CT features of pulmonary embolism in patients with COVID-19 pneumonia.

OBJECTIVE: The aim of this study was to describe the Computed Tomography (CT) features of pulmonary embolism in patients hospitalized for acute COVID-19 pneumonia and to evaluate the prognostic significance of these features. PATIENTS AND METHODS: This retrospective study included 110 consecutive patients who were hospitalized for acute COVID-19 pneumonia and underwent pulmonary computed tomography angiography (BTPA) on the basis of clinical suspicion. The diagnosis of COVID-19 infection was determined by CT findings typical of COVID-19 pneumonia and/or a positive result of a reverse transcriptase-polymerase chain reaction test. RESULTS: Of the 110 patients, 30 (27.3%) had acute pulmonary embolism and 71 (64.5%) had CT features of chronic pulmonary embolism. Of the 14 (12.7%) patients who died despite receiving therapeutic doses of heparin, 13 (92.9%) had CT features of chronic pulmonary embolism and 1 (7.1%) of acute pulmonary embolism. CT features of chronic pulmonary embolism were more common in deceased patients than in surviving patients (92.9% vs. 60.4%, p=0.01, respectively). Low oxygen saturation and high urine microalbumin creatinine ratio at admission in COVID-19 patients are important determinants of mortality after adjusting for sex and age in logistic procedures. CONCLUSIONS: CT features of chronic pulmonary embolism are common in COVID-19 patients undergoing Computed Tomography Pulmonary Angiography (CTPA) in the hospital. The coexistence of albuminuria, low oxygen saturation and CT features of chronic pulmonary embolism at admission in COVID-19 patients may herald fatal outcomes.

The effect of the COVID-19 pandemic on anesthesia techniques in tertiary hospital: general anesthesia or regional anesthesia - a retrospective cohort study.

OBJECTIVE: We aimed to find out how the pandemic process changed the anesthesia methods applied in Çorum Single Tertiary Region Hospital. In our hospital, we investigated the anesthesia methods used for surgical procedures before and during the pandemic, the number of cases, and the impact of the pandemic on emergency and elective surgeries. MATERIALS AND METHODS: This is a retrospective cohort study comparing COVID-19 pandemic's effect on the number of surgical operations and anesthesia techniques. The 22-month surgeries during the pandemic period and the 22-month pre-pandemic surgeries were compared in terms of anesthesia methods, branch-specific, and overall case changes. The data obtained were analyzed comparatively in terms of anesthetic techniques, branch-specific and overall case changes of the patients operated on in the operating room before and during the pandemic. RESULTS: While 65,984 surgical procedures were performed in the pre-pandemic period, only 54,352 were performed during the COVID-19 pandemic. The total number of surgical procedures decreased by 17.63% during the pandemic. While there was a 21.1% decrease in elective surgeries due to the pandemic, there was a 71.43% increase in emergency surgeries during the pandemic period. There was a significant disparity in the distribution of both elective and emergency cases by surgical specialty. It was found that the surgical specialties that received the most cases during the pandemic were General Surgery, Obstetrics-Gynecologic Surgery, Urologic Surgery and Orthopedic Surgery. During the COVID-19 pandemic, regional anesthesia (RA) was used in 16.95% of cases (as the primary technique). The use of RA as the primary anesthetic technique was significantly higher (10.61%) than in the pre-pandemic data. It was observed that specialties such as General Surgery, Obstetrics-Gynecologic Surgery, Urologic Surgery, And Orthopedic Surgery were prominent in the distribution of regional anesthesia. CONCLUSIONS: The COVID-19 pandemic was not the first and will not be the last and during this period we saw how important the personnel and material management are. Our study plays an important role in showing the uneven distribution of expected surgical procedures in operating rooms during the pandemic situation. It may provide guidance on the distribution of limited and essential personnel and personal protective equipment (PPE, medications, etc.) during the pandemic period. In this context, regional anesthesia may play an important role in the future because it can provide high-quality perioperative care to patients while minimizing the preference for general anesthesia during surgical procedures, thus minimizing personnel burden and limited resource use.

Stochastic Production Planning with Flexible Manufacturing Systems and Uncertain Demand: A Column Generation-based Approach

The ongoing pandemic, namely COVID-19, has rendered widespread economic disorder. The deficiencies have delayed production at manufacturers in several industries on the supply side. The effects of disruption were more notable for industries with longer supply chains, especially reaching East Asia. Regarding the demand, sectors can be divided into three categories: i) the ones, like e-commerce companies, that experienced augmented demand;ii) the ones with a plunged demand, like what hotels and restaurants experience;iii) the companies experiencing a roller-coaster-ride business. After mitigation efforts, the economy started recovering, resulting in increased demand. However, regardless of their struggles, the companies have not fully returned to their pre-pandemic levels. One of the strategies to gain resilience in its supply chain and manage the disruptions is to employ flexible/hybrid manufacturing systems. This paper considers a flexible/hybrid manufacturing production setting with typically dedicated machinery to satisfy regular demand and a flexible manufacturing system (FMS) to handle surge demand. We model the uncertainty in demand using a scenario-based approach and allow the business to make here-and-now and wait-and-see decisions exploiting the cost-effectiveness of the standard production and responsiveness of the FMS. We propose a column generation-based algorithm as the solution approach. Our computational analysis shows that this hybrid production setting provides highly robust response to the uncertainty in demand, even with high fluctuations. Copyright (C) 2022 The Authors.

COVID-19, Symptoms with Pre-Existing and Not Pre-Existing Neurological Disorders in Pediatrics

Objective The symptoms of coronavirus disease 2019 (COVID-19) in children with pre-existing neurological disease are unknown. We aimed to find out the difference in the symptoms of children with pre-existing neurological disease and those without. Methods In this single-center, retrospective, cohort study, 96 pediatric patients who had COVID-19 between March 2020 and April 2021 were enrolled. Results There were 35 males and 61 females. The median age was 14 years (interquartile range [IQR] 10.25-16). Fever (38.5%), headache (35.4%), and cough (32.3%) were the most common symptoms. In 53.1%, neurological complaints (headache, taste-smell loss, vertigo, febrile seizure, coma, and ataxia), in 40.6%, respiratory symptoms (cough, dyspnea, rhinitis, and pharyngitis), and in 8.3%, gastrointestinal symptoms (gastroenteritis, vomiting, nausea, and abdominal pain) were seen. While 23 (62.2%) patients with fever did not have neurological complaints, 14 (37.8%) had neurological complaints (p = 0.017). Eight (21.6%) patients with fever were hospitalized (p = 0.067). Fever was seen significantly more frequently with preexisting neurological disease (p < 0.001). Younger children were more likely to have fever (p = 0.008). Headaches and taste-smell loss were seen more frequently in patients with no pre-existing neurological disease (p < 0.001, p= 0.034, respectively). The patients with headaches were older than the ones without headaches (p < 0.001). Patients with headaches and loss of taste and smell were older than those without (p = 0.003). Conclusion Neurological symptoms differed significantly between those who had pre-existing neurological disease and those who did not. Headaches and taste-smell loss were seen more frequently in patients with no pre-existing neurological disease. Fever was significantly higher in patients who had pre-existing neurological disease.

Pulmonary embolism in patients with dyspnea after COVID-19 infection.

OBJECTIVE: Pulmonary embolism as a potential complication that may occur late in the course of COVID-19 cases. The aim of our study is to evaluate the frequency of pulmonary embolism in patients with new or ongoing dyspnea after a COVID-19 infection. PATIENTS AND METHODS: This is a single-center, prospective observational study to evaluate the clinical and radiological outcomes of consecutive patients presenting outpatient clinic diseases to the chest and a new or ongoing dyspnea after a COVID-19 infection. Demographic, clinical and laboratory data were collected. Dyspnea was evaluated according to the New York Heart Association (NYHA) classification. RESULTS: Pulmonary embolism was detected in 23.8% (25/105) of patients with new or ongoing dyspnea after a COVID-19 infection. Proportion of pulmonary embolism in patients with NYHA classes I, II, III and IV were respectively 8.7%, 20.0%, 30.0% and 35.3% (p for trend=0.02). Compared to NYHA class I and II patients with dyspnea, those in NYHA classes III and IV showed a higher rate of pulmonary embolism [31.6% vs. 14.6%, OR: 2.7 (1.0 to 7.1), p=0.04, respectively]. In Logistic Procedures, NYHA classes of dyspnea (OR: 4.3, 95% CI: 1.2 to 16.6, p=0.03) (NYHA class III and IV vs. NYHA class I and II) determine the likelihood of pulmonary embolism after COVID-19 infection. CONCLUSIONS: Pulmonary embolism is common in patients with new or ongoing shortness of breath after a COVID-19 infection. Pulmonary embolism is more likely to develop in patients with higher NYHA classes.