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1.
Lancet ; 398(10307): 1257-1268, 2021 10 02.
Article in English | MEDLINE | ID: covidwho-1447236

ABSTRACT

Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively. Cardiac arrests in these circumstances represent an increasing proportion of all treated cardiac arrests, often have a preventable cause, and require additional interventions to correct a reversible cause during resuscitation. The evidence for treating these conditions is mostly of low or very low certainty and further studies are needed. Irrespective of the cause, treatments for cardiac arrest are time sensitive and most effective when given early-every minute counts.


Subject(s)
Anaphylaxis/therapy , Asphyxia/therapy , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Hypothermia/therapy , Pregnancy Complications, Cardiovascular/therapy , Pulmonary Embolism/therapy , Wounds and Injuries/therapy , Anaphylaxis/complications , Asphyxia/complications , COVID-19/complications , COVID-19/therapy , Electric Countershock , Female , Heart Arrest/etiology , Humans , Hypothermia/complications , Intraoperative Complications/therapy , Out-of-Hospital Cardiac Arrest/etiology , Out-of-Hospital Cardiac Arrest/therapy , Personal Protective Equipment , Postoperative Complications/therapy , Practice Guidelines as Topic , Pregnancy , Pulmonary Embolism/complications , Return of Spontaneous Circulation , SARS-CoV-2 , Wounds and Injuries/complications
2.
Anesth Analg ; 133(2): 483-490, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1311272

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with high perioperative morbidity and mortality among adults. The incidence and severity of anesthetic complications in children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. We hypothesized that there would be an increased incidence of intra- and postoperative complications in children with SARS-CoV-2 infection as compared to those with negative testing. METHODS: We conducted a retrospective cohort study analyzing complications for children <18 years of age who underwent anesthesia between April 28 and September 30, 2020 at a large, academic pediatric hospital. Each child with a positive SARS-CoV-2 test within the prior 10 days was matched to a patient with a negative SARS-CoV-2 test based on American Society of Anesthesiologists (ASA) physical status, age, gender, and procedure. Children who were intubated before the procedure, underwent organ transplant surgery, or had severe COVID-19 were excluded. The primary outcome was the risk difference of a composite of intra- or postoperative respiratory complications in children positive for SARS-CoV-2 compared to those with negative testing. Secondarily, we used logistic regression to determine the odds ratio for respiratory complications before and after adjustment using propensity scores weighting to adjust for possible confounders. Other secondary outcomes included neurologic, cardiovascular, hematologic, and renal complications, unanticipated postoperative admission to the intensive care unit, length of hospital stay, and mortality. RESULTS: During the study period, 9812 general anesthetics that had a preoperative SARS-CoV-2 test were identified. Sixty encounters occurred in patients who had positive SARS-CoV-2 testing preoperatively and 51 were included for analysis. The matched controls cohort included 99 encounters. A positive SARS-CoV-2 test was associated with a higher incidence of respiratory complications (11.8% vs 1.0%; risk difference 10.8%, 95% confidence interval [CI], 1.6-19.8; P = .003). After adjustment, the odds ratio for respiratory complications was 14.37 (95% CI, 1.59-130.39; P = .02) for SARS-CoV-2-positive children as compared to controls. There was no occurrence of acute respiratory distress syndrome, postoperative pneumonia, or perioperative mortality in either group. CONCLUSIONS: Pediatric patients with nonsevere SARS-CoV-2 infection had higher rates of perianesthetic respiratory complications than matched controls with negative testing. However, severe morbidity was rare and there were no mortalities. The incidence of complications was similar to previously published rates of perianesthetic complications in the setting of an upper respiratory tract infection. This risk persisted after adjustment for preoperative upper respiratory symptoms, suggesting an increased risk in symptomatic or asymptomatic SARS-CoV-2 infection.


Subject(s)
Anesthesia/adverse effects , COVID-19/epidemiology , Intraoperative Complications/epidemiology , Postoperative Complications/epidemiology , Adolescent , Age Factors , COVID-19/diagnosis , COVID-19/mortality , Child , Child, Preschool , Female , Hospital Mortality , Humans , Incidence , Intensive Care Units, Pediatric , Intraoperative Complications/diagnosis , Intraoperative Complications/mortality , Intraoperative Complications/therapy , Length of Stay , Male , Patient Admission , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Postoperative Complications/therapy , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , Texas/epidemiology , Time Factors
3.
Medicine (Baltimore) ; 100(24): e26332, 2021 Jun 18.
Article in English | MEDLINE | ID: covidwho-1269621

ABSTRACT

BACKGROUND: Patients after breast cancer surgery have a high sense of stigma due to the formation of surgical scars, loss of breast shape or other reasons, leading to anxiety, depression, and other adverse mental health problems, thus reducing their quality of life. Remote peer support intervention based on telephone, internet or email is low-cost and easy to spread, and protects patients' privacy, solves the barriers to access that many patients face when attending face-to-face programs. Therefore, remote peer support may be an effective way to reduce stigma and improve mental health in patients after breast cancer surgery during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Eight databases (PubMed, Embase, Cochrane Library, CNKI, PsycNET, MEDLINE, Psychology & Behavioral Sciences Collection and Web of Science) will be used to select eligible studies that were published from inception to May, 2021. The eligible studies will be screened, extracted and then the methodological quality will be evaluated independently by 2 reviewers. Review manager software version 5.3 software and Stata version 14.0 software will be used for meta-analysis. RESULTS: The results of this study will show the effect of remote peer support on stigma, depression and anxiety in patients after breast cancer surgery during the COVID-19 pandemic and will be submitted to a peer-reviewed journal for publication. CONCLUSION: The results of this study will provide evidence for the effectiveness of remote peer support in patients after breast cancer surgery during the COVID-19 pandemic. PROSPERO REGISTRATION NUMBER: CRD42021255971.


Subject(s)
Breast Neoplasms/psychology , Mastectomy/psychology , Postoperative Complications/therapy , Social Stigma , Social Support , Anxiety/etiology , Anxiety/therapy , Breast Neoplasms/surgery , COVID-19 , Depression/etiology , Depression/therapy , Female , Humans , Meta-Analysis as Topic , Peer Group , Postoperative Complications/etiology , Postoperative Complications/psychology , Research Design , SARS-CoV-2 , Systematic Reviews as Topic , Treatment Outcome
4.
Transplantation ; 105(7): 1433-1444, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1228580

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) fatality rate is high among kidney transplant recipients. Among survivors, kidney outcomes, seroconversion, and persistence of viral shedding are unexplored. METHODS: Single-center prospective cohort study including data from kidney transplant recipients with confirmed COVID-19 between March 20, 2020 and July 31, 2020. Outcomes were adjudicated until August 31, 2020 or the date of death. RESULTS: There were 491 patients with COVID-19 among the 11 875 recipients in follow-up. The majority were middle aged with ≥1 comorbidities. Thirty-one percent were treated at home, and 69% required hospitalization. Among the hospitalized, 61% needed intensive care, 75% presented allograft dysfunction, and 46% needed dialysis. The overall 28-day fatality rate was 22% and among hospitalized patients it was 41%. Age (odds ratio, 3.08; 95% confidence interval, 1.86-5.09), diabetes mellitus (odds ratio, 1.69; 95% confidence interval, 1.06-2.72), and cardiac disease (odds ratio, 2.00; 95% confidence interval, 1.09-3.68) were independent factors for death. Among the 351 survivors, 19% sustained renal graft dysfunction, and there were 13 (4%) graft losses. Biopsy (n = 20) findings were diverse but decisive to guide treatment and estimate prognosis. Seroconversion was observed in 79% of the survivors and was associated with disease severity. Persistence of viral shedding was observed in 21% of the patients without detectable clinical implications. CONCLUSIONS: This prospective cohort analysis confirms the high 28-day fatality rate of COVID-19, associated primarily with age and comorbidities. The high incidence of allograft dysfunction was associated with a wide range of specific histologic lesions and high rates of sequelae and graft loss. Seroconversion was high and the persistence of viral shedding deserves further studies.


Subject(s)
COVID-19/etiology , Kidney Transplantation , Postoperative Complications , Adult , Aged , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Disease Progression , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Postoperative Complications/therapy , Prognosis , Prospective Studies
5.
J Surg Res ; 261: 113-122, 2021 05.
Article in English | MEDLINE | ID: covidwho-1164141

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) global pandemic has led to a halt in elective surgeries throughout the United States and many other countries throughout the world. Early reports suggest that COVID-19 patients undergoing surgery have an increased risk of requiring intensive care unit (ICU) admission and overall mortality. MATERIALS AND METHODS: A retrospective review was performed of all COVID-19, positive with polymerase chain reaction confirmation, patients who had surgery between February 17, 2020 and April 26, 2020 at a major New York City hospital. Clinical characteristics and outcomes including ICU admission, ventilator requirement, and mortality were analyzed. RESULTS: Thirty-nine COVID-19 surgical patients were identified. Mean age was 53.9 y, and there were more men than women in the cohort (56.4% versus 43.6%). Twenty-two patients (56.4%) had a confirmed positive COVID-19 test preoperatively, and the remainder tested positive after their procedure. The majority (59%) of patients had an American Society of Anesthesiologists (ASA) class of 3 or higher. Postoperatively, 7 patients (17.9%) required ICU level care with a mean length of stay of 7.7 d. There were 4 deaths (10.3%) in this patient population, all of which occurred in patients who were ASA class 3 or 4. CONCLUSIONS: This study represents the largest study to date, that objectively analyzes the outcomes of COVID-19 positive patients who underwent surgery. Overall, ICU admission rates and mortality are similar to reported rates in the literature for nonsurgical COVID-19 patients. Notably, in COVID-19 patients with ASA 1 or 2, there was a 0% mortality rate in the postoperative period.


Subject(s)
COVID-19/complications , Critical Care/statistics & numerical data , Postoperative Complications/virology , Surgical Procedures, Operative , Adult , Aged , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Female , Humans , Male , Middle Aged , New York City/epidemiology , Postoperative Care/statistics & numerical data , Postoperative Complications/mortality , Postoperative Complications/therapy , Prognosis , Retrospective Studies , Risk Factors
6.
Arch Ital Urol Androl ; 93(1): 71-76, 2021 Mar 19.
Article in English | MEDLINE | ID: covidwho-1146951

ABSTRACT

This collection of cases describes some unusual urological tumors and complications related to urological tumors and their treatment. Case 1: A case of uretero-arterial fistula in a patient with long-term ureteral stenting for ureteral oncological stricture and a second case associated to retroperitoneal fibrosis were described. Abdominal CT, pyelography, cystoscopy were useful to show the origin of the bleeding. Angiography is useful for confirming the diagnosis and for subsequent positioning of an endovascular prosthesis which represents a safe approach with reduced post-procedural complications. Case 2: A case of patient who suffered from interstitial pneumonitis during a cycle of intravesical BCG instillations for urothelial cancer. The patient was hospitalized for more than two weeks in a COVID ward for a suspected of COVID-19 pneumonia, but he did not show any evidence of SARS-CoV-2 infection during his hospital stay. Case 3: A case of a young man with a functional urinary bladder paraganglioma who was successfully managed with complete removal of the tumor, leaving the urinary bladder intact. Case 4: A case of a 61 year old male suffering from muscle invasive bladder cancer who was admitted for a radical cystectomy and on the eighth postoperative day developed microangiopathic hemolytic anemia and thrombocytopenia, which clinically defines thrombotic microangiopathy.


Subject(s)
Urologic Neoplasms/therapy , Administration, Intravesical , Adult , BCG Vaccine/therapeutic use , COVID-19/complications , COVID-19/therapy , Carcinoma, Transitional Cell/pathology , Computed Tomography Angiography , Cystectomy , Fistula/complications , Fistula/therapy , Humans , Male , Middle Aged , Paraganglioma/surgery , Paraganglioma/therapy , Pneumonia/complications , Pneumonia/therapy , Postoperative Complications/therapy , Purpura, Thrombotic Thrombocytopenic/etiology , Purpura, Thrombotic Thrombocytopenic/therapy , Ureteral Diseases/complications , Ureteral Diseases/diagnostic imaging , Ureteral Diseases/therapy , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/therapy , Urologic Neoplasms/complications , Urologic Neoplasms/diagnostic imaging
7.
Transpl Int ; 34(4): 721-731, 2021 04.
Article in English | MEDLINE | ID: covidwho-1119269

ABSTRACT

Available data on clinical presentation and mortality of coronavirus disease-2019 (COVID-19) in heart transplant (HT) recipients remain limited. We report a case series of laboratory-confirmed COVID-19 in 39 HT recipients from 3 French heart transplant centres (mean age 54.4 ± 14.8 years; 66.7% males). Hospital admission was required for 35 (89.7%) cases including 14/39 (35.9%) cases being admitted in intensive care unit. Immunosuppressive medications were reduced or discontinued in 74.4% of the patients. After a median follow-up of 54 (19-80) days, death and death or need for mechanical ventilation occurred in 25.6% and 33.3% of patients, respectively. Elevated C-reactive protein and lung involvement ≥50% on chest computed tomography (CT) at admission were associated with an increased risk of death or need for mechanical ventilation. Mortality rate from March to June in the entire 3-centre HT recipient cohort was 56% higher in 2020 compared to the time-matched 2019 cohort (2% vs. 1.28%, P = 0.15). In a meta-analysis including 4 studies, pre-existing diabetes mellitus (OR 3.60, 95% CI 1.43-9.06, I2  = 0%, P = 0.006) and chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39-10.31, I2  = 0%, P = 0.009) were associated with increased mortality. These findings highlight the aggressive clinical course of COVID-19 in HT recipients.


Subject(s)
COVID-19/diagnosis , Heart Transplantation , Postoperative Complications/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/etiology , COVID-19/mortality , COVID-19/therapy , COVID-19 Testing , Female , Follow-Up Studies , France , Humans , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/mortality , Postoperative Complications/therapy , Prognosis , Prospective Studies , Respiration, Artificial/statistics & numerical data , Risk Factors , Severity of Illness Index , Young Adult
9.
J Laryngol Otol ; 135(2): 117-124, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1093305

ABSTRACT

BACKGROUND: Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre. METHODS: After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019. RESULTS: An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients. CONCLUSIONS: Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.


Subject(s)
Ambulatory Care/statistics & numerical data , COVID-19 , Epistaxis/therapy , Hospitalization/statistics & numerical data , Peritonsillar Abscess/therapy , Tonsillitis/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Ear , Ear Diseases/epidemiology , Ear Diseases/therapy , Emergencies , Emergency Service, Hospital , Epistaxis/epidemiology , Female , Foreign Bodies/epidemiology , Foreign Bodies/therapy , Humans , Male , Middle Aged , Otorhinolaryngologic Diseases/epidemiology , Otorhinolaryngologic Diseases/therapy , Peritonsillar Abscess/epidemiology , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Practice Guidelines as Topic , Referral and Consultation/trends , SARS-CoV-2 , Tonsillitis/epidemiology , United Kingdom/epidemiology , Young Adult
10.
Eur J Cardiothorac Surg ; 58(5): 991-996, 2020 Nov 01.
Article in English | MEDLINE | ID: covidwho-1066298

ABSTRACT

OBJECTIVES: We reviewed the incidence of coronavirus disease 2019 cases and the postoperative outcomes of patients who had thoracic surgery during the beginning and at the highest point of transmission in our community. METHODS: We retrospectively reviewed patients who had undergone elective thoracic surgery from 12 February 2020 to 30 April 2020 and were symptomatic or tested positive for severe acute respiratory syndrome coronavirus 2 infection within 14 days after surgery, with a focus on their complications and potential deaths. RESULTS: Out of 101 surgical procedures, including 57 primary oncological resections, 6 lung transplants and 18 emergency procedures, only 5 cases of coronavirus disease 2019 were identified, 3 in the immediate postoperative period and 2 as outpatients. All 5 patients had cancer; the median age was 64 years. The main virus-related symptom was fever (80%), and the median onset of coronavirus disease 2019 was 3 days. Although 80% of the patients who had positive test results for severe acute respiratory syndrome coronavirus 2 required in-hospital care, none of them were considered severe or critical and none died. CONCLUSIONS: These results indicate that, in properly selected cases, with short preoperative in-hospital stays, strict isolation and infection control protocols, managed by a dedicated multidisciplinary team, a surgical procedure could be performed with a relatively low risk for the patient.


Subject(s)
Betacoronavirus , Carcinoma, Squamous Cell/surgery , Coronavirus Infections/etiology , Elective Surgical Procedures , Lung Neoplasms/surgery , Pneumonia, Viral/etiology , Postoperative Complications , Thoracic Surgical Procedures , Adult , Aged , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Follow-Up Studies , Humans , Incidence , Male , Outcome Assessment, Health Care , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Retrospective Studies , SARS-CoV-2 , Spain , Treatment Outcome
11.
Eur J Cardiothorac Surg ; 58(5): 899-906, 2020 11 01.
Article in English | MEDLINE | ID: covidwho-1066297

ABSTRACT

OBJECTIVES: Few anecdotal cases have been reported in the literature regarding heart transplant recipients and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report our experience with 6 patients hospitalized in Northern Italy during the outbreak. METHODS: Of the 396 living heart transplant recipients from 1985 to 2020 included in the study, 6 patients developed the novel 2019 coronavirus disease. Risk factors, last follow-up characteristics, onset presentation, in-hospital course of disease and blood examinations data were collected for these patients. RESULTS: All patients were symptomatic and had positive results from a nasopharyngeal swab test for SARS-CoV-2. Of the 6 patients, 5 were hospitalized and 1 remained self-quarantined at home. Two patients died and 3 were discharged home. Two patients were admittted to the intensive care unit . Immunosuppressive therapy was modified with a median reduction comprising doses that were 50% cyclosporine and 50% mycophenolate. All patients received a medium-dose of corticosteroids as a bolus medication in addition to their therapy. All hospitalized patients received hydroxychloroquine; 2 patients received ritonavir/lopinavir. Broad-spectrum antibiotics for prophylaxis were administered to all. One patient had an ischaemic stroke and died of sepsis. CONCLUSIONS: In the absence of any strong evidence regarding the treatment of heart transplant recipients infected with SARS-CoV-2, we faced a new challenge in managing viral infection in an immunosuppressed population. Because immunomodulation interaction with the infection seems to be crucial for developing severe forms of the disease, we managed to reduce immunosuppressive therapy by adding medium doses of corticosteroids. Despite the limited number of affected patients, this report suggests that special considerations should be given to treating coronavirus disease in the heart transplant recipient population.


Subject(s)
Betacoronavirus , Coronavirus Infections/etiology , Heart Transplantation , Pneumonia, Viral/etiology , Postoperative Complications/etiology , Aged , Aged, 80 and over , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Follow-Up Studies , Humans , Italy , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Risk Factors , SARS-CoV-2
13.
Ear Nose Throat J ; 100(2_suppl): 148S-151S, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1013115

ABSTRACT

Patients with severe coronavirus disease 2019 (COVID-19) may have endothelial inflammation, pseudoaneurysm, and an increasing risk of bleeding, especially during surgical procedures. In this article, we reported 2 cases of COVID-19 patients with neck vascular lesions. The first patient had pseudoaneurysm of the cricothyroid artery, which was treated by percutaneous glue injection through ultrasonography guidance. The second patient presented lateral neck hematoma in front of the left superior thyroid artery, which was managed by coil endovascular embolization. In the context of pandemic, the management of vascular lesions may be performed through interventional radiological procedures that may reduce the risk of virus aerosolization and health care provider contamination.


Subject(s)
Adhesives/therapeutic use , Aneurysm, False/therapy , COVID-19/therapy , Embolization, Therapeutic/methods , Hematoma/therapy , Postoperative Complications/therapy , Radiology, Interventional , Tracheotomy , Aged , Aneurysm, False/complications , Aneurysm, False/diagnostic imaging , COVID-19/complications , Computed Tomography Angiography , Cyanoacrylates/therapeutic use , Endovascular Procedures , Hematoma/complications , Hematoma/diagnostic imaging , Humans , Male , Middle Aged , Neck , Postoperative Complications/diagnostic imaging , SARS-CoV-2 , Thyroid Gland/blood supply , Ultrasonography
15.
Eur J Vasc Endovasc Surg ; 61(2): 306-315, 2021 02.
Article in English | MEDLINE | ID: covidwho-921971

ABSTRACT

OBJECTIVE: During the most aggressive phase of the COVID-19 outbreak in Italy, the Regional Authority of Lombardy identified a number of hospitals, named Hubs, chosen to serve the whole region for highly specialised cases, including vascular surgery. This study reports the experience of the four Hubs for Vascular Surgery in Lombardy and provides a comparison of in hospital mortality and major adverse events (MAEs) according to COVID-19 testing. METHODS: Data from all patients who were referred to the Vascular Surgery Department of Hubs from 9 March to 28 April 2020 were collected prospectively and analysed. A positive COVID-19 polymerase chain reaction swab test, or symptoms (fever > 37.5 °C, upper respiratory tract symptoms, chest pain, and contact/travel history) associated with interstitial pneumonia on chest computed tomography scan were considered diagnostic of COVID-19 disease. Patient characteristics, operative variables, and in hospital outcomes were compared according to COVID-19 testing. A multivariable model was used to identify independent predictors of in hospital death and MAEs. RESULTS: Among 305 included patients, 64 (21%) tested positive for COVID-19 (COVID group) and 241 (79%) did not (non-COVID group). COVID patients presented more frequently with acute limb ischaemia than non-COVID patients (64% vs. 23%; p < .001) and had a significantly higher in hospital mortality (25% vs. 6%; p < .001). Clinical success, MAEs, re-interventions, and pulmonary and renal complications were significantly worse in COVID patients. Independent risk factors for in hospital death were COVID (OR 4.1), medical treatment (OR 7.2), and emergency setting (OR 13.6). COVID (OR 3.4), obesity class V (OR 13.5), and emergency setting (OR 4.0) were independent risk factors for development of MAEs. CONCLUSION: During the COVID-19 pandemic in Lombardy, acute limb ischaemia was the most frequent vascular disease requiring surgical treatment. COVID-19 was associated with a fourfold increased risk of death and a threefold increased risk of major adverse events.


Subject(s)
COVID-19 , Infection Control , Postoperative Complications , Vascular Diseases , Vascular Surgical Procedures , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Emergencies/epidemiology , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Female , Hospital Mortality , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Outcome and Process Assessment, Health Care , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Prognosis , Retrospective Studies , Risk Adjustment/methods , Risk Factors , SARS-CoV-2/isolation & purification , Vascular Diseases/diagnosis , Vascular Diseases/mortality , Vascular Diseases/surgery , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/methods
16.
J Plast Reconstr Aesthet Surg ; 74(3): 644-710, 2021 03.
Article in English | MEDLINE | ID: covidwho-912072

ABSTRACT

Globally, there has been a measured response to rationalise elective operating during the Coronavirus disease 2019 (COVID-19) pandemic. In terms of breast cancer care, this has led to a restricted provision of reconstruction with autologous free tissue transfer. A primary concern is the risk of mortality in elective surgery patients who develop COVID-19. The aim of this report is to describe the observed physiological impact of the virus on our patient, and to address how outpatient care after autologous free tissue transfer can be delivered to COVID-19 positive patients. In March 2020, we performed a bilateral breast reconstruction with a deep inferior epigastric perforator flap and a superficial inferior epigastric perforator flap. The patient became symptomatic on day three post-operatively, tested positive for COVID-19 and was discharged home. Drain and dressing management was continued through the use of telemedicine. Two weeks following the operation, a breast seroma formed that was drained semi-electively in the COVID-19 positive area of the Emergency Department. The patient visited the dressing clinic twice in total and healed after three weeks. Despite undergoing complex surgery and having pre-operative chemotherapy, our patient suffered a mild form of the virus limited to upper respiratory symptoms. Physiologically we did not see any significant difference to that of the normal post-operative course. This case demonstrates the possibility of managing autologous breast reconstruction patients using telemedicine. Although COVID-19 can complicate, or even be fatal, in the perioperative course, our patient thankfully suffered no discernable negative outcome from her infection.


Subject(s)
Aftercare , Breast Neoplasms , COVID-19 , Neoplasm Recurrence, Local , Patient Isolation , Postoperative Complications , Aftercare/methods , Aftercare/trends , Breast Neoplasms/pathology , Breast Neoplasms/surgery , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Female , Free Tissue Flaps , Humans , Mammaplasty/adverse effects , Mammaplasty/methods , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/surgery , Patient Discharge/trends , Patient Isolation/methods , Patient Isolation/organization & administration , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Treatment Outcome , Wound Healing
17.
Transplant Proc ; 52(9): 2620-2625, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-899626

ABSTRACT

Kidney transplant recipients who develop symptoms consistent with coronavirus disease 2019 (COVID-19) are bringing unique challenges to health care professionals. Telemedicine has surged dramatically since the pandemic in effort to maintain patient care and reduce the risk of COVID-19 exposure to patients, health care workers, and the public. Herein we present reports of 3 kidney transplant recipients with COVID-19 who were managed using telemedicine via synchronous video visits integrated with an electronic medical record system, from home to inpatient settings. We demonstrate how telemedicine helped assess, diagnose, triage, and treat patients with COVID-19 while avoiding a visit to an emergency department or outpatient clinic. While there is limited information about the duration of viral shedding for immunosuppressed patients, our findings underscore the importance of using telemedicine in the follow-up care for kidney transplant recipients with COVID-19 who have recovered from symptoms but might have persistently positive nucleic acid tests. Our experience emphasizes the opportunities of telemedicine in the management of kidney transplant recipients with COVID-19 and in the maintenance of uninterrupted follow-up care for such immunosuppressed patients with prolonged viral shedding. Telemedicine may help increase access to care for kidney transplant recipients during and beyond the pandemic as it offers a prompt, safe, and convenient platform in the delivery of care for these patients. Yet, to advance the practice of telemedicine in the field of kidney transplantation, barriers to increasing the widespread implementation of telemedicine should be removed, and research studies are needed to assess the effectiveness of telemedicine in the care of kidney transplant recipients.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/therapy , Kidney Transplantation/adverse effects , Pneumonia, Viral/therapy , Postoperative Complications/therapy , Telemedicine/methods , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Female , Humans , Immunocompromised Host/immunology , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Postoperative Complications/diagnosis , Postoperative Complications/immunology , SARS-CoV-2
18.
Rev Gastroenterol Mex (Engl Ed) ; 85(4): 437-442, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-841106

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a serious respiratory illness caused by SARS-CoV-2. There is controversy about whether their immunosuppressive status is a risk factor or a protective factor for developing severe disease. We report herein the clinical outcome of three family members that had COVID-19 infection, presenting with and without different risk factors that have been described in more severe disease. Paradoxically, the patient with more risks of developing a severe disease, a 64-year-old woman, 2-years liver transplant recipient under treatment with tacrolimus, presented a similar outcome compared to the two other members of the family. She showed shorter hospitalization time, similar clinical outcome with fewer oxygen needs. The present clinical observation raises the question about the possible beneficial effect of tacrolimus in patients with COVID-19. Indeed, tacrolimus (FK-506) have an inhibitory effect on human coronaviruses by: 1) an antiviral effect by binding to the FK-506-binding proteins (FKBP) with a subsequent inhibition of their peptidyl-prolyl cis/trans isomerase (PPIase) activity, which seems to be important for the coronavirus life cycle; and 2) regulating the immune response by the inhibition of the activity of the nuclear factor of activated T-cells (NFAT) required for immunosuppression. The present observation states that liver recipients' patients with COVID-19 may not have worse outcomes when compared with other patients that have COVID-19 risk factors and puts in evidence the two mechanisms related to tacrolimus.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Immunosuppressive Agents/therapeutic use , Liver Transplantation , Pneumonia, Viral/therapy , Postoperative Complications/therapy , Tacrolimus/therapeutic use , Adult , Betacoronavirus/isolation & purification , COVID-19 , Combined Modality Therapy , Coronavirus Infections/diagnosis , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Postoperative Complications/diagnosis , Prognosis , SARS-CoV-2 , Severity of Illness Index
20.
Clin Transplant ; 34(12): e14091, 2020 12.
Article in English | MEDLINE | ID: covidwho-772451

ABSTRACT

A chronic immunosuppressed state as in solid organ transplant recipients is a reported risk factor for the novel 2019 coronavirus infection. Patients with a history of orthotopic heart transplant (OHT) at a tertiary care transplant center in Detroit, Michigan were retrospectively reviewed from March until May 2020. Clinical parameters and outcomes of 5 OHT recipients and one combined heart-lung recipient with confirmed SARS-CoV-2 were obtained. The cohort was predominately African American males with median age of 59 years (interquartile range, 48.25-73.25). All patients were classified as having mild-moderate disease; none required intubation or ICU admission with no deaths. The most common presenting symptoms were fever and shortness of breath 83% (n = 5), followed by cough and chills 67% (n = 4). All admitted patients (n = 5) received hydroxychloroquine and 3 received high-dose steroids. Antimetabolites were held for 2 patients (33.3%). The calcineurin inhibitor trough goal was decreased in only 1 patient; 3 other patients, without change in goal, required calcineurin inhibitor dosage reduction. Two patients requiring readmission presented 7 and 23 days after initial symptoms onset. In conclusion, our experience with OHT patients infected by the SARS-CoV-2 virus did not have an elevated risk of severe infection. Impact of modifying immunosuppression remains unclear.


Subject(s)
COVID-19/immunology , Heart Transplantation , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Postoperative Complications/immunology , Adult , Aged , COVID-19/diagnosis , COVID-19/etiology , COVID-19/therapy , COVID-19 Testing , Combined Modality Therapy , Female , Graft Rejection/prevention & control , Hospitalization , Humans , Immunosuppressive Agents/therapeutic use , Male , Michigan , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Postoperative Complications/virology , Retrospective Studies , Severity of Illness Index , Treatment Outcome
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