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Introduction: For multiple reasons, elective pediatric otolaryngology surgical procedures have declined during the COVID-19 pandemic. However, it is less clear how COVID- 19 has affect acute care surgeries. The purpose of this study was to assess whether the prevalence of pediatric head or neck abscesses managed with operative drainage decreased compared with previous years. Method: In a retrospective study, we evaluated medical records of 203 pediatric cases diagnosed with abscess of the head or neck and treated with incision and drainage at a large tertiary care children's hospital between the dates of April 1 and November 30 from 2015 to 2020. We compared outcomes for each year from 2015 with 2019 with the same date range in 2020, which included location of the infection, abscess size, symptoms, duration of antibiotic treatment before and after operative intervention, microbiology, and the number of cases per year. Results: The mean ± SD presenting age in the 2015-2019 group was 5.10 ± 5.10 years and 2.24 ± 1.91 years in the 2020 group. Neck abscesses were more common than head abscesses from 2015 to 2019 (81.7% vs 18.3%), whereas only neck abscesses presented in 2020 (P = .030). The mean number of cases between 2015 and 2019 was 36 ± 3.81, whereas the number of cases in 2020 was 23 (P = .036). The most common symptom was neck stiffness or swelling in both groups (2015-2019, 74.4% vs 2020, 100%, P = .003). Of those patients who underwent intravenous antibiotic therapy prior to presentation (n = 43), the mean number of days before admission was 1.98 ± 2.95 (n = 40) from 2015 to 2019 and 12.00 ± 10.39 (n = 3) in 2020 (P = .008). The percentage of cases with multiple strains cultured between 2015 and 2019 was 13.8% vs 18.2% in (P = .007). Conclusion: There was a decrease in the number of operative head or neck abscesses in 2020 during the COVID-19 pandemic compared with the mean number per year from 2015 to 2019 within the same date range. COVID-19 mitigation strategies leading to reduced transmission of other viral and bacterial illnesses and a tendency toward prolonged medical management to avoid surgery during the pandemic are 2 possible reasons for this decrease.
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In a prospective observational study (pre-AndroCoV Trial), the use of nitazoxanide, ivermectin and hydroxychloroquine demonstrated unexpected improvements in COVID-19 outcomes when compared to untreated patients. The apparent yet likely positive results raised ethical concerns on the employment of further full placebo controlled studies in early-stage COVID-19. The present analysis aimed to elucidate, through a comparative analysis with two control groups, whether full placebo-control randomized clinical trials (RCTs) on early-stage COVID-19 are still ethically acceptable. The Active group (AG) consisted of patients enrolled in the Pre-AndroCoV-Trial (n = 585). Control Group 1 (CG1) consisted of a retrospectively obtained group of untreated patients of the same population (n = 137), and Control Group 2 (CG2) resulted from a precise prediction of clinical outcomes based on a thorough and structured review of indexed articles and official statements. Patients were matched for sex, age, comorbidities and disease severity at baseline. Compared to CG1 and CG2, AG showed reduction of 31.5-36.5% in viral shedding (p < 0.0001), 70-85% in disease duration (p < 0.0001), and 100% in respiratory complications, hospitalization, mechanical ventilation, deaths and post-COVID manifestations (p < 0.0001 for all). For every 1000 confirmed cases for COVID-19, at least 70 hospitalizations, 50 mechanical ventilations and five deaths were prevented. Benefits from the combination of early COVID-19 detection and early pharmacological approaches were consistent and overwhelming when compared to untreated groups, which, together with the well-established safety profile of the drug combinations tested in the Pre-AndroCoV Trial, precluded our study from continuing employing full placebo in early COVID-19.
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BACKGROUND: Clinicians around the world are experiencing skin breakdown due to the prolonged usage of masks while working long hours to treat patients with COVID-19. The skin damage is a result of the increased friction and pressure at the mask-skin barrier. Throughout the COVID-19 pandemic, clinicians have been applying various skin barriers to prevent and ameliorate skin breakdown. However, there are no studies to our knowledge that assess the safety and efficacy of using these skin barriers without compromising a sufficient mask-face seal. AIM: To conduct the largest study to date of various skin barriers and seal integrity with quantitative fit testing (QNFT). METHODS: This pilot study explored whether the placement of a silicone scar sheet (ScarAway®), Cavilon™, or Tegaderm™ affects 3M™ half-face mask respirator barrier integrity when compared to no barrier using QNFT. Data were collected from nine clinicians at an academic level 1 trauma centre in New Jersey. FINDINGS: The silicone scar sheet resulted in the lowest adequate fit, whereas Cavilon provided the highest fit factor when compared to other interventions (P < 0.05). CONCLUSION: These findings help inform clinicians considering barriers for comfort when wearing facemasks during the COVID-19 pandemic and for future pandemics.