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Jones Delores
Archives of Nursing Practice and Care, Volume 8, pp 007-009; https://doi.org/10.17352/2581-4265.000059

Abstract:
An epidemic that travels throughout the world is called a pandemic [1]. There have been several pandemics that have impacted the world. One example of a pandemic that became global is Spanish influenza. This pandemic was very severe and attacked more than 30% of the world population. Approximately 50 million people died from the first outbreak.
Sheila Sheth, David Fetzer, Mary Frates, Laurence Needleman, William Middleton, Jill Jones, Ann Podrasky,
Ultrasound Quarterly, Volume 36, pp 200-205; https://doi.org/10.1097/ruq.0000000000000526

Abstract:
The coronavirus disease 2019 is caused by the severe acute respiratory syndrome coronavirus 2. The virus can be spread by close person-to-person contact primarily by respiratory droplets. Given the close proximity of the sonographer or sonologist with the patient during ultrasound examinations, special precautions should be taken to limit the exposure of radiology personnel to patients with coronavirus disease 2019 while still providing optimal patient care. Methods covered in this article include modified workflow, close scrutiny and prioritization of imaging orders, and design of targeted ultrasound protocols. These guidelines summarize the personal experience and insight of multiple colleagues who lead ultrasound sections or are experts in the field.
Giorgia Prontera, Alessandro Perri, Giovanni Vento,
Published: 16 November 2021
Neonatology, Volume 119, pp 129-132; https://doi.org/10.1159/000519712

Abstract:
The COVID-19 pandemic has upset habits in any workplace. In hospitals, several precautions have been taken to maintain health-care workers’ safety and to avoid disease spread or the possible creation of new epidemic outbreaks. The use of medical devices makes the contamination and the nosocomial virus spread possible, causing infection in medical operators and hospitalized patients. In the neonatal intensive care unit, ultrasound has been an increasingly used tool because it is a non-invasive, repeatable method and it is side effect-free as the newborn is not exposed to radiation. It makes a fast diagnosis and then therapy possible such as in the lung diseases and other life-threatening conditions. The use of portable devices such as the wireless probe has many advantages in routine clinical practice, and during the COVID-19 pandemic, it has proved to be fundamental for the patient and the physician’s safety because it reduced the risk of contamination. We report the use of the wireless ultrasound probe in 2 isolated neonates born to SARS-CoV-2-positive mothers.
, Tommaso Schepis, , Rosario Landi, Beatrice Orlandini, Valerio Pontecorvi, Pietro Familiari, Andrea Tringali, Vincenzo Perri, Guido Costamagna
Therapeutic Advances in Gastroenterology, Volume 13; https://doi.org/10.1177/1756284820935187

Abstract:
On 31 December 2019, the WHO China Country Office was informed of cases of pneumonia of unknown etiology detected in Wuhan (Hubei Province of China). In January 2020, a new coronavirus named SARS-CoV2 was isolated and, since that time, SARS-CoV2 related disease (COVID-19) rapidly spread all over the world becoming pandemic in March 2020. The COVID-19 outbreak dramatically affected the public-health and the health-care facilities organization. Bilio-pancreatic endoscopy is considered a high-risk procedure for cross-contamination and, even though it is not directly involved in COVID-19 diagnosis and management, its reorganization is crucial to guarantee high standards of care minimizing the risk of SARS-CoV2 transmission among patients and health-care providers. Bilio-pancreatic endoscopic procedures often require a short physical distance between the endoscopist and the patient for a long period of time, a frequent exchange of devices, the involvement of a large number of personnel, the use of complex endoscopes difficult to reprocess. On this basis, endoscopic units should take precautions with adjusted management of bilio-pancreatic endoscopy. The aim of this article is to discuss the approach to bilio-pancreatic endoscopy in the COVID-19 era with focus on diagnostic algorithms, indications, management of the endoscopic room, proper use of Personal Protective Equipment and correct reprocessing of instrumentation.
, B. Balamurugan
Journal of Pharmaceutical Research International pp 44-48; https://doi.org/10.9734/jpri/2022/v34i10a35517

Abstract:
Covid-19 pandemic is an unprecedented crisis and has changed dynamics of health care by severely straining the resources for patients coming for both elective and emergency surgeries. Ultrasound guided nerve block has been a life saver in most covid-19 positive patients coming for emergency surgical procedures as they reduce the risk of general anaesthesia in a patient with already compromised lung physiology and also minimizes risk of aerosol contamination of the operation theatre and health care personnel. We describe the anaesthetic management of a 67year old male patient with uncontrolled diabetes mellitus and sepsis for diabetic foot wound fasciotomy and wound debridement. The patient was operated under ultrasound guided popliteal sciatic and Saphenous nerve block of the right lower limb with all precautions taken to prevent covid spread as the patient had a high index of suspicion for covid-19. The patient was reported positive for RT-PCR in the postoperative period.
, Andrea Santamato, Alessandro Picelli, Giovanni Morone, Nicola Smania, Stefano Paolucci, Pietro Fiore
Published: 23 June 2020
Frontiers in Neurology, Volume 11; https://doi.org/10.3389/fneur.2020.00719

Abstract:
, 28–30) • cleaning and sanitizing of instrumentation and environments are mandatory (18): - the environmental sanitation procedures must be implemented as per institutional or company indications by the dedicated staff, equipped with the appropriate PPE - in general, surfaces frequently touched by a large number of people (such as doorknobs, chairs, desks) must be cleaned at least daily and if possible more frequently; the use of regular detergents can be considered sufficient if there has been no contact with confirmed or suspected COVID-19 patients - However, it is conceivable to arrange additional cleaning of the surfaces and devices used during the procedures between one patient and another (e.g., ultrasound or electrical stimulation devices in injections with botulinum toxin, examination table). For this purpose, after removing any visible traces, a suitable product should be used wherever possible. Current evidence suggests (31) the use of a standard detergent associated, where possible, with a virucidal product or sodium hypochlorite 0.05% or ethanol 70% - the use of disposable devices that avoid contamination of the devices is desirable (e.g., probe cover when using ultrasound for injection procedures with BoNT-A). Figure 2. Personal Protection Equipment (PPE) management: risk assessment related to the procedure and patient characteristics. As previously stated, spasticity treatment requires multidisciplinary management. In particular, adjunctive treatment might improve the clinical effect of BoNT-A, and they should be applied in the health care facility immediately after the BoNT-A injection (12). However, in order to minimize the risk during COVID-19 pandemic, several issues must be carefully considered: • it must be highlighted that the screening procedures must be implemented at each access to the facility (24) • we suggest that the rules of distancing between patients (>1 m) (28) must also be applied in the organization of the areas where the patient's rehabilitation treatment takes place (e.g., gyms, areas dedicated to the occupational therapy) • the correct use of PPE for the staff involved must be considered based on the patient's characteristics (18, 22, 23) • consider information panels and provide suitable material (e.g., hand wash gel) within the area (18, 24) • prepare adequate plans for cleaning and sanitizing rooms and tools; in particular, attention must be paid to cleaning the equipment used by patients (e.g., electrical stimulation devices, dedicated equipment, and machinery, beds) (18, 31) • if appropriate, exposure risk should be limited by implementing communication technologies which can support remote rehabilitation treatment (27, 32). The treatment of the patients suffering from spasticity, while not showing the characters of urgency except for some procedures such as ITB refill or monitoring, is worthy of particular attention in this phase of the COVID-19 pandemic. It must be highlighted that this prolonged suspension of deferred activities has potentially exposed many patients to the disabling consequences of untreated spasticity. Given these aspects, close monitoring of patients is recommended in order to plan an adequate schedule for the resumption of patients' treatment, in compliance with the rules for reducing the spread of the COVID-19 pandemic. The use of remote assessment tools can support the identification of patients who require treatment in a short time to prevent the onset of complications that may further limit their level of activity and participation. Looking ahead and considering the foreseeable need to adopt these precautions in the medium term, using these technologies can also allow adequate planning of patients' follow-up and rehabilitation treatment. AB: conception of the document, document draft and revision. PF, SP, NS, GM, AP, and AS: conception of the document and document revision. All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Authors wish to thank the Italian Society of Physical and Rehabilitation Medicine (SIMFER) and the Italian Society of Neurological Rehabilitation (SIRN) for the endorsement of this document. 1. Dressler D, Bhidayasiri R, Bohlega S, Chana P, Chien HF, Chung TM, et al. Defining spasticity: a new approach considering current movement disorders terminology and botulinum toxin therapy. J Neurol. (2018) 265:856–62. doi: 10.1007/s00415-018-8759-1 PubMed Abstract | CrossRef Full Text | Google Scholar 2. Martin A, Abogunrin S, Kurth H, Dinet J. Epidemiological, humanistic and economic burden of illness of lower limb spasticity in adults: a systematic review. Neuropsychiatr Dis Treat. (2014) 10:111–22. doi: 10.2147/NDT.S53913 PubMed Abstract | CrossRef Full Text | Google Scholar 3. Spasticity in Under 19s: Management. London: National Institute for Health and Care Excellence (UK) (2016). Google Scholar 4. Esquenazi A. The human and economic burden of post- stroke spasticity and muscle overactivity. J Clin Outcomes Manage. (2011) 18:607–14 Google Scholar 5. Tyry T, Salter A, Largent J, Ann Marrie R. The impact of spasticity severity on healthcare utilization among MS patients: a large-scale six-year follow-up study. J Neurol Sci. (2013) 333:376–7. doi: 10.1016/j.jns.2013.07.1371 CrossRef Full Text | Google Scholar 6. Kheder A, Nair KPS. Spasticity: pathophysiology, evaluation and management. Pract Neurol. (2012) 12:289–98. doi: 10.1136/practneurol-2011-000155 PubMed Abstract | CrossRef Full Text | Google Scholar 7. Denno MS, Gillard PJ, Graham GD, Dibonaventura MD, Goren A, Varon SF, et al. Anxiety and depression associated with caregiver burden in caregivers of stroke survivors with spasticity. Arch Phys Med Rehabil. (2013) 94:1731–6. doi: 10.1016/j.apmr.2013.03.014 PubMed Abstract | CrossRef Full Text | Google Scholar 8. Esquenazi A, Albanese A, Chancellor MB, Elovic E, Segal KR, Simpson DM, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of adult spasticity in the upper motor neuron syndrome. Toxicon. (2013) 67:115–28. doi: 10.1016/j.toxicon.2012.11.025 PubMed Abstract | CrossRef Full Text | Google Scholar 9. National Collaborating Centre for Women's and Children's Health (UK). Spasticity in Children and Young People with Non-Progressive Brain Disorders: Management of Spasticity and Co-Existing Motor Disorders and Their Early Musculoskeletal Complications. London: RCOG Press; 2012. Google Scholar 10. Nair KP, Marsden J. The management of spasticity in adults. BMJ. (2014) 349:g4737. doi: 10.1136/bmj.g4737 PubMed Abstract | CrossRef Full Text | Google Scholar 11. Lumsden DE, Crowe B, Basu A, Amin S, Devlin A, DeAlwis Y, et al. Pharmacological management of abnormal tone and movement in cerebral palsy. Arch Dis Child. (2019) 104:775–80. doi: 10.1136/archdischild-2018-316309 PubMed Abstract | CrossRef Full Text | Google Scholar 12. Picelli A, Santamato A, Chemello E, Cinone N, Cisari C, Gandolfi M, et al. Adjuvant treatments associated with botulinum toxin injection for managing spasticity: an overview of the literature. Ann Phys Rehabil Med. (2019) 62:291–6. doi: 10.1016/j.rehab.2018.08.004 PubMed Abstract | CrossRef Full Text | Google Scholar 13. Boster AL, Adair RL, Gooch JL, Nelson ME, Toomer A, Urquidez J, et al. Best practices for intrathecal baclofen therapy: dosing and long-term management. Neuromodulation. (2016) 19:623–31. doi: 10.1111/ner.12388 PubMed Abstract | CrossRef Full Text | Google Scholar 14. Wissel J, Ward AB, Erztgaard P, Bensmail D, Hecht MJ, Lejeune TM, et al. European consensus table on the use of botulinum toxin type A in adult spasticity. J Rehabil Med. (2009) 41:13–25. doi: 10.2340/16501977-0303 PubMed Abstract | CrossRef Full Text | Google Scholar 15. Lazzaro C, Baricich A, Picelli A, Caglioni PM, Ratti M, Santamato A. AbobotulinumtoxinA and rehabilitation vs rehabilitation alone in post-stroke spasticity: a cost-utility analysis. J Rehabil Med. (2020) 52:jrm00016. doi: 10.2340/16501977-2636 PubMed Abstract | CrossRef Full Text | Google Scholar 16. Boldrini P, Bernetti A, Fiore P. Impact of COVID-19 outbreak on rehabilitation services and Physical and Rehabilitation Medicine (PRM) physicians' activities in Italy. An official document of the Italian PRM Society (SIMFER). Eur J Phys Rehab Med. (2020). doi: 10.23736/S1973-9087.20.06256-5. [Epub ahead of print]. PubMed Abstract | CrossRef Full Text | Google Scholar 17. Singh R, Burn J, Sivan M. The impact of covid-19 on rehabilitation services and activities. Letter to the editor in response to official document of SIMFER. Eur J Phys Rehabil Med. (2020). doi: 10.23736/S1973-9087.20.06296-6 PubMed Abstract | CrossRef Full Text | Google Scholar 18. European Centre for Disease Prevention and Control. Infection Prevention and Control for COVID-19 in Healthcare Settings – Third Update. (2020) ECDC: Stockholm. PubMed Abstract | Google Scholar 19. Centers for Disease Control and Preventions – COVID-19. People with disabilities (2020). Available online at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-disabilities.html (accessed May 27, 2020). Google Scholar 20. European Centre for Disease Prevention and Control. Checklist for Hospitals Preparing for the Reception and Care of Coronavirus 2019 (COVID-19) Patients. ECDC: Stockholm; 2020 Google Scholar 21. Bartolo M, Intiso D, Lentino C, Sandrini G, Paolucci S, Zampolini M, and the Board of the Italian Society of Neurological Rehabilitation (SIRN). Urgent measures for the containment of the Coronavirus (Covid-19) epidemic
Su Min Ha,
Journal of the Korean Medical Association, Volume 64, pp 671-677; https://doi.org/10.5124/jkma.2021.64.10.671

Abstract:
Background: Coronavirus disease 2019 (COVID-19) vaccine-induced lymphadenopathy is a critical side effect that should be a concern to clinicians, patients, radiologists, and oncologists. Vaccine-induced lymphadenopathy causes a diagnostic dilemma, especially for breast radiologists who examine both axillary regions during breast ultrasound examinations. Appropriate imaging guidelines are needed to manage vaccine-induced lymphadenopathy for patients undergoing screening examinations or symptomatic patients, including cancer patients.Current Concepts: For patients with axillary lymphadenopathy in the setting of recent ipsilateral vaccination, clinical follow-up is recommended. In other scenarios, short-term follow-up axillary ultrasound examinations are recommended if the clinical concerns persist for more than 6 weeks after vaccination. To mitigate the diagnostic dilemma of vaccine-induced lymphadenopathy, patients should schedule screening imaging examinations before the first vaccination or at least six weeks following the second vaccination. For clinicians and radiologists, documenting the patients’ vaccination status is critical to decreasing unnecessary follow-up imaging, biopsies, and patient’s anxiety.Discussion and Conclusion: Our proposal can help reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged lymph nodes in the setting of recent COVID-19 vaccination. Further, it can avoid delays in vaccination and breast cancer screening during the COVID-19 pandemic.
, Garrett De Francis, Sara Schwartz, William L. Duvall, Bhaskar Arora, David I. Silverman
Journal of the American Society of Echocardiography, Volume 33, pp 895-899; https://doi.org/10.1016/j.echo.2020.05.005

The publisher has not yet granted permission to display this abstract.
, Brian Kaufman
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, Volume 15, pp 447-448; https://doi.org/10.1097/sih.0000000000000513

Abstract:
Summary Statement The dramatic outbreak of COVID-19 placed unprecedented strain on the critical care workforce of New York City. The enhanced precautions required to safely care for COVID-19 patients impacted the performance of even routine critical care procedures. Meanwhile, staff were stretched to care for exponentially rising case volume as COVID intensive care units (ICUs) expanded. Simulation was used to bridge these gaps—first to familiarize personnel within the Division of Pulmonary and Critical Care with revised COVID-19 care procedures, then to orient noncritical care clinicians volunteering from other specialties for COVID ICU deployment to general critical care and COVID-19 care principles. Using mannequin-based simulation scenarios followed by comprehensive debriefing sessions, simulation participants received high-intensity, high-fidelity training in respiratory failure, circulatory failure, bedside ultrasound, bedside ICU procedures, and elements of COVID-19–specific care. More than 200 physicians and advanced practice practitioners completed simulation training in preparation for deployment, supplementing and enhancing the ICU workforce at a decisive time during the outbreak.
, , Daniela Bernardi, Paolo Belli, , Massimo Calabrese, Lucia Camera, Luca A. Carbonaro, Francesca Caumo, Paola Clauser, Veronica Girardi, Chiara Iacconi, Laura Martincich, Pietro Panizza, Antonella Petrillo, Simone Schiaffino, Alberto Tagliafico, Rubina M. Trimboli, Chiara Zuiani, , et al.
Published: 13 July 2020
La radiologia medica, Volume 125, pp 926-930; https://doi.org/10.1007/s11547-020-01254-3

Abstract:
The Italian College of Breast Radiologists by the Italian Society of Medical Radiology (SIRM) provides recommendations for breast care provision and procedural prioritization during COVID-19 pandemic, being aware that medical decisions must be currently taken balancing patient’s individual and community safety: (1) patients having a scheduled or to-be-scheduled appointment for in-depth diagnostic breast imaging or needle biopsy should confirm the appointment or obtain a new one; (2) patients who have suspicious symptoms of breast cancer (in particular: new onset palpable nodule; skin or nipple retraction; orange peel skin; unilateral secretion from the nipple) should request non-deferrable tests at radiology services; (3) asymptomatic women performing annual mammographic follow-up after breast cancer treatment should preferably schedule the appointment within 1 year and 3 months from the previous check, compatibly with the local organizational conditions; (4) asymptomatic women who have not responded to the invitation for screening mammography after the onset of the pandemic or have been informed of the suspension of the screening activity should schedule the check preferably within 3 months from the date of the not performed check, compatibly with local organizational conditions. The Italian College of Breast Radiologists by SIRM recommends precautions to protect both patients and healthcare workers (radiologists, radiographers, nurses, and reception staff) from infection or disease spread on the occasion of breast imaging procedures, particularly mammography, breast ultrasound, breast magnetic resonance imaging, and breast intervention procedures.
N S T Tejaswi Karri, Sowmya Devi Uppaluri, Akshatha Savith, V H Ganaraja
INDIAN JOURNAL OF APPLIED RESEARCH pp 28-29; https://doi.org/10.36106/ijar/1001024

Abstract:
INTRODUCTION: Corona virus disease-19 (COVID-19) is one among the worst pandemics faced by mankind and there are various neurological manifestations either direct or indirect effect of Corona virus. Here we report a case of foot drop secondary to entrapment peroneal injury in COVID-19 patient as a sequelae of prone positioning. CASE REPORT: A 55-year-old gentleman was diagnosed with RT PCR positive COVID19 and was hospitalized for severe respiratory syndrome. HRCT thorax done showed CORADS score of 6 with severity index of 14/25. During this period, patient was on treatment according to ICMR guidelines and prone position for about 20 hours/day for 20 days for severe pneumonia. During follow up after 15 days of discharge, he had developed features of foot drop secondary to common peroneal nerve palsy which was later conrmed by electro diagnostic studies and nerve ultrasound. Patient was started on oral steroids and along with supportive measures. He is followed up for a period of 3 months and has noted 50% improvement in his symptoms. CONCLUSION: While prone positioning should continue to be utilized in COVID-19 pneumonia as dictated by the current literature, precaution has to be taken with it. Changing patient positioning at shorter intervals and timely mobilization are necessary.
, F P Chmiel, Y Cheong
Published: 4 November 2020
Human Reproduction, Volume 36, pp 99-106; https://doi.org/10.1093/humrep/deaa251

Abstract:
STUDY QUESTION What is the optimal follicular tracking strategy for controlled ovarian stimulation (COS) in order to minimise face-to-face interactions? SUMMARY ANSWER As data from follicular tracking scans on Days 5, 6 or 7 of stimulation are the most useful to accurately predict trigger timing and risk of over-response, scans on these days should be prioritised if streamlined monitoring is necessary. WHAT IS KNOWN ALREADY British Fertility Society guidance for centres restarting ART following coronavirus disease 2019 (COVID-19) pandemic-related shutdowns recommends reducing the number of patient visits for monitoring during COS. Current evidence on optimal monitoring during ovarian stimulation is sparse, and protocols vary significantly. Small studies of simplifying IVF therapy by minimising monitoring have reported no adverse effects on outcomes, including live birth rate. There are opportunities to learn from the adaptations necessary during these extraordinary times to improve the efficiency of IVF care in the longer term. STUDY DESIGN, SIZE, DURATION A retrospective database analysis of 9294 ultrasound scans performed during monitoring of 2322 IVF cycles undertaken by 1875 women in a single centre was performed. The primary objective was to identify when in the IVF cycle the data obtained from ultrasound are most predictive of both oocyte maturation trigger timing and an over-response to stimulation. If a reduced frequency of clinic visits is needed due to COVID-19 precautions, prioritising attendance for monitoring scans on the most predictive cycle days may be prudent. PARTICIPANTS/MATERIALS, SETTING, METHODS The study comprised anonymised retrospective database analysis of IVF/ICSI cycles at a tertiary referral IVF centre. Machine learning models are used in combining demographic and follicular tracking data to predict cycle oocyte maturation trigger timing and over-response. The primary outcome was the day or days in cycle from which scan data yield optimal model prediction performance statistics. The model for predicting trigger day uses patient age, number of follicles at baseline scan and follicle count by size for the current scan. The model to predict over-response uses age and number of follicles of a given size. MAIN RESULTS AND THE ROLE OF CHANCE The earliest cycle day for which our model has high accuracy to predict both trigger day and risk of over-response is stimulation Day 5. The Day 5 model to predict trigger date has a mean squared error 2.16 ± 0.12 and to predict over-response an area under the receiver operating characteristic curve 0.91 ± 0.01. LIMITATIONS, REASONS FOR CAUTION This is a retrospective single-centre study and the results may not be generalisable to centres using different treatment protocols. The results are derived from modelling, and further clinical validation studies will verify the accuracy of the model. WIDER IMPLICATIONS OF THE FINDINGS Follicular tracking starting at Day 5 of stimulation may help to streamline the amount of monitoring required in COS. Previous small studies have shown that minimal monitoring protocols did not adversely impact outcomes. If IVF can safely be made less onerous on the clinic’s resources and patient’s time, without compromising success, this could help to reduce burden-related treatment drop-out. STUDY FUNDING/COMPETING INTEREST(S) F.P.C. acknowledges funding from the NIHR Applied Research Collaboration Wessex. The authors declare they have no competing interests in relation to this work. TRIAL REGISTRATION NUMBER N/A.
Amol M Lahoti, Kavita Makasare
Journal of Dr. NTR University of Health Sciences, Volume 9; https://doi.org/10.4103/jdrntruhs.jdrntruhs_57_20

Abstract:
As we are facing a country wide lockdown in view of international pandemic of Corona Virus-2019 (COVID-19) and deal with never seen before circumstances all over the world, healthcare personnel are often first one to get affected in view of direct exposure because of limited availability of knowledge and personal protection equipment (PPE). Planning and preparedness are essential to respond effectively to outbreaks and epidemic. Radiologists have greater risk of acquiring and transmitting infection due to its close contact with patients during ultrasound (USG) and other procedures related to invasive patient care the service needs to offer. High density, limited space, and working in air conditioned set up are needed for computed tomography, MRI, ultrasonography, X-ray machines; this makes it essential to set specific guidelines to limit transmission and utilize resources in the best possible way so as to minimize the transmission, and at the same time, implementation of a well-prepared plan as per the radiology department is required to prevent further transmission of the virus to department staff members and patients. A multitiered, updated scientific approach suited to us needs to be devised, followed, and monitored at the administrative and departmental level, taking into account the Radiology team that includes doctors, technicians, assistants, and patient contact-operating points. Here, is a systematic scientific review of infection control measures that cover the different dynamics of utmost patient care and staff protocols without hampering the patient treatment for the radiology department set up. We review precautions and safety measures for radiology department personnel to manage patients. It is not clear to what extent the COVID-19 epidemic would establish itself and how long it is going to continue in India. As case diagnosis may take anywhere from a minimum of 14 days to a few months to be visible, we need to enhance surveillance and prepare the community in a proportionate way. Radiology department and the overall health care system should be prepared, educated to continue the servicing emergency scans procedures and important elective procedures following the strict aseptic precautions so health care workers and patients safety are maintained. Each one of us should understand the disease dynamics, routes, and source of transmission and should take utmost precautions to prevent transmission to colleagues and patients by properly using PPE, as early detection and limiting exposure of healthcare workers, employees, and patients is of utmost importance.
Audrey Herbert, Frances M. Russell, , , , ,
Published: 19 May 2022
Abstract:
Objective: Point-of-care ultrasound (POCUS), traditionally, requires the proximity of learners and educators, making POCUS education challenging during the COVID-19 pandemic. We set out to evaluate three alternate approaches to teaching POCUS in UME. Sessions progressed from an online seminar to a remote, interactive simulation to a “progressive dinner” style session, as precautions evolved throughout the pandemic. Methods: This prospective study details a series of three POCUS workshops that were designed to align with prevailing social distancing precautions during the COVID-19 pandemic. Overall, 656 medical students were included. The first and second workshops used web-based conferencing technology with real-time ultrasound imaging, with the second workshop focusing on clinical integration through simulation. As distancing precautions were updated, a novel “progressive dinner” technique was used for the third workshop. Surveys were conducted after each session to obtain feedback on students’ attitudes toward alternative teaching techniques and quantitative and qualitative analyses were used. Results: The initial, remote POCUS workshop was performed for 180 medical students. Ninety-nine (177) percent of students felt the session was “intellectually challenging” and “stimulating.” Ninety-nine percent of students (340/344), after the second workshop, indicated the session was intellectually challenging, stimulating, and a positive learning experience. Students' ability to correctly identify pathologic images increased post-session evaluation from in-session polling. For workshop three, 99% (107/108) of students indicated that the session was “informative.” There was a significant improvement in pre- to post-workshop knowledge regarding image acquisition, interpretation, and clinical integration. Conclusion: While image acquisition skills are best conveyed at the bedside, these modified POCUS teaching techniques developed and delivered in alignment with COVID-19 pandemic restrictions during a series of three workshops were shown to be effective surrogates for traditional teaching approaches when social distancing requirements, a large learner pool, or lack of local expertise exist.
, Andrew W. Horne, Mike Armour, Stacey A. Missmer, Horace Roman, Luk Rombauts, Lone Hummelshoj, Arnaud Wattiez, George Condous, Neil P. Johnson
Frontiers in Reproductive Health, Volume 2; https://doi.org/10.3389/frph.2020.00005

Abstract:
post-operatively. We support the joint statement by several gynecologic surgical societies, where expert opinion recommendations on intraoperative precautions have been put forward (25). Adequate preoperative screening and diagnosis of SARS-CoV-2 will be an important consideration for the resumption of endometriosis surgery (26). Though most patients undergoing surgery for endometriosis are relatively young and healthy, we must be cognizant of the increased risk in those with perioperative SARS-CoV-2 infection. It has recently been noted that post-operative pulmonary complications occur in half of the patients with perioperative SARS-CoV-2 infection and are associated with high mortality (27). At this time, we do not believe that the COVID-19 pandemic warrants a sustained change in the overall medical approach to the management of endometriosis (e.g., avoid surgery and favor medical management). Regardless of a pandemic, we encourage healthcare providers to comprehensively counsel patients on the therapeutic options available for each individual with endometriosis. The possible risks and realistic scheduling obstacles secondary to COVID-19 must be part of this conversation, but patients should still retain their autonomy to choose the option that is best for them. We believe that the COVID-19 pandemic can lead to sustained improvements in the care for those with endometriosis. Firstly, there may be an ongoing openness to telehealth (28). This could dramatically minimize the geographic barriers to care that many women experience, and facilitate the development of endometriosis networks of expertise, which is recommended by the World Endometriosis Society (2). Telehealth may also be an appropriate alternative for patients with pain that limits their ability to travel to their healthcare provider in some settings. Secondly, there may be increased awareness to self-management strategies that have always existed, yet were under-utilized (e.g., mindfulness, physical exercise, and diet) until COVID-19 resulted in them becoming valuable tools for patients (15). Finally, the current situation mandates a more discerning approach to surgery now and in the future, so that we “operate sparingly and operate well.” This approach can be guided by preoperative triaging tools including advanced clinical algorithms and imaging strategies (29) to avoid multiple repeated surgical procedures. This manuscript has been released as a pre-print in Authorea (30). All authors meet justification criteria of authorship as per ICMJE: substantial contributions to conception and design or acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This viewpoint article is endorsed by the World Endometriosis Society (WES) and the International Federation of Fertility Societies (IFFS). ML reports grants from Australian Women and Children's Research Foundation, outside the submitted work. AH reports grants from Chief Scientist Office, NIHR EME, MRC, Wellbeing of Women, Ferring, and Roche Diagnostics during the conduct of the study; and honoraria for consultancy for Ferring, Roche, and AbbVie, outside the submitted work. MA reports grants from Metagenics and Spectrum outside the submitted work. SM reports a grant and consulting fees from Abbvie, and consulting fees from Roche outside the submitted work. LR reports personal fees from Monash IVF Group, grants from Ferring Australia, personal fees from Ferring Australia, non-financial support from Merck Serono, non-financial support from MSD, non-financial support from Guerbet, outside the submitted work; and Minority shareholder and Group Medical Director for Monash IVF Group and the President-Elect of the World Endometriosis Society. HR reports personal fees from Olympus, personal fees from Ethicon, personal fees from Nordic Pharma, personal fees from Plasma Surgical Ltd., outside the submitted work. LH reports personal fees from AbbVie, is the chief executive of the World Endometriosis Society, and the owner of Endometriosis.org., outside the submitted work. GC reports personal fees from Roche, personal fees from GE Healthcare, grants from Australian Women and Children's Research Foundation, outside the submitted work. NJ reports personal fees from Guerbet, personal fees from Vifor Pharma, grants and personal fees from Myovant Sciences, grants from AbbVie, personal fees from Roche, outside the submitted work. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. 1. ^People Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC. Available online at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html (accessed April 18, 2020). 1. Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, et al. World endometriosis society consensus on the classification of endometriosis. Hum Reprod. (2017) 32:315–24. doi: 10.1093/humrep/dew293 PubMed Abstract | CrossRef Full Text | Google Scholar 2. Johnson NP, Hummelshoj L, and World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod. (2013) 28:1552–68. doi: 10.1093/humrep/det050 CrossRef Full Text | Google Scholar 3. Horne AW, and Saunders PTK. SnapShot: endometriosis. Cell. (2019) 179:1677.e1. doi: 10.1016/j.cell.2019.11.033 PubMed Abstract | CrossRef Full Text 4. Zondervan KT, Becker CM, and Missmer SA. Endometriosis. N Engl J Med.(2020) 382:1244–56. doi: 10.1056/NEJMra1810764 PubMed Abstract | CrossRef Full Text 5. AAGL – Elevating Gynecologic Surgery. COVID-19: Joint Statement on Elective Surgeries (2020). Available online at: https://www.aagl.org/news/covid-19-joint-statement-on-elective-surgeries/ (accessed April 5, 2020). 6. American Society for Reproductive Medicine. COVID-19: Suggestions on Managing Patients Who Are Undergoing Infertility Therapy or Desiring Pregnancy (2020). Available online at: https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/covid-19-suggestions-on-managing-patients-who-are-undergoing-infertility-therapy-or-desiring-pregnancy/ (accessed March 24, 2020). 7. Bourne T, Leonardi M, Kyriacou C, Al-Memar M, Landolfo C, Cibula D, et al. ISUOG Consensus Statement on rationalization of gynecological ultrasound services in context of SARS-CoV-2. Ultrasound Obstet Gynecol. (2020) 55:879–85. doi: 10.1002/uog.22047 PubMed Abstract | CrossRef Full Text | Google Scholar 8. Nezhat C, Lindheim SR, Backhus L, Vu M, Vang N, Nezhat A, et al. Thoracic endometriosis syndrome: a review of diagnosis and management. J Soc Laparoendosc Surg. (2019) 23:e2019.00029. doi: 10.4293/JSLS.2019.00029 PubMed Abstract | CrossRef Full Text | Google Scholar 9. Visouli AN, Darwiche K, Mpakas A, Zarogoulidis P, Papagiannis A, Tsakiridis K, et al. Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature. J Thorac Dis. (2012) 4(Suppl. 1):17–31. doi: 10.3978/j.issn.2072-1439.2012.s006 PubMed Abstract | CrossRef Full Text | Google Scholar 10. Siegelman ES, and Oliver E. R. MR imaging of endometriosis: ten imaging pearls. Radiographics (2012) 32:1675–91. doi: 10.1148/rg.326125518 PubMed Abstract | CrossRef Full Text | Google Scholar 11. Leonardi M, and Condous G. How to perform an ultrasound to diagnose endometriosis. Aust J Ultrasound Med. (2018) 21:61–9. doi: 10.1002/ajum.12093 PubMed Abstract | CrossRef Full Text | Google Scholar 12. Leyland N, Casper R, Laberge P, Singh SS, Allen L, Arendas K, et al. Endometriosis: diagnosis and management. J Obstet Gynaecol Canada. (2010) 32:S1–28. doi: 10.1016/S1701-2163(16)34589-3 PubMed Abstract | CrossRef Full Text | Google Scholar 13. Fang L, Karakiulakis G, and Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. (2020) 8:e21. doi: 10.1016/S2213-2600(20)30116-8 PubMed Abstract | CrossRef Full Text | Google Scholar 14. World Health Organization. The Use of Non-steroidal Anti-inflammatory Drugs (NSAIDs) in Patients With COVID-19: Scientific Brief (2020). Available online at: https://www.who.int/publications/i/item/the-use-of-non-steroidal-anti-inflammatory-drugs-(nsaids)-in-patients-with-covid-19 (accessed June 7, 2020). Google Scholar 15. Leonardi M, Horne AW, Vincent K, Sinclair J, Sherman KA, Ciccia D, et al. Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic. Hum Reprod Open. (2020) 2020:hoaa028. doi: 10.1093/hropen/hoaa028 PubMed Abstract | CrossRef Full Text | Google Scholar 16. American College of Surgeons, American Society of Anesthesiologists Association of periOperative Registered Nurses, and American Hospital Association. Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic (2020). Available online at: https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/joint-statement-on-elective-surgery-after-covid-19-pandemic (accessed June 7, 2020). PubMed Abstract 17. Royal College of Obstetricians and Gynaecologists. Restoration and Recovery: Priorities for Obstetrics and Gynaecology. London (2020). 18. Society of Gynecologic Surgeons. Joint Statement on Re-introduction of Hospital and Office-based Procedures in the COVID-19 Climate for the Practicing Gynecologist (2020). Available online
, Gaurav Kochar
Journal of Cardiac Critical Care TSS, Volume 5, pp 082-083; https://doi.org/10.1055/s-0041-1732837

Abstract:
Tracheostomy is a well-established procedure which is performed in critically ill adults requiring prolonged invasive ventilation. Transoral endotracheal tubes are poorly tolerated, have risk of dislodgement, require more sedation, and limits movement and communication, while tracheostomy has been shown to improve patient comfort and facilitate weaning and better respiratory tract toilet. The common indications of tracheostomy in ICU are prolonged ventilation weaning from ventilator support, tracheobronchial toileting and secretion management, upper airway obstruction and permanent airway control in malignancies, trauma or neurological conditions. Although a commonly performed procedure, certain questions about tracheostomy such as optimum timing and selection of patients still remain to be fully resolved. The COVID pandemic has not only led to the emergence of a multitude of new issues but has also challenged established practices. For example, fear of intubation, state of” happy hypoxia,” possibility of different pathophysiology, etc. were all such factors which might have impacted the decision to intubate many COVID patients. Tracheostomy in COVID patients is another such area where medical fraternity was hauled “back to square one” in many ways. Questions challenging otherwise established opinions and practices regarding the need for, safety, optimum method and timing, and safest method of tracheostomy have resurfaced in the context of COVID. As per one estimate from the US, > 20% of hospitalized COVID patients needed intubation at least once.[1] Studies from other researchers indicate that 10 to 15% of hospitalized COVID patients require mechanical ventilation.[2] [3] [4] A significant proportion of intubated COVID patients have been reported to need prolonged ventilation.[1] Addressing the role of tracheostomy in COVID patients is therefore a very logical step. Tracheostomy is a known aerosol-generating procedure. Data from SARS-CoV-1 epidemic points toward increased risk of viral transmission, with an odds ratio of 4:2 during tracheostomy.[5] In case of COVID-19, data from multiple studies suggest no increase in health care personnel infection when enhanced personal protection equipment (PPE) precautions, including eye protection, powered air-purifying respirators (PAPR)/N95 mask, fluid-repellent disposable surgical gown, and gloves, are used during tracheostomy.[6] [7] [8] Tracheostomy by the most experienced operator, minimization of number of staff, and negative pressure operating room are additional precautions which should be taken. No particular technique of tracheostomy has been recommended for COVID patients as of now. Between surgical and percutaneous tracheostomy, the latter usually requires more frequent disconnection of ventilator circuit; however, sufficient data to recommend surgical over percutaneous technique is not available. Use of sealed ventilator circuits and single-use bronchoscopes should be preferred. Performance of procedure under deep sedation and paralysis avoids coughing and complications and distraction due to patient movement, with resultant prolongation of procedure. Pausing ventilation during insertion of the tracheostomy tube can minimize aerosol spread; however, risk of desaturation during brief apnea should be evaluated beforehand. Percutaneous ultrasound is an alternative method of guidance for percutaneous tracheostomy which avoids aerosol generation.[9] The insertion of a tracheostomy after around 7 to 10 days of invasive mechanical ventilation is generally considered a standard of care, due to potential to reduce the duration of mechanical ventilation and length of stay (LOS) in intensive care[10] [11] Early tracheostomy has the potential advantage of shortening duration of ventilation and sedation, thereby enabling a more efficient use of mechanical ventilators, ICU beds and other resources. Median time from hospital admission to death in COVID has been reported to vary from 3 to 11 days; therefore, it seems prudent to delay tracheostomy until patient has started improving and prognosis is clearer before doing a tracheostomy. This not only avoids futile tracheostomy and associated risk of exposure to staff but also enables a more secure airway (oropharyngeal vs. transtracheal) in case patient requires proning. The American Academy of Otolaryngology-Head and Neck Surgery currently recommends that tracheostomy should not be performed prior to 14 days of endotracheal intubation.[12] Moreover, some data points toward possibility of increased mortality in patients in whom tracheostomy is done earlier than 14 days.[13] Initial studies have shown that viral loads from nasal and throat swabs were highest in the early phase of the disease, with clearance by days 9 to 15.[14] [15] The evidence thus far in terms of viral load risk would suggest that delaying tracheostomy to at least 14 days postintubation would represent the safest possible balance.[15] In conclusion, tracheostomy has an important role to play in management of COVID patients who need ventilator. If conducted with all precautions and little modifications, it is safe for both operator and the patient. Little is known about early versus late tracheostomy in pediatric patients. In this issue, there are two interesting papers from All India Institute of Medical Sciences (AIIMS) cardiac surgery population over a 1-year period. They found that the early tracheostomy group (< 7 days) had significantly reduced hospital LOS, sepsis, ventilator-associated pneumonia (VAP), and escalation of antibiotics and antifungals. They also had reduced ICU LOS, lesser enteral nutrition (EN) interruptions, and ventilator days. This was a large population 41/1084 patients and is a significant finding. In the same cohort, in a separate paper, the authors studied risk factors for nonsurvival. They found that lower pH SPO2, platelet count, and higher S. lactate and...
, Mauro Feola, Alberto Palazzuoli
Frontiers in Cardiovascular Medicine, Volume 7; https://doi.org/10.3389/fcvm.2020.581458

Abstract:
Coronavirus disease 2019 (COVID-19) is a new viral infection causing acute respiratory distress syndrome (ARDS) that has spread around the world counting 32,429,965 cases and 985,823 deaths as of September 26, 20201. Because of the high percentage of COVID-19–related hospital admission, in Italy a reduction in cardiovascular disease hospitalization was observed, which could contribute to an increased rate of cardiovascular death out-of-hospital (1, 2). Acute heart failure (AHF) syndromes are characterized by a rapid symptom onset requiring fast hospitalization and treatment. Similarly, COVID-19–related ARDS needs hospital admission both for diagnosis and for treatment. However, dyspnea represents a common symptom of these pathological conditions, and for this reason, there is an unmet need of established in-hospital route to better manage the two diseases and to reduce in-hospital infection spread. First, after presentation to the emergency department (ED), it is mandatory to distinguish two different routes: one is for known positive coronavirus patients and the other for unknown coronavirus patients. In case of positive coronavirus patients, they should recover in the “red zone” of the ED, where AHF patients should undergo clinical, laboratory, and instrumental assessment by clinicians with the support of a cardiologist advisor provided with showerproof single-use coat, gloves, facial protection, and FFP3 mask (3, 4). AHF diagnosis should be done following the latest guidelines criteria (5). Venous blood sample, arterial blood gas analysis, electrocardiogram, and chest x-ray are mandatory to identify the main diagnosis of each patient (viral infection ARDS or cardiovascular disease or cardiovascular involvement during COVID-19). Chest computed tomography scan should be performed according to clinical suspect of interstitial pneumonia. Monitoring electrocardiogram should be useful because of the high risk of arrhythmias in COVID-19 patients. In these patients, echocardiography should be performed in case of new-onset AHF (without medical history of HF), suspected pericardial tamponade, suspected acute pulmonary embolism, suspected AHF associated to acute coronary syndrome (ACS), and suspected acute valvular heart diseases. However, there are some limitations to using echocardiography in COVID-19 patients: (1) high risk of clinician contamination during echocardiography; (2) higher rate of echocardiography failure due to severe respiratory distress. The first concern should be avoided using the latest fast-echo protocol for COVID-19 patients with handheld tablet ultrasound, which provides appropriate information about cardiac conditions, limiting contact and contamination (6). The second concern should be overcome by the use of a contrast agent that enhances the identification/exclusion of ventricular thrombosis, abnormalities in wall motions, and computation of left ventricular ejection fraction (7). AHF treatment should be shared between the cardiologist advisor and ED clinicians, taking into account renal function deterioration, diuresis, electrolytes unbalance, and ARDS complication. ARDS complication should be managed in the “red zone” of the intensive care unit (ICU) together with ICU clinicians. In case of coronavirus-positive AHF patients, who do not show ARDS and do not require invasive ventilation (IV), these patients should be allocated into internal medicine ward, which should be organized as COVID-19 care unit. In this unit, patients should be managed by internal medicine clinicians together with a cardiologist advisor. In case of unknown for COVID-19 AHF patients, it is necessary to limit infection among patients and health care workers. It should be optimal to recognize a “gray zone” within the ED where patients should be screened for coronavirus. In this “gray zone,” patients should be far at least for 2 m, and healthcare workers should wear showerproof single-use coat, gloves, facial protection, and FFP3 mask (3, 4). Recovered patients should undergo nasopharyngeal swabbing at hospital admission and after 24–48 h. The cardiologist advisor should support clinicians for AHF diagnosis and treatment during coronavirus infection assessment, wearing showerproof single-use coat, gloves, facial protection, and FFP3 mask. In case of positive coronavirus nasopharyngeal swab, AHF patients should be managed in the “red zone” together with ED clinicians; these patients should be transferred to the ICU or COVID-19 care unit according to ARDS complications and the need for IV. In case of two negative coronavirus nasopharyngeal swab results, AHF patients could be transferred in the cardiology ward (“green zone”) and should be managed and treated by cardiologists. In the “green zone,” cardiologist and other healthcare workers should wear disposable paper gown, surgical masks, and gloves. All patients may wear surgical masks during the hospitalization period. Cardiac biomarkers (D-dimer, troponin, and natriuretic peptide) monitoring should be performed in all patients to recognize treatment efficacy, worsening heart failure, and acute cardiovascular complication related or not to COVID-19, such as acute pulmonary embolism or ACS (Figure 1). Figure 1. Flow chart for AHF patients hospital admission during COVID-19. ACS, acute coronary syndrome; AHF, acute heart failure; ARDS, acute respiratory distress syndrome; BNP, B-type natriuretic peptide; CBC, count blood cell; CRP, C-reactive protein; CT, computed tomography; ECG, electrocardiogram; ED, emergency department; ICU, intensive care unit; ICHU, intensive care heart unit; IV, invasive ventilation; PCT, procalcitonin. GR give a substantial contribution in conception, design, writing, and revising the manuscript. MF and AP revising manuscript. All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. 1. ^ https://covid19.who.int/ 1. De Filippo O, D'Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, et al. Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy. N Engl J Med. (2020) 383:88–9. doi: 10.1056/NEJMc2009166 PubMed Abstract | CrossRef Full Text | Google Scholar 2. Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med. (2020) 383:496–8. doi: 10.1056/NEJMc2010418 PubMed Abstract | CrossRef Full Text | Google Scholar 3. Centers for Disease Control and Prevention. Discontinuation of Transmission-Based Precautions and Disposition of Patients With COVID-19 in Healthcare Settings (Interim Guidance). (2020). Available online at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html Google Scholar 4. Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY. Surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. (2020) 323:1610–2. doi: 10.1001/jama.2020.3227 PubMed Abstract | CrossRef Full Text | Google Scholar 5. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC)Developed With the Special Contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. (2016) 37:2129–200. doi: 10.1093/eurheartj/ehw128 CrossRef Full Text | Google Scholar 6. McMahon SR, De Francis G, Schwartz S, Duvall WL, Arora B, Silverman DI. Tablet-based limited echocardiography to reduce sonographer scan and decontamination time during the COVID-19 pandemic. J Am Soc Echocardiogr. (2020) 33:895–9. doi: 10.1016/j.echo.2020.05.005 PubMed Abstract | CrossRef Full Text | Google Scholar 7. Argulian E, Sud K, Bohra C, Vogel B, Garg V, Talebi S, et al. Safety of ultrasonic enhancing agents in patients with COVID-19. J Am Soc Echocardiogr. (2020) 33:906–8. doi: 10.1016/j.echo.2020.04.022 PubMed Abstract | CrossRef Full Text | Google Scholar Keywords: acute heart failure, ARDS, COVID-19, inhospital routes, emergency department Citation: Ruocco G, Feola M and Palazzuoli A (2020) In-hospital Routes of Acute Heart Failure Admissions During COVID-19. Front. Cardiovasc. Med. 7:581458. doi: 10.3389/fcvm.2020.581458 Received: 19 July 2020; Accepted: 21 August 2020; Published: 08 October 2020. Edited by: Reviewed by: Copyright © 2020 Ruocco, Feola and Palazzuoli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. *Correspondence: Gaetano Ruocco, [email protected]
, Ozlem Moraloglu Tekin, Arda Buglagil, , Aykan Yucel, Atakan Tanacan, Filiz Halici Ozturk, Betul Yakistiran, Didem Yucel Yetiskin, Serpil Unlu, Derya Gokcinar
The Journal of Maternal-Fetal & Neonatal Medicine, Volume 34, pp 3591-3600; https://doi.org/10.1080/14767058.2021.1875440

Abstract:
Compartmental models simplify the mathematical modeling of infectious diseases based on reported cases. In the absence of precautions, personal protective equipment, quarantine and social distancing, a Susceptible–Exposed–Infectious–Recovered (SuEIR) model with Unscented Kalman Filter for coronavirus disease-19 (COVID-19) Forecasts in Turkey has revealed 174 641 infected people on August 15, 2020, whilst the reported case was 12 216. Through numerical experiments, the effects of quarantine, social distancing, and COVID-19 testing on the dynamics of the outbreak varies. We herein present the documentation of the work in a perinatology clinic during COVID-19 pandemic to find the reflection in a pandemic hospital as even in the pandemic, pregnancy complications and fetal diagnosis/therapy are time-sensitive and cannot be delayed. During the prevention of the horizontal transmission to the health-care workers (HCWs), testing all pregnant women with nasopharyngeal/oropharyngeal swabs for severe acute respiratory syndrome coronavirus (SARS-COV-2) undergoing birth, ultrasound examinations, invasive procedures appear to be the gold standard so that appropriate precautions can be taken if the screen is positive. Though it is logical, it may be incompatible with a busy obstetric practise as a pending polymerase chain reaction (PCR) result should never delay any emergent procedure. We aim to describe the development of COVID-19 disease of 408 HCW out of 1462 by the exposure to pregnant women while providing obstetric care in a single tertiary perinatology unit under strict clinical triage, recommended precautions and wearing personal protective equipment and compare the maternal and perinatal outcome with those of the preceding three months. A prospective cohort study involving the pregnant women and the HCW with positive PCR for SARS-COV-2 were carried out to correlate with the horizontal transmission while documenting the perinatal work. 25 HCW, including nurses/midwives: 11, doctors: 7 and health technicians: 3 and support staff: 4 developed positive PCR for SARS-COV-2 while providing healthcare to 162 cases: mild-moderate (n = 146), severe (n = 12) and critical (n = 1) and asymptomatic (n = 3) in obstetric population. 22 out of 25 HCW were working in the perinatology unit. COVID-19 clinic was asymptomatic (n = 8), mild-moderate (13) or severe (n = 2) in HCW. However, “Exposed” group in the SuEIR model, both the pregnant women and the HCW that have already been infected and have not been tested, which have been also capable of infecting the “Susceptible” group could not be determined. Some of the HCW and the pregnant women in the “Exposed” group were tested and transferred to the “Infectious” group (which were reported to be PCR positive), while the rest of them who recovered, transitted to the so-called “Unreported Recovered” group. The ratio of the women with severe pre-eclampsia admitted to intensive care unit increased significantly during the lockdown (p = .01). In a nonstop pandemic perinatology clinic, exposure to 162 PCR positive pregnant women may be correlated with a 5.4% (22/408) documented horizontal transmission in the frontline HCW despite clinical triage and personal protective equipment.
Shuang Song, Yidan Chen, Ying Han, Feng Wang,
Published: 12 May 2021
Frontiers in Medicine, Volume 8; https://doi.org/10.3389/fmed.2021.618599

Abstract:
or confirmed patients are found in the ward, relevant emergency plans and work procedures will be activated and transferred to a specific area for treatment (18). • All hospitalized patients are checked for 2019-nCoV nucleic acid, questionnaire about upper respiratory symptoms, fever, myalgia and anosmia, domicile or traveling in hot areas, and contact history with confirmed or suspected COVID-19 patients within the past 14 days (8, 19). • Hygienic environment of the normal ward reference 3.1 • Not infected patients are normally prepared for eye surgery. • For patients who are diagnosed or suspected and must be operated, an independent negative pressure operating room should be arranged. If there is no negative pressure operating room, an independent clean room with relatively independent spatial location should be selected (8, 14, 19). • If 2 or more suspected or confirmed infections occur at the same time, surgery should be performed for the more critically ill patients (19). • Disposable medical supplies are preferred. Non-disposable equipment and items must have a clear cleaning and disinfection process. • Perform detailed inspections of surgical supplies before surgery to reduce the activities of personnel during surgery. • Most ophthalmic operations are not general anesthesia, patients can continue to wear surgical masks during the operation; if it is general anesthesia, it is recommended to place a disposable filter between the tracheal intubation and the breathing circuit to reduce the pollution of the breathing circuit, the anesthesia machine Strictly disinfect after use (20). • Ordinary goggles seriously impede microsurgery, replaced it with homemade goggles by sealing the own glasses or flat lenses around the eyes with plastic wrap and remove the plastic wrap from the center of the lens to get protection and clear vision during the ophthalmic microsurgery (21, 22). • Protective shields can be added to the slit lamp microscope to reduce the risk of close face-to-face contact between doctors and patients (21–23). • Adjust the examination light from weak to strong, increasing gradually to avoid tears or a reflex sneeze. • The third level of protection for surgeons in the whole process: hand-brushing clothing, medical protective clothing (disposable), surgical gown (disposable), medical protective masks, work caps, protective visor/goggles, double gloves (23). • The number of people in the room is limited to the minimum number of patients required for care and surgery. • Medical staff escorting the patient should do a tertiary level of protection, and the patient must wear a mask all the way. • A special transfer flat car should be used to achieve “one person, one use, one disinfection,” and the transfer elevator should also be disinfected on the surface. During the transfer of patients, attention should be paid to the protection of public areas and public appliances. Transfer patients according to the transfer route specified by the hospital and the special transfer route in the negative pressure operating room (14, 19). • Disposal of surgical supplies, reusable medical supplies are placed separately and transported to disinfection supply center for centralized processing. Disposable items used in patients need to be handed over separately, delivered directly, and processed uniformly. A new coronavirus label is prominently placed on the outside of the pathological specimen bag and delivered by special personnel (14, 19). All medical staff involved in the operation of suspected or infected patients should be isolated for medical observation after surgery. If the suspected case excludes infection, release the isolation of the surgical staff; if it is an infected person, continue to isolate and observe until 14 day. And pay attention to observe whether the clinical manifestations of the new coronary pneumonia mentioned above, and report to the competent department. 2019-nCoV is a global biochemical crisis. Ophthalmologists should remind patients to pay attention to eye protection and hand hygiene to prevent the eyes from becoming a gateway to viral infection. Prevent mutual infection between patients and patients, and between patients and doctors, disinfection and isolation of departments and operating rooms, and establish a simple and effective diagnosis and treatment process is necessary. In this review, we clearly told patients with eye diseases which conditions can be post-poned for medical treatment, which conditions require urgent medical attention, and provide our experience on the protective measures in the outpatient and ward. We have experienced two local outbreaks of the epidemic, and the infection rate is zero. It is difficult to determine which method is the most important, but in the face of infectious diseases, every detail is very important. China's success in fighting the epidemic shows that these methods are effective. In the context of the normalization of the global epidemic, we hope that our experience can help ophthalmologists. FW designed the article. YS drafted important content. SS wrote the manuscript. YC and YH provided important intellectual conment during revising the article. All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. 1. Wang Y, Liu Y, Struthers J, Lian M. Spatiotemporal characteristics of the COVID-19 epidemic in the United States. Clin Infect Dis. 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