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1.
Lasers Med Sci ; 36(7): 1555-1556, 2021 09.
Article in English | MEDLINE | ID: covidwho-1554591
4.
ANZ J Surg ; 92(1-2): 57-61, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1494594

ABSTRACT

BACKGROUND: Surgical smoke or plume is produced by a variety of surgical coagulators and dissectors. A number of jurisdictions have recently introduced policies to reduce the associated occupational health risks including WorkSafe Victoria and New South Wales Health. METHOD: This paper is a narrative review of potential risks, including any associated with COVID-19, and options for mitigation. RESULTS: Surgical smoke or plume contains potentially toxic chemicals, some of which are carcinogens. Plume may also contain live virus, notably Human Papilloma and Hepatitis B, though any possible viral transmission is limited to a few case reports. Despite identifying COVID-19 ribonucleic acid fragments in various body tissues and fluids there are no current reports of COVID-19 transmission. Although plume is rapidly removed from the atmosphere in modern operating rooms, it is still inhaled by the operative team. Mitigation should include ensuring diathermy devices have evacuators while plume extraction should be standard for laparoscopic procedures. Consideration needs to be given to the potential to compromise the operating field of view, or the noise of the extractor impairing communication. There is an increasing range of suitable products on the market. The future includes pendant systems built into the operating room. CONCLUSION: The potential risks associated with surgical plume cannot be ignored. Health services should invest in plume extraction devices with a view to protecting their staff. The conduct of the operation should not be compromised by the devices chosen. Future operating theatres need to be designed to minimize exposure to plume.


Subject(s)
COVID-19 , Occupational Exposure , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Occupational Exposure/adverse effects , Occupational Exposure/prevention & control , Operating Rooms , SARS-CoV-2 , Smoke/adverse effects
5.
J Bras Pneumol ; 47(5): e20210219, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1486867

ABSTRACT

This review study aimed to determine the relationship between exposure to smoke from biomass burning in the Amazon rain forest and its implications on human health in that region in Brazil. A nonsystematic review was carried out by searching PubMed, Google Scholar, SciELO, and EMBASE databases for articles published between 2005 and 2021, either in Portuguese or in English, using the search terms "biomass burning" OR "Amazon" OR "burned" AND "human health." The review showed that the negative health effects of exposure to smoke from biomass burning in the Amazon have been poorly studied in that region. There is an urgent need to identify effective public health interventions that can help improve the behavior of vulnerable populations exposed to smoke from biomass burning, reducing morbidity and mortality related to that exposure.


Subject(s)
Rainforest , Smoke , Biomass , Brazil , Humans , Smoke/adverse effects
6.
J Laparoendosc Adv Surg Tech A ; 31(10): 1106-1113, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1475742

ABSTRACT

Background: The smoke created by energy-based devices during surgery may have the potential to transmit viral components to operating room staff. The COVID-19 pandemic has changed staff safety regulations. However, it is not clearly understood whether it can be transmitted via surgical smoke. Laparoscopic approaches have become the standard surgical procedure in many cases, but some of previous investigations have advised to pretermit these approaches due to high risk of COVID-19 transmission. Materials and Methods: We reviewed the English literature that were indexed in the PubMed, Google Scholar, and Scopus databases by using key words including Virus, viral transmission, surgical smoke, surgical plum, laparoscopy, and COVID-19 both solely and in two-word combination. A total of 87 articles were found relevant, and after reviewing the abstract, 33 articles were shortlisted and summarized. Results: Previous studies have focused on different surgical instruments that generate smoke, methods to collect and analyze the smoke and to understand the implications of its exposure after an analysis. A total of 9 out of 11 studies on the potential transmission of human papilloma virus through surgical smoke found evidence in favor of transmission. There were studies on the possible transmission of HIV, hepatitis B virus, and Sabin poliomyelitis vaccine virus 2. Conclusion: We do not believe that laparoscopic procedures may have extra risk for COVID-19 transmission compared with the open procedures, but it is always advised that the operating room staff adhere to the safety instructions during the COVID-19 pandemic.


Subject(s)
COVID-19 , Laparoscopy , Humans , Infection Control , Infectious Disease Transmission, Patient-to-Professional , Pandemics , SARS-CoV-2 , Smoke/adverse effects
7.
Sci Total Environ ; 809: 151158, 2022 Feb 25.
Article in English | MEDLINE | ID: covidwho-1475054

ABSTRACT

The 2020 COVID-19 outbreak in New South Wales (NSW), Australia, followed an unprecedented wildfire season that exposed large populations to wildfire smoke. Wildfires release particulate matter (PM), toxic gases and organic and non-organic chemicals that may be associated with increased incidence of COVID-19. This study estimated the association of wildfire smoke exposure with the incidence of COVID-19 in NSW. A Bayesian mixed-effect regression was used to estimate the association of either the average PM10 level or the proportion of wildfire burned area as proxies of wildfire smoke exposure with COVID-19 incidence in NSW, adjusting for sociodemographic risk factors. The analysis followed an ecological design using the 129 NSW Local Government Areas (LGA) as the ecological units. A random effects model and a model including the LGA spatial distribution (spatial model) were compared. A higher proportional wildfire burned area was associated with higher COVID-19 incidence in both the random effects and spatial models after adjustment for sociodemographic factors (posterior mean = 1.32 (99% credible interval: 1.05-1.67) and 1.31 (99% credible interval: 1.03-1.65), respectively). No evidence of an association between the average PM10 level and the COVID-19 incidence was found. LGAs in the greater Sydney and Hunter regions had the highest increase in the risk of COVID-19. This study identified wildfire smoke exposures were associated with increased risk of COVID-19 in NSW. Research on individual responses to specific wildfire airborne particles and pollutants needs to be conducted to further identify the causal links between SARS-Cov-2 infection and wildfire smoke. The identification of LGAs with the highest risk of COVID-19 associated with wildfire smoke exposure can be useful for public health prevention and or mitigation strategies.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Wildfires , Air Pollutants/analysis , Air Pollution/analysis , Australia , Bayes Theorem , Environmental Exposure , Humans , Incidence , New South Wales/epidemiology , Particulate Matter/analysis , SARS-CoV-2 , Smoke/adverse effects
8.
AORN J ; 114(4): P4-P6, 2021 10.
Article in English | MEDLINE | ID: covidwho-1449913
9.
J Hosp Infect ; 117: 89-95, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1373122

ABSTRACT

BACKGROUND: Gaseous by-products generated by surgical devices - collectively referred to as 'surgical smoke' - present the hazard of transmitting infective viruses from patients to surgical teams. However, insufficient evidence exists to evaluate and mitigate the risks of SARS-CoV-2 transmission via surgical smoke. AIM: To demonstrate the existence and infectivity of human coronavirus RNA in surgical smoke using a model experiment and to evaluate the possibility of lowering transmission risk by filtration through a surgical mask. METHODS: Pelleted HeLa-ACE2-TMPRSS2 cells infected with human coronavirus were incised by electric scalpel and ultrasonic scalpel, separately. A vacuum system was used to obtain surgical smoke in the form of hydrosol. Reverse transcription-quantitative polymerase chain reaction was used to analyse samples for the presence of viral RNA, and infectivity was determined through plaque assay. Furthermore, a surgical mask was placed centrally in the vacuum line to evaluate its ability to filter viral RNA present in the surgical smoke. FINDINGS: In this model, 1/106 to 1/105 of the viral RNA contained in the incision target was detected in the collected surgical smoke. The virus present in the smoke was unable to induce plaque formation in cultured cells. In addition, filtration of surgical smoke through a surgical mask effectively reduced the amount of viral RNA by at least 99.80%. CONCLUSION: This study demonstrated that surgical smoke may carry human coronavirus, though viral infectivity was considerably reduced. In clinical settings, surgical mask filtration should provide sufficient additional protection against potential coronavirus, including SARS-CoV-2, infection facilitated by surgical smoke.


Subject(s)
COVID-19 , Smoke , Humans , Masks , RNA, Viral/genetics , SARS-CoV-2 , Smoke/adverse effects
12.
J Expo Sci Environ Epidemiol ; 31(5): 797-803, 2021 09.
Article in English | MEDLINE | ID: covidwho-1309430

ABSTRACT

BACKGROUND: Air pollution has been linked to increased susceptibility to SARS-CoV-2. Thus, it has been suggested that wildfire smoke events may exacerbate the COVID-19 pandemic. OBJECTIVES: Our goal was to examine whether wildfire smoke from the 2020 wildfires in the western United States was associated with an increased rate of SARS-CoV-2 infections in Reno, Nevada. METHODS: We conducted a time-series analysis using generalized additive models to examine the relationship between the SARS-CoV-2 test positivity rate at a large regional hospital in Reno and ambient PM2.5 from 15 May to 20 Oct 2020. RESULTS: We found that a 10 µg/m3 increase in the 7-day average PM2.5 concentration was associated with a 6.3% relative increase in the SARS-CoV-2 test positivity rate, with a 95% confidence interval (CI) of 2.5 to 10.3%. This corresponded to an estimated 17.7% (CI: 14.4-20.1%) increase in the number of cases during the time period most affected by wildfire smoke, from 16 Aug to 10 Oct. SIGNIFICANCE: Wildfire smoke may have greatly increased the number of COVID-19 cases in Reno. Thus, our results substantiate the role of air pollution in exacerbating the pandemic and can help guide the development of public preparedness policies in areas affected by wildfire smoke, as wildfires are likely to coincide with the COVID-19 pandemic in 2021.


Subject(s)
Air Pollutants , COVID-19 , Wildfires , Air Pollutants/adverse effects , Air Pollutants/analysis , Humans , Nevada , Pandemics , Particulate Matter/adverse effects , Particulate Matter/analysis , SARS-CoV-2 , Smoke/adverse effects , United States/epidemiology
13.
Asian J Endosc Surg ; 14(3): 620-623, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1294946

ABSTRACT

The pandemic of COVID-19 has been a game changer in many aspects of medical care, including laparoscopic surgery service. Uncertainty in the early pandemic has led to the fear of doing laparoscopic surgery with regard to the possibility of SARS-COV-2 transmission through surgical smoke. We carried out laparoscopic surgery during the COVID-19 pandemic with intention to test our local adaptation of a laparoscopic smoke evacuator. Twenty-five laparoscopic cases for digestive surgery were performed with uneventful results. In summary, a low cost local adaptation of laparoscopic smoke and safe surgical behavior should be the standard of care when delivering laparoscopic surgery service in the pandemic era and forward.


Subject(s)
COVID-19 , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy/methods , Laparotomy/methods , Smoke/adverse effects , Ventilation/methods , Humans , Infection Control/methods , Pandemics , SARS-CoV-2
14.
Int J Environ Res Public Health ; 18(12)2021 06 08.
Article in English | MEDLINE | ID: covidwho-1282463

ABSTRACT

Bushfires substantially increase the environmental health risks for people living in affected areas, especially the disadvantaged (e.g., those experiencing health inequities due to their socio-economic status, racial/ethnic backgrounds, geographic location and/or sexual orientation) and those with pre-existing health conditions. Pregnant women exposed to bushfire smoke are at a greater risk of adverse pregnancy and foetal outcomes, especially if they smoke tobacco, which may compound the toxic impacts. Bushfires may also exacerbate mental stress, leading to an increase in smoking. There are gaps in the evidence and more research is required on the combined effect of bushfire smoke and tobacco smoke on pregnant populations.


Subject(s)
Smoke , Tobacco Smoke Pollution , Environmental Health , Female , Humans , Male , Pregnancy , Pregnant Women , Smoke/adverse effects , Smoking , Tobacco
15.
Surg Innov ; 29(2): 154-159, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1219016

ABSTRACT

Background. The COVID-19 pandemic leads to several debates regarding the possible risk for healthcare professionals during surgery. SAGES and EAES raised the issue of the transmission of infection through the surgical smoke during laparoscopy. They recommended the use of smoke evacuation devices (SEDs) with CO2 filtering systems. The aim of the present study is to compare the efficacy of different SEDs evaluating the CO2 environmental dispersion in the operating theater. Methods. We prospectively evaluated the data of 4 group of patients on which we used different SEDs or standard trocars: AIRSEAL system (S1 group), a homemade device (S2 group), an AIRSEAL system + homemade device (S3 group), and with standard trocars and without SED (S4 group). Quantitative analysis of CO2 environmental dispersion was carried out associated to the following data in order to evaluate the pneumoperitoneum variations: a preset insufflation pressure, real intraoperative pneumoperitoneum pressure, operative time, total volume of insufflated CO2, and flow rate index. Results. 16 patients were prospectively enrolled. The [CO2] mean value was 711 ppm, 641 ppm, 593 ppm, and 761 ppm in S1, S2, S3, and S4 groups, respectively. The comparison between data of all groups showed statistically significant differences in the measured ambient CO2 concentration. Conclusion. All tested SEDs seem to be useful to reduce the CO2 environmental dispersion respect to the use of standard trocars. The association of AIRSEAL system and a homemade device seems to be the best solution combining an adequate smoke evacuation and a stable pneumoperitoneum during laparoscopic surgery.


Subject(s)
COVID-19 , Laparoscopy , Pneumoperitoneum , COVID-19/prevention & control , Carbon Dioxide , Humans , Laparoscopy/methods , Pandemics , Pneumoperitoneum, Artificial , Smoke/adverse effects
16.
Surgeon ; 19(6): e452-e461, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1117691

ABSTRACT

BACKGROUND: The current COVID-19 pandemic has greatly changed the way surgery is delivered. In particular, current guidelines and policies have highlighted the need to use high level Personal Protective Equipment to reduce the risk of viral infection during open and laparoscopic surgical procedures. In particular, it was felt that the laparoscopic approach was at higher risk of viral transmission due to the chimney effect of the smoke escape from the trocars during and after the procedure. However, with this being a new and largely unknown viral agent, guidelines have been based on speculation and extrapolation from previous studies conducted in completely different situations, and led to anxiety amongst surgeons and theatre staff. We decided to conduct a systematic review of the Literature to try to clarify whether inhalation of surgical smoke can increase the risk of COVID-19 infection. METHODS: A thorough search of the relevant Literature was performed following the PRISMA guidelines and the most relevant papers on this topic were selected for qualitative analysis. Duplicates, review, personal opinions and guidelines have been excluded. Quantitative analysis has not been performed due to the lack of homogeneous high-quality studies. RESULTS: Literature search identified 740 papers but only 34 of them were suitable for qualitative analysis. The quality of those studies is generally quite low. We were not able to find any evidence directly linking surgical smoke with viral transmission, other than in patients with active HPV infection. DISCUSSION: Inhalation of surgical smoke can be generally hazardous, and therefore the use of PPE during surgical operations must be recommended in any case. However, the present systematic review of the existent Literature did not identify any significant evidence of the risk of viral transmission with the surgical smoke, therefore the current guidelines restricting the use of laparoscopy and/or diathermy during the current Covid-19 pandemic may be considered excessive and non-evidence based.


Subject(s)
COVID-19 , Laparoscopy , Humans , Infection Control , Infectious Disease Transmission, Patient-to-Professional , Laparoscopy/adverse effects , Pandemics , SARS-CoV-2 , Smoke/adverse effects
18.
Surg Endosc ; 36(2): 1243-1250, 2022 02.
Article in English | MEDLINE | ID: covidwho-1092681

ABSTRACT

BACKGROUND: Surgical smoke during operation is a well-known health hazard for medical staff. This study aimed to investigate the dynamics of surgical smoke during open surgery or laparoscopic surgery for colorectal disease. METHODS: This study quantitated particulate matter (PM) counts as part of surgical smoke in 31 consecutive patients who underwent colectomy at the Niigata City General Hospital using a laser particle counter. Particles were graded by size as ≤ 2.5 µm PM (PM2.5) or > 2.5 µm PM (large PM). Operative procedures were categorized as either open surgery (n = 14) or laparoscopic surgery (n = 17). RESULTS: The median patient age was 72 (range 41-89) years and 58.1% were male. The total PM2.5, PM2.5 per hour, and maximum PM2.5 per minute counts during operation were significantly higher in open surgery than in laparoscopic surgery (P = 0.001, P < 0.001, and P = 0.029, respectively). Large PM counts (total, per hour, and maximum per minute) were also higher in the open surgery group than in the laparoscopic surgery group. The maximum PM2.5 concentration recorded was 38.6 µm/m3, which is considered "unhealthy for sensitive groups" according to the U.S. Environment Protection Agency air quality index standards, if it was a 24-h period mean value. CONCLUSION: Exposure to surgical smoke is lower during laparoscopic surgery than during open surgery for colorectal diseases.


Subject(s)
COVID-19 , Colorectal Neoplasms , Laparoscopy , Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , SARS-CoV-2 , Smoke/adverse effects
19.
Surg Innov ; 28(4): 485-495, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1083313

ABSTRACT

Background. Laparoscopic surgery generates end products that can have potentially harmful effects for the surgical team from short- or long-time exposure. In view of the current SARS-CoV-2 circumstances, controversy has risen concerning the safety of surgical smoke (SS) and aerosols and the perception of an increased risk of exposure during laparoscopic surgery. Methods. The present qualitative systematic review was conducted according to Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE). A literature search was performed from March 2020 up to May 10, 2020, using the PubMed database, Cochrane, and Google Scholar to assess the risk of airborne transmission of viruses and the potential health risk of surgical smoke- and aerosol-generating procedures produced during laparoscopic surgery. The keywords were introduced in combination to obtain better search results. Application of the inclusion and exclusion criteria identified 44 relevant articles. Results. Genetic material from certain viruses, or the virus itself, has been detected in SS and aerosols. However, in the current SARS-CoV-2, as in other coronavirus situations, studies analyzing the presence of airborne transmission of viruses in surgical smoke are lacking. Conclusion. Despite the lack of clear evidence regarding the risk of diseases as the result of smoke- and aerosol-generating procedures during laparoscopic surgery, further investigation is needed. Meanwhile, all available precautions must be taken.


Subject(s)
COVID-19 , Laparoscopy , Aerosols/adverse effects , Hazardous Substances , Humans , Infectious Disease Transmission, Patient-to-Professional , Laparoscopy/adverse effects , SARS-CoV-2 , Smoke/adverse effects
20.
Am J Physiol Lung Cell Mol Physiol ; 320(1): L152-L157, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1054733

ABSTRACT

The COVID-19 pandemic is associated with severe pneumonia and acute respiratory distress syndrome leading to death in susceptible individuals. For those who recover, post-COVID-19 complications may include development of pulmonary fibrosis. Factors contributing to disease severity or development of complications are not known. Using computational analysis with experimental data, we report that idiopathic pulmonary fibrosis (IPF)- and chronic obstructive pulmonary disease (COPD)-derived lung fibroblasts express higher levels of angiotensin-converting enzyme 2 (ACE2), the receptor for SARS-CoV-2 entry and part of the renin-angiotensin system that is antifibrotic and anti-inflammatory. In preclinical models, we found that chronic exposure to cigarette smoke, a risk factor for both COPD and IPF and potentially for SARS-CoV-2 infection, significantly increased pulmonary ACE2 protein expression. Further studies are needed to understand the functional implications of ACE2 on lung fibroblasts, a cell type that thus far has received relatively little attention in the context of COVID-19.


Subject(s)
Angiotensin-Converting Enzyme 2/biosynthesis , COVID-19/pathology , Fibroblasts/metabolism , Idiopathic Pulmonary Fibrosis/pathology , Pulmonary Disease, Chronic Obstructive/pathology , Adult , Animals , Female , Gene Expression Regulation/drug effects , Humans , Male , Mice , Mice, Inbred C57BL , Middle Aged , Receptors, Virus/biosynthesis , Respiratory Distress Syndrome/pathology , Respiratory Distress Syndrome/virology , SARS-CoV-2/metabolism , Smoke/adverse effects
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