTS: Tracheostomy was performed in 19.8% of ICU patients or 36.9% of all patients on mechanical ventilation within 6.5±2.5 days [min 3, max 11]. There were 22 survivors with tracheostomy (70.9%) that is comparable with survival of patients without mechanical ventilation (79.7%) and slightly higher than in patients on ventilation without tracheostomy (65.4%). No complications during the procedure were noted. CONCLUSION: Endoscopy-assisted dilatational tracheostomy is preferred for prolonged mechanical ventilation, including patients with COVID-19. The undeniable advantages of this operation are fewer intraoperative complications due to endoscopic control, and lower risk of tracheal strictures.


Subject(s)
Coronavirus Infections/prevention & control , Dilatation/methods , Disease Outbreaks/prevention & control , Endoscopy/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Tracheostomy/instrumentation , Tracheostomy/methods , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Dilatation/adverse effects , Female , Humans , Male , Middle Aged , SARS-CoV-2 , Tracheostomy/adverse effects
10.
Am J Otolaryngol ; 42(2): 102779, 2021.
Article in English | MEDLINE | ID: covidwho-885171

ABSTRACT

PURPOSE: Upper airway stenosis is one of the most formidable situations in medicine and is frequently encountered in the ENT clinic. We introduce here our method of emergency endonasal endotracheal intubation under videoendoscopic observation. METHODS: Transnasal endoscopic observation was done, and the region of airway stenosis was detected. Then, the endotracheal tube was prepared and the endoscope was inserted into the tube. The endoscope with tube was inserted up to the larynx. Immediately after the administration of lidocaine to the larynx, the endoscope with tube was inserted to the endolarynx and then to the trachea. The endotracheal tube was tightly held in the nostril, and the endoscope was removed. RESULTS: We have encountered four cases this year. The primary disease developing airway stenosis was acute epiglottitis due to pharyngeal and deep neck abscesses in three cases and laryngeal edema due to Ludwig's angina. All patients underwent uneventful intubation, and dyspnea was immediately ceased. CONCLUSION: In cases showing severe suffocation, the clinician should perform airway maintenance even in an outpatient setting apart from a more monitored setting like the operation room. This technique resembles the usual nasal endoscopic laryngeal observation and is done even in the usual ENT office and/or emergency room. The supine position tends to worsen airway stenosis in patients with upper airway stenosis; however, this technique can be performed in a sitting or semi-sitting position. This method is less invasive for patients and also reduces the risk to the medical staff, especially in this COVID-19 era.


Subject(s)
Dyspnea/therapy , Endoscopy/methods , Intubation, Intratracheal/methods , Laryngostenosis/therapy , Tracheal Stenosis/therapy , Video Recording , Aged , Aged, 80 and over , Dyspnea/etiology , Epiglottitis/complications , Female , Humans , Laryngeal Edema/complications , Laryngostenosis/etiology , Male , Tracheal Stenosis/etiology
11.
Laryngoscope ; 131(5): 956-960, 2021 05.
Article in English | MEDLINE | ID: covidwho-871404

ABSTRACT

OBJECTIVES: The presence of high SARS-Cov-2 viral loads in the upper airway, including the potential for aerosolized transmission of viral particles, has generated significant concern amongst otolaryngologists worldwide, particularly those performing endoscopic sinus surgery (ESS). We evaluated a simple negative-pressure mask technique to reduce viral exposure. METHODS: Two models simulating respiratory droplets >5-10 µm and fine respiratory nuclei <5 µm using fluorescein dye and wood smoke, respectively, were utilized in a fixed cadaveric study in a controlled environment. Using ultraviolet light, fluorescein droplet spread was assessed during simulated ESS with powered microdebrider and powered drilling. Wood smoke ejection was used to evaluate fine particulate escape from a negative-pressure mask using digital subtraction image processing. RESULTS: The use of a negative-pressure mask technique resulted in 98% reduction in the fine particulate aerosol simulation and eliminated larger respiratory droplet spread during simulated ESS, including during external drill activation. CONCLUSIONS: As global ear, nose & throat (ENT) services resume routine elective operating, we demonstrate the potential use of a simple negative-pressure mask technique to reduce the risk of viral exposure for the operator and theatre staff during ESS. LEVEL OF EVIDENCE: 5 Laryngoscope, 131:956-960, 2021.


Subject(s)
COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Equipment Design/instrumentation , Paranasal Sinus Diseases/surgery , Aerosols/adverse effects , Air Pressure , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Cadaver , Endoscopy/methods , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Masks/virology , Occupational Exposure/prevention & control , SARS-CoV-2/genetics , Simulation Training/methods , Virion
12.
Eur J Gastroenterol Hepatol ; 32(10): 1301-1304, 2020 10.
Article in English | MEDLINE | ID: covidwho-709228

ABSTRACT

OBJECTIVE: SARS-CoV-2 outbreak is spreading worldwide. As a consequence of the new circumstances, almost all endoscopic units underwent in-depth reorganization involving patients' selection. We analyzed the efficacy of the newly adopted endoscopic triage. METHODS: In March 2020, we monitored endoscopies to evaluate the effects of the novel selective triage aimed to reduce the number of investigations and viral spread/contagions. Clinical-demographic data of the patients, indications, type of endoscopy, endoscopic findings (subtyped in major and minor), finding rates (major and minor) and diagnostic yields (major findings) have been analyzed and compared to the endoscopic procedures performed in March 2019. Furthermore, patients were called at least 21 days after the endoscopy to evaluate the possibility of a Covid-19 onset. RESULTS: Accordingly to the novel triage, the number of procedures dropped from 530 to 91 (-84%). The finding rates and diagnostic yields were 83% (74-89) vs 71% (66-73) (P 0.015) and 56% (46-65) vs 43% (38-47) (P 0.03) on March 2020 and March 2019, respectively. A significant increase of operative procedures has been reported in 2020, 34% vs 22% in March 2019. All the patients were recalled and neither cases of onset of Covid-19 like symptoms nor positive nasopharyngeal swabs PCR have been evidenced. CONCLUSION: The novel endoscopic triage significantly reduced the number of procedures and increased finding rates and diagnostic yields. However, a careful schedule of canceled procedures should be applied to avoid to miss relevant pathologies. No Covid-19 onset or infection has been noted after endoscopies.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Emergencies , Endoscopy/methods , Pandemics , Pneumonia, Viral/epidemiology , Triage/methods , COVID-19 , Female , Humans , Male , Middle Aged , Risk Factors , SARS-CoV-2
14.
J Endocrinol Invest ; 44(3): 635-636, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-639909

ABSTRACT

PURPOSE: During the Covid-19 pandemic every hospital has had to change its internal organization. Different institutions have highlighted the risks connected with endoscopic endonasal surgery. The goal of this paper is to illustrate the feasibility of pituitary region surgery during the SARS-CoV-2 pandemic. METHODS: After two negative Covid tests were obtained, three patients with macro GH-secreting tumors, and two patients with micro ACTH-secreting tumors resistant to medical treatment underwent surgery during the pandemic. During the surgery, every patient was treated as if they were positive. RESULTS: Neither operator, nor patient have developed Covid symptoms. The two neurosurgeons performing the operations underwent two Covid swab, which resulted negative. CONCLUSIONS: Pituitary surgery is a high risk non-urgent surgery. However, the method described has so far been effective and is safe for both patients and healthcare providers.


Subject(s)
ACTH-Secreting Pituitary Adenoma/surgery , Adenoma/surgery , COVID-19 , Growth Hormone-Secreting Pituitary Adenoma/surgery , Infection Control , Neurosurgical Procedures/methods , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing/standards , Cross Infection/prevention & control , Endoscopy/methods , Endoscopy/standards , Feasibility Studies , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/standards , Italy/epidemiology , Neurosurgical Procedures/standards , Nose/surgery , Pandemics , Patient Safety/standards , Patient Selection , Protective Clothing , Protective Devices , Retrospective Studies , SARS-CoV-2/physiology
15.
Int J Surg ; 80: 21-25, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-638076

ABSTRACT

The current dreadful pandemic of coronavirus disease (COVID-19) is playing havoc with humanity, socio-communal systems and economic reserves worldwide. Certain countries have managed to curtail COVID-19 crisis to some extent, however, a great majority still remains helpless in containing this outbreak. Rapidly evolving disease patterns and complex epidemiology of the COVID-19 necessitate a tailored approach by medical experts in dealing with this devastating outbreak. Similar to other medical disciplines, surgical associations and societies have developed a tailored approach of patients' selection and management plans with improvised endolaparoscopic practice during the COVID-19 pandemic. Non-essential and non-urgent surgical procedures are deferred till this outbreak is abated. Benefits of delaying elective and non-urgent surgery outweighs the risk of performing surgical procedures on patients with asymptomatic or active COVID-19 disease. Laparoendoscopic procedures increase the risk of aerosol exposure, disease transmission and contamination. Limiting the number of operating room personnel, use of disposable instruments, small trocar incisions, negative pressure environment, and setting energy devices at low modes can help reduce disease transmission during laparoendocsopic procedures. This write up sheds lights on the impact of the COVID-19, big data analytics of response of medical personnel in understanding and curtailing the disease process and the consensus guidelines for carrying out laparoscoendoscopic procedures.


Subject(s)
Coronavirus Infections/prevention & control , Disposable Equipment , Endoscopy/methods , Health Care Rationing , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy/methods , Neoplasms/surgery , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/prevention & control , Betacoronavirus , Big Data , COVID-19 , Clinical Protocols , Coronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Data Science , Elective Surgical Procedures/methods , Electrocoagulation/methods , Equipment Contamination/prevention & control , Health Personnel , Humans , Operating Rooms , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2 , Ultrasonic Surgical Procedures/methods
18.
Clinics ; 75: e1989, 2020. graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-608407

ABSTRACT

OBJECTIVES: The present coronavirus disease (COVID-19) pandemic has ushered in an unprecedented era of quality control that has necessitated advanced safety precautions and the need to ensure the adequate protection of healthcare professionals (HCPs). Endoscopy units, endoscopists, and other HCP may be at a significant risk for transmission of the virus. Given the immense burden on the healthcare system and surge in the number of patients with COVID-19, well-designed protocols and recommendations are needed. We aimed to systematically characterize our approach to endoscopic procedures in a quaternary university hospital setting and provide summary protocol recommendations. METHOD: This descriptive study details a COVID-19-specific protocol designed to minimize infection risks to patients and healthcare workers in the endoscopy unit. RESULTS: Our institution, located in São Paulo, Brazil, includes a 900-bed hospital, with a 200-bed-specific intensive care unit exclusively designed for patients with moderate and severe COVID-19. We highlighted recommendations for infection prevention and control during endoscopic procedures, including appropriate triage and screening, outpatient management and procedural recommendations, role and usage of personal protective equipment (PPE), and role and procedural logistics involving COVID-19-positive patients. We also detailed hospital protocols for reprocessing endoscopes and cleaning rooms and also provided recommendations to minimize severe acute respiratory syndrome coronavirus 2 transmission. CONCLUSION: This COVID-19-specific administrative and clinical protocol can be replicated or adapted in multiple institutions and endoscopy units worldwide. Furthermore, the recommendations and summary protocol may improve patient and HCP safety in these trying times.


Subject(s)
Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Coronavirus Infections/prevention & control , Endoscopy/standards , Pandemics/prevention & control , Betacoronavirus , Hospitals, University/standards , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Brazil , Risk Factors , Health Personnel/standards , Practice Guidelines as Topic , Coronavirus Infections/transmission , Endoscopy/methods , Personal Protective Equipment/standards , SARS-CoV-2 , COVID-19
20.
Eur Urol Focus ; 6(5): 1070-1085, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-548747

ABSTRACT

CONTEXT: The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge. OBJECTIVE: To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic. EVIDENCE ACQUISITION: Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria. EVIDENCE SYNTHESIS: Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence). CONCLUSIONS: To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal. PATIENT SUMMARY: We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Standard of Care , Urologic Neoplasms/surgery , Urology/standards , Betacoronavirus , COVID-19 , Clinical Decision-Making , Endoscopy/methods , Humans , Laparoscopy/methods , Neoplasm Grading , Neoplasm Staging , Pandemics , Robotic Surgical Procedures/methods , SARS-CoV-2 , Urologic Diseases/surgery , Urologic Neoplasms/pathology , Urologic Surgical Procedures/methods
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