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Subbiah Ponniah H, Ahmed M, Edwards T, Cobb J, Dean E, Clark C, Logishetty K. 905 How to prioritise patients and safely resume elective surgery during the Covid-19 pandemic. Br J Surg 2021. [PMCID: PMC8135653 DOI: 10.1093/bjs/znab134.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
There are now over 2.5 million NHS patients awaiting elective surgery, with the most in orthopaedics. We present an algorithm and results for safely and equitably restarting surgery at COVID-light sites.
Method
An MDT applied the COVID-19 Algorithm for Resuming Elective Surgery (CARES) on 1169 patients awaiting elective orthopaedic surgery. It assessed safety, procedural efficacy, and biopsychosocial factors, to prioritise patients. They were assigned to five categories and underwent surgery at one of three COVID-light sites (1. access to HDU/ITU/Paediatrics/specialist equipment, 2. an NHS elective surgical unit and 3. a private elective surgical unit).
Results
21 ‘Urgent’ patients received expedited care; 118 were Level 1/2; 222 were Level 3; 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery.
Conclusions
We validated a widely generalisable model to facilitate resumption of elective surgery in COVID-light sites. It enabled surgery for patients in most suffering, undergoing the most efficacious procedures and/or at highest risk of deterioration, without compromising patient-safety.
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Bhojwani A, Ahmed M, Mahmood F, Sellahewa C, Desai C. 888 Challenges in The Management of Lower Gastrointestinal Bleeding in General Surgery: Developing Consistent Practice and Application of BSG Guidelines. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Lower gastrointestinal bleeding (LGIB) accounts for 3% of all surgical referrals in the UK, with an in-hospital mortality of 3.4%. The BSG 2019 guidelines recommend risk stratification as per Oakland scoring, inpatient lower GI endoscopy for admissions and CT-angiography for unstable patients. This study evaluates the delivery of these outcomes in a district hospital setting.
Method
Retrospective audit assessing all acute LGI bleed admissions from 01-07-2019 to 28-02-2020 at Russells Hall Hospital. Shock Index (SI) and Oakland score used to stratify patients into unstable, stable-major and stable-minor LGIB. Compliance with BSG standards was assessed by review of investigations and emergent patient management.
Results
143 patients (Median age = 70years) evaluated, with 64 admissions having no formal risk stratification (OAKLAND-score) documented. Only 12 admissions underwent inpatient LGI endoscopy with sigmoid diverticulosis the most common pathology (39.3%). CT-angiogram was the initial investigation for 75% of patients admitted with unstable LGIB.
Conclusions
OAKLAND-scoring is a sensitive tool to stratify LGIB patients based on clinical parameters. Application of BSG-2019 guidelines and developing consistency in management is challenged by the lack of routine access to LGI endoscopy and tools to manage bleeding endoscopically.
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Kapoor S, Choudhry B, Ahmed M. 870 Early Weight Bearing In > 60 Years - Is It All A Dream? Br J Surg 2021. [DOI: 10.1093/bjs/znab134.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background: Early weight bearing (EWB) is increasingly considered acceptable in surgically managed fractures. However, there are two different outlooks for rehabilitation. EWB in a biologically weak bone may lead to implant failure compared to EWB being beneficial for quicker recovery. We aim to review outcomes for EWB in surgically managed fragility fractures.
Method: This was a retrospective analysis; data was collected from departmental records of operative fixation of lower limb injuries in patients above 60 years. We excluded patients who had procedures for proximal femoral fractures and polytrauma. We compared SF-12 scores, complications, and reoperation rates in those that were EWB to those that were at the conventional 6-week mark.
Results: During a 6-month period from November 2019 to April 2020 we performed 60 operations. N = 30 surgeries were performed in EWB group versus 30 surgeries in late weight bearing group (LWB). The average physical and mental SF-12 score in EWB group was 44.82 and 56.36 compared to a SF-12 score of 44.51and 52.18 in LWB.
Conclusions
We found that the SF-12 scores were different despite EWB. There was no evidence of early complications in the EWB group. Therefore, we advocate EWB for group >60 who were known to have osteoporosis.
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Hashmi Z, Ahmed R, Ahmed M, Yousaf N, Zafar T, Chaudhary K, Islam R, Aljarad F, Madanu M. 957 Comparison of Inguinodynia In Patients Undergoing Prophylactic Ilioinguinal Neurectomy vs No Neurectomy In Lichtenstein Mesh Hernioplasty. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
The objective of this study is to compare the frequency of inguinodynia in ilioinguinal neurectomy VS no neurectomy in patients undergoing Lichtenstein mesh hernioplasty.
Method
200 male patients with unilateral, primary, reducible inguinal hernia were randomly distributed in to two groups by using lottery method to undergo Lichtenstein’s hernia repair i.e., with and without ilioinguinal neurectomy. All the operation were carried out under local anesthesia. Pain score was calculated using the VAS system at 3rd month and inguinodynia was labelled if it is more than 1 on VAS scale.
Results
200 male patients with mean age of 53.25 ± 6.768 were included. 42 (21%) had Inguinodynia after surgery. When we cross tabulated both groups with inguinodynia, results came up significant (p = 0.001). In neurectomy group 10 patients had inguinodynia while in no neurectomy group, 32 patients were having Inguinodynia. There was no effect of malnutrition on outcome. Younger age group benefitted more from procedure.
Conclusions
It is concluded that there is difference in frequency of inguinodynia in ilioinguinal neurectomy versus no neurectomy in patients undergoing Lichtenstein hernia repair. Patients with ilioinguinal neurectomy had reduced incidence of inguinodynia.
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Ali A, Weinstein J, Nasser I, Morrow M, Faintuch S, Ahmed M, Sarwar A. Abstract No. 439 Histological outcomes in resected tumor specimens after Yttrium-90 transarterial radioembolization using resin microspheres. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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81
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Raef H, Wong L, Garelli C, Kim E, Ahmed M, Pike K, Moses S, Harris J, Marshak-Rothstein A, Rashighi M, Richmond J. 041 CXCR3 blockade reduces skin germinal center B cells and autoantibody titers in murine cutaneous lupus erythematosus. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Subrize M, Ali A, Weinstein J, Faintuch S, Ahmed M, Sarwar A. Abstract No. 70 Post-surgical outcomes for patients with intrahepatic cholangiocarcinoma treated with neoadjuvant resin Yttrium-90 radioembolization using MIRD dosimetry. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ali A, Ahmed M, Daily L, Lewis T, Weinstein J, Ou J, Novack V, Faintuch S, Sarwar A. Abstract No. 440 Multimodality therapy improves survival in hepatocellular carcinoma patients with cirrhosis: a propensity score matching analysis. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ali A, Ahmed M, Evenson A, Weinstein J, Raven K, Eckhoff D, Nasser I, Morrow M, Faintuch S, Sarwar A. Abstract No. 75 Neoadjuvant Yttrium-90 transarterial radioembolization using MIRD dosimetry with resin microspheres. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Adeyemi K, Sola-Ojo F, Ishola J, Ahmed M, Lawal M. Influence of Anacardium occidentale leaf supplementation in broiler chicken diet on performance, caecal microbiota, blood chemistry, immune status, carcass, and meat quality. Br Poult Sci 2021; 62:552-561. [PMID: 33635179 DOI: 10.1080/00071668.2021.1894321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
1. This study investigated the growth performance, caecal microbiota, blood chemistry, splenic cytokines, serum immunoglobulins, carcase, meat quality and oxidative status of broiler chickens fed diets supplemented with Anacardium occidentale leaf powder (AOLP) in comparison with antibiotic and synthetic antioxidant.2. Three hundred and twenty, one-day old Arbor Acre broiler chicks were randomly allotted into four treatment groups consisting of eight pen replicates with 10 birds per pen. The treatment groups were T0, basal diet only; T1, basal diet + 0.4 g/kg oxytetracycline + 0.12 g/kg butylated hydroxyanisole (BHA); T2, basal diet + 2 g/kg AOLP and T3, basal diet + 4 g/kg AOLP. The birds were fed for 42 d when performance was assessed, and then euthanised.3. During 0-42 d, feed conversion ratio was higher (P = 0.033) in T0 birds compared with birds fed other diets. Diet did not affect carcase traits, organ weights, serum biochemical indices, and meat composition, pH, cook loss or meat colour. Supplemented birds had higher erythrocyte (P = 0.042) and haemoglobin (P = 0.025), and lower leukocytes (P = 0.012) compared with the T0 birds.4. Diet T3 upregulated (P = 0.020) splenic interleukin-10 compared with other diets. The T0 birds had higher (P < 0.05) interleukin-6 and serum IgG and IgM compared with the supplemented birds. Caecal E. coli and Salmonella spp. counts were higher (P < 0.05) in T0 birds than in the supplemented groups. Lactobacillus spp. counts were higher (P = 0.001) in T3 birds than in those fed other diets. Breast and thigh meat from the T0 birds had higher (P < 0.05) TBARS value, and carbonyl content compared to the supplemented birds. The T0 breast meat had higher drip loss (P = 0.001) than meat from the supplemented birds.5. The results suggested that AOLP exhibited antimicrobial and antioxidant properties that were comparable to the responses to oxytetracycline and BHA (T1) in broiler diets. Nonetheless, the efficacy of AOLP needs to be verified under disease challenge or compromised health condition.
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Madhani F, Maniar RA, Burfat A, Ahmed M, Farooq S, Sabir A, Domki AK, Page-Shipp L, Khowaja S, Safdar N, Khan AJ, Khan PY. Automated chest radiography and mass systematic screening for tuberculosis. Int J Tuberc Lung Dis 2021; 24:665-673. [PMID: 32718398 DOI: 10.5588/ijtld.19.0501] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Systematic screening for TB using automated chest radiography (ACR) with computer-aided detection software (CAD4TB) has been implemented at scale in Karachi, Pakistan. Despite evidence supporting the use of ACR as a pre-screen prior to Xpert® MTB/RIF diagnostic testing in presumptive TB patients, there has been no data published on its use in mass screening in real-world settings.METHOD: Screening was undertaken using mobile digital X-ray vehicles at hospital facilities and community camps. Chest X-rays were offered to individuals aged ≥15 years, regardless of symptoms. Those with a CAD4TB score of ≥70 were offered Xpert testing. The association between Xpert positivity and CAD4TB scores was examined using data collected between 1 January and 30 June 2018 using a custom-built data collection tool.RESULTS: Of the 127 062 individuals screened, 97.2% had a valid CAD4TB score; 11 184 (9.1%) individuals had a CAD4TB score ≥70. Prevalence of Xpert positivity rose from 0.7% in the <50 category to 23.5% in the >90 category. The strong linear association between CAD4TB score and Xpert positivity was found in both community and hospital settings.CONCLUSION: The strong association between CAD4TB scores and Xpert positivity provide evidence that an ACR-based pre-screening performs well when implemented at scale in a high-burden setting.
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Finnerty D, Ní Eochagáin A, Ahmed M, Poynton A, Butler JS, Buggy DJ. A randomised trial of bilateral erector spinae plane block vs. no block for thoracolumbar decompressive spinal surgery. Anaesthesia 2021; 76:1499-1503. [PMID: 33878196 DOI: 10.1111/anae.15488] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
Major spinal surgery causes significant postoperative pain. We tested the efficacy and safety of bilateral erector spinae block on quality of recovery and pain after thoracolumbar decompression. We randomly allocated 60 adults to standard care or erector spinae block. Erector spinae block improved the mean (SD) quality of recovery-15 score at 24 postoperative hours, from 119 (20) to 132 (14), an increase (95%CI) of 13 (4-22), p = 0.0044. Median (IQR [range]) comprehensive complication index was 1 (0-3 [0-5]) in the control group vs. 1 (0-1 [0-4]) after block, p = 0.4. Erector spinae block reduced mean (SD) area under the curve pain during the first 24 postoperative hours: at rest, from 78 (49) to 50 (39), p = 0.018; and on sitting, from 125 (51) to 91 (50), p = 0.009. The cumulative mean (SD) oxycodone consumption to 24 h was 27 (18) mg in the control group and 19 (26) mg after block, p = 0.20. In conclusion, erector spinae block improved recovery and reduced pain for 24 h after thoracolumbar decompression surgery.
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Shourick J, Ahmed M, Seneschal J, Passeron T, Andreux N, Qureshi A, Chow EY, Natella PA, Harris J, Tran VT, Ezzedine K. Development of a shared decision-making tool in vitiligo: an international study. Br J Dermatol 2021; 185:787-796. [PMID: 33830502 DOI: 10.1111/bjd.20137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Shared decision-making tools (SDMt) are visual tools developed to promote joint medical decisions between physicians and patients. There is a paucity of such tools in dermatology. OBJECTIVES To develop and validate a SDMt for use in specialized consultation for vitiligo. METHODS A prospective cross-sectional study was carried out from March 2019 to March 2020. We first conducted a qualitative study of topics discussed by patients and clinicians during therapeutic decision-making in the setting of a specialized consultation for vitiligo using an anchored-theory method, which allowed conceptualization of the SDMt. The usefulness of the SDMt was evaluated by a working group of multidisciplinary health workers and patients with vitiligo. Consensus on the final tool was obtained through an e-Delphi method. RESULTS We recruited 30 patients with vitiligo for the qualitative study, which identified 91 topics related to therapeutic decision-making. Hierarchical clustering analysis confirmed the distribution of these topics in two subgroups (general treatment goals and priorities, and topics specific to each treatment). The consensus of a multidisciplinary group was used to develop the SDMt. The tool was comprised of eight A5 cards, which addressed face repigmentation; body repigmentation (limited area); body repigmentation (extended area); partial or complete depigmentation; coping with the disease; stabilization of disease; maintaining repigmentation; and disease information. Cognitive interviews confirmed the satisfaction, readability and usefulness of the SDMt. The SDMt was then translated and culturally validated in English. CONCLUSIONS We developed a tool for shared decision-making in nonsegmental vitiligo, which we translated and cross-culturally validated in a US patient population with vitiligo to ensure its generalizability.
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Levy L, Moshkelgosha S, Huszti E, Hunter S, Ahmed M, Zhang K, Ghany R, Keshavjee S, Singer L, Tikkanen J, Juvet S, Martinu T. Bronchoalveolar Lavage Markers of Inflammation Early Post Lung-Transplant are Associated with CLAD and Death. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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90
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Zhang C, Ahmed M, Huszti E, Levy L, Hunter S, Boonstra K, Sage A, Ghany R, Liu M, Yeung J, Crespin O, Singer L, Keshavjee S, Martinu T. The Diagnostic and Prognostic Value of Bronchial Wash for Evaluating Microaspiration in Lung Transplant Recipients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Schneeberger P, Zhang C, Santilli J, Wijesinha Z, Levy L, Chen B, Xu W, Lee Y, Huszti E, Ahmed M, Boonstra K, Moshkelgosha S, Weigt S, Shah P, Budev M, Frankel C, Todd J, Snyder L, Palmer S, Yeung J, Keshavjee S, Singer L, Coburn B, Martinu T. The Pulmonary Microbiome after Lung Transplantation is Associated with Gastroesophageal Reflux Disease, Inflammation, and Allograft Dysfunction. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jeng E, Sharaf O, Parker A, Vilaro J, Al-Ani M, Ahmed M, Aranda J, Beduschi T, Bleiweis M. Long-Term Triple Temporary Mechanical Circulatory Support as a Bridge to Triple Organ Transplant. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Dimza M, Al-Ani M, Naik D, Kennedy S, Elsayed A, Parker A, Ahmed M, Aranda J, Vilaro J. Predictors of Survival to Hospital Discharge with IABP Use in Acute Myocardial Infarction with Cardiogenic Shock. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Levy L, Ahmed M, Huszti E, Zhang C, Hunter S, Boonstra K, Sage A, Ghany R, Budev M, Shah P, Reynolds J, Snyder L, Belperio J, Singer L, Palmer S, Keshavjee S, Todd J, Weigt S, Martinu T. Bronchoalveolar Bile Acids are Associated with Acute Rejection, Inflammation, and Allograft Survival: A Multi-Center Study. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Fathema K, Hassan MN, Mazumder MW, Benzamin M, Ahmed M, Islam MR, Haque N, Sutradhar PK, Rahman AR, Rukunuzzaman M. COVID 19 in Children: Gastrointestinal, Hepatobiliary and Pancreatic Manifestation. Mymensingh Med J 2021; 30:570-579. [PMID: 33830145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The most devastating pandemic of this era coronavirus disease-2019 (COVID-19) is caused by a novel virus named severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Although it is primarily a respiratory pathogen, it can also result in several extra-pulmonary manifestations includes gastrointestinal symptoms, hepatocellular injury. Angiotensin-converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2), the entry receptor for the causative coronavirus SARS-CoV-2 is co-express in the gastrointestinal tract, hepatocyte, and cholangiocytes similar to the respiratory mucosa. The presence of these receptors facilitates the entry into the tissue and causes direct viral tissue damage, which is a proposed mechanism of injury. Diarrhoea, nausea, vomiting, abdominal discomfort are common gastrointestinal manifestations, whereas derangement of liver function tests is the most hepatic manifestation in COVID-19. In this article, we reviewed on SARS-CoV-2 disease COVID-19 regarding gastrointestinal, hepatic, and pancreatic manifestation, the mechanisms by which the virus may inflict damage, and their management perspective.
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Jeng E, Esseghir F, Ahmed M, Parker A, Al-Ani M, Vilaro J, Aranda J, Peek G, Bleiweis M. Single Center Experience with Venoarterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant under the Contemporary UNOS Heart Allocation System. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Padmanabhan A, Keshava SN, Ahmed M, Moorthy RK. Transient Blindness after Endovascular Parent Artery Occlusion to Treat Giant Aneurysm of Internal Carotid Artery: a Case Report. HONG KONG JOURNAL OF RADIOLOGY 2021. [DOI: 10.12809/hkjr2117191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gimpaya N, Khan R, Gallinger ZR, Scaffidi MA, Al Abdulqader AK, Ahmed M, Gholami R, Ramkissoon A, James PD, Mosko J, Griller N, Bansal R, Grover SC. A77 A REUSABLE POLYCARBONATE BOX TO DECREASE DROPLET CONTAMINATION DURING UPPER ENDOSCOPY: A SIMULATION-BASED STUDY FOR THE COVID-19 PANDEMIC. J Can Assoc Gastroenterol 2021. [PMCID: PMC7989228 DOI: 10.1093/jcag/gwab002.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Upper gastrointestinal (GI) endoscopic procedures are aerosol-generating, increasing the risk of healthcare workers (HCW) contracting Coronavirus disease 2019 (COVID-19). Aims To present a polycarbonate box (EndoBox) designed for use in upper GI endoscopy and evaluate its impact on the contamination of endoscopy staff during simulated procedures. Methods Simulated gastroscopies were performed using an upper body simulator placed in left lateral decubitus (LLD) and supine positions. The endoscopist and assistant wore personal protective equipment. Droplet exposure was measured using fluorescent abiotic surrogate particles. Two blinded observers independently viewed images from each scenario to qualitatively evaluate contamination levels. The primary outcome was the level of HCW contamination by droplets generated from a simulated cough with and without the EndoBox on the upper body simulator. The endoscopist’s ergonomic behaviour was also assessed using the Rapid Upper Limb Assessment (RULA) tool. Results Without the EndoBox, there was a higher level of contamination on the endoscopist when the upper body simulator is in the LLD position. A higher level of contamination was observed on the assistant when the simulator is in supine position. With the EndoBox, the contamination levels on the endoscopy staff were lower in both LLD and supine scenarios. The endoscopist’s ergonomics were rated 2 to 3 on the RULA tool when using the EndoBox. Conclusions The EndoBox reduces macroscopic droplet contamination during simulated gastroscopy. The endoscopist’s risk of musculoskeletal injury remained in the low risk categories as assessed by the RULA tool. Another advantage of the EndoBox design is the arch extending from the bottom that allows for removal of the box without withdrawing the endoscope. This enables rapid access to the patient’s airway if they experience respiratory distress. This study was limited by an inability to assess microscopic contamination and contamination at the level of the port or buttons when suction is applied. Within these limitations, the EndoBox may be a useful adjunct to traditional personal protective equipment. Funding Agencies SMHA AFP COVID-Related Innovation Funds
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Gopalakrishna A, Bole R, Parikh N, Ahmed M, Pagel E, Book J, Yang D, Jimbo M, Ziegelmann M, Lomas D, Kohler T. 116 Comparison of Nitrous Oxide Sedation versus Oral Sedation in Patients Undergoing Rezūm Prostate Ablation: A Feasibility Study. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ahmed M, Ahmed M, Dey S, Osman K, Mohamed A, Abdelrahman N. Pain Control With Intra-Articular Steroid Injection Can Reduce Dementia-related Mood and Behavioral Changes in Nursing Home Settings. J Am Med Dir Assoc 2021; 22:B7. [PMID: 34287187 DOI: 10.1016/j.jamda.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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