COVID-19 infection, a potential threat to surgical patients and staff? A retrospective cohort study

Effectiveness of patient triage at the orthopedic hospital and the hygiene concept in a professional handball team in the first year of the SARS-CoV-2 pandemic

The first severe acute respiratory syndrome coronavirus type 2 (SARS-CoV‑2) pandemic wave in Germany in spring 2020 challenged the largely unprepared healthcare system. A prevention concept was implemented to protect the vulnerable patient group at our orthopedic department. The patient triage during the pre-admission process included screening for symptoms and obtaining information on travel, occupation, contact and cluster (TOCC) [16].In March 2020, all sporting events were also cancelled or postponed [12]. Mitigation strategies for sport activities were necessary to restart training and competition. For the professional handball team of the Sport Club Magdeburg (SCM), a hygiene concept including strict mitigation measures combined with a polymerase chain reaction (PCR) test regime was implemented.We reviewed 15,739 patient contacts in a 12-month period at orthopedic department during the SARS-CoV‑2 pandemic. This epidemiological, retrospective study presents the results of patient triage detecting cases with suspected SARS-CoV‑2 infections when entering the clinic. We also considered 2328 inpatient PCR test results and the infection rates among the medical staff. At the same period, professional athletes underwent 1428 PCR tests as a part of the hygiene concept.During the triage process, 333 cases (2.12%) with suspected SARS-CoV‑2 infections were detected at the orthopedic outpatient department. Three patients had a positive PCR test result after triage. Another four positive PCR tests were found among the inpatient group and one positive result among the medical staff. In the athletes' cohort, none of the 1428 PCR tests was positive.Patient triage as a part of the preadmission process is an effective tool to protect the maximum-care hospital from a SARS-CoV‑2 mass outbreak. A hygiene concept with a defined PCR test regime protects a professional athlete team from SARS-CoV‑2 infections during international competition and training.

Peptide nucleic acid and antifouling peptide based biosensor for the non-fouling detection of COVID-19 nucleic acid in saliva

The electrochemical biosensor with outstanding sensitivity and low cost is regarded as a viable alternative to current clinical diagnostic techniques for various disease biomarkers. However, their actual analytical use in complex biological samples is severely hampered due to the biofouling, as they are also highly sensitive to nonspecific adsorption on the sensing interfaces. Herein, we have constructed a non-fouling electrochemical biosensor based on antifouling peptides and the electroneutral peptide nucleic acid (PNA), which was used as the recognizing probe for the specific binding of the viral RNA of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Different from the negatively charged DNA probes that will normally weaken the biosensors' antifouling capabilities owing to the charge attraction of positively charged biomolecules, the neutral PNA probe will generate no side-effects on the biosensor. The biosensor demonstrated remarkable sensitivity in detecting SARS-CoV-2 viral RNA, possessing a broad linear range (1.0 fM - 1.0 nM) and a detection limit down to 0.38 fM. Furthermore, the sensing performance of the constructed electrochemical biosensor in human saliva was nearly similar to that in pure buffer, indicating satisfying antifouling capability. The combination of PNA probes with antifouling peptides offered a new strategy for the development of non-fouling sensing systems capable of assaying trace disease biomarkers in complicated biological media.

Prevalence of surgery cancelation and challenges in restarting elective surgery in the pandemic: A cross-sectional study

Objectives

The COVID-19 pandemic caused primary disruption of health services, especially to elective surgery. As the pandemic goes in waves of high and low infection rates in a country, restarting elective surgery must be dynamic while balancing patients’ needs, staff safety and the hospital capacity. We aim to report the prevalence of elective surgery and minimally invasive procedures cancelation due to positive Covid-19 screening and describe steps in restarting elective cases after the third wave of Covid-19 infection.

Methods

This study was a descriptive cross-sectional study in Indonesia's tertiary referral and teaching hospital from January to September 2021. Subjects were patients scheduled for elective surgery or minimally invasive procedures from our outpatient clinic. Subjects were screened for SARS-CoV-2 using real-time polymerase chain reaction (rRT-PCR) 24-48 hours before scheduled surgery or intervention. Data was taken from the hospital information system and the central operating theatre online surgical list. Statistical analysis is presented in percentage.

Results

There were 5286 subjects identified for the study, and 3088 were included with an available PCR result from the outpatient department. The average elective cancelation rate was 7.4%, and the highest cancelation was on August 2021, with 14.7%. All subjects with positive results were asymptomatic, with more than 90% cycle time rRT-PCR above 30.

Conclusion

Elective surgery cancelation can reflect a trend in community infection, and monitoring its values is crucial for saving elective surgery plans during a pandemic.

Immune Cells Profiles In The Peripheral Blood Of Patients With Moderate To Severe COVID-19 And Healthy Subjects With and Without Vaccination With The Pfizer-BioNTech mRNA Vaccine

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus disease 2019 (COVID-19), has caused a global crisis. Patients with COVID-19 present with a range of clinical manifestations, from no symptoms to severe illness. However, little is known about the profiles of immune cells required to protect against SARS-CoV-2. This study was performed to determine the immune cells profiles in the peripheral blood of COVID-19 patients with moderate to severe disease (n=52), and compare the findings with those from healthy subjects vaccinated with Pfizer BioNTech mRNA vaccine (VS) (n=62), and non-vaccinated healthy subjects (HS) (n=30) from Kuwait. Absolute counts and percentages of total lymphocytes and lymphocyte subsets (CD3+ T cells, CD4+ T cells, CD8+ T cells, CD19+ B cells, and CD16+CD56+ NK cells) in the peripheral blood of the three groups were analyzed using flow cytometry. The results showed that the absolute counts of total lymphocytes, CD3+, CD4+, and CD8+ T cells, CD19+ B cells, and CD56+ NK cells, were significantly lower in COVID-19 patients than normal healthy controls and vaccinated subjects. The percentages of CD3+ and CD4+ T lymphocytes were also significantly lower in the COVID-19 patients. However, the percentage of CD16+CD56+ NK cells was significantly higher in the peripheral blood of COVID-19 patients, compared to the HS and VS groups with no detectable differences in the percentages of CD8+ T cells and CD19+ B cells between the three groups. Analysis of the monocyte subsets has showed a significantly higher percentage of CD14+HLA-DR+ monocytes in COVID-19 patients compared to HS whereas the inflammatory CD14+CD16+ HLA-DR+ monocytes, and the non-classical CD16+HLA-DR+ monocytes showed significantly lower frequency in the blood of the patients than that of HS. These findings demonstrate perturbations of both innate and adaptive immune cell subsets that reflect dysregulated host responses in COVID-19 patients with moderate to severe disease.

Are patients' fears of catching COVID-19 during an emergency hospital admission with an acute urological problem justified?-A UK epicentre experience

Background

To establish the risk of catching COVID-19 as urology emergency inpatient and assess patients’ fears and attitudes towards seeking help.

Methods

A single-centre retrospective study of urological emergency admissions was conducted over a 10-week period in 2019 and compared to same period of 2020 pandemic. Also, a telephone survey was performed based on a COVID-19 fear questionnaire.

Results

In-hospital, infection rate was 0.82% during or within 28 days of discharge with no related mortality. The majority of patients were afraid to visit A&E during the pandemic with less being afraid to visit their GPs; 64% were reluctant to seek medical input by trying self-treatment; 56% admitted intentional delay to visit the hospital. Additionally, 56% considered risk of getting COVID-19 was higher rather than leaving their condition untreated. Interestingly, the vast majority (82%) stated that they would not change approach regarding hospital visits if the same situation occurred.

Conclusions

The risk of contracting COVID 19 while a urology in patient in a COVID-19 epicentre was very low with no COVID-19-related mortality. Our data support that patients should be encouraged to attend rather than stay at home during future surges in the pandemic to prevent further non–COVID-19-related harm.

Prevalence and influencing factors of anxiety and depression symptoms among surgical nurses during COVID-19 pandemic: A large-scale cross-sectional study

Aim

To evaluate the prevalence and influencing factors of anxiety and depression symptoms in surgical nurses during the COVID‐19 epidemic in Anhui, China.

Methods

A cross‐sectional, multic'entre quantitative study was conducted among surgical nurses in Anhui province. SAS, SDS and SSRS scales were used for the investigation. Data were collected between 3 March 2020 to 19 March 2020.

Results

A total of 3,492 surgical nurses completed the survey. The average level of anxiety and depression of surgical nurses were higher than that of the Chinese norm. Levels of social support for surgical nurses were significantly negatively associated with the degree of anxiety and depression. Fertility status, participation in care for COVID‐19 patients, likelihood of being infected with COVID‐19 and social support were significantly influencing surgical nurses’ anxiety degree. Similarly, these characteristics were significantly associated with the odds of depression symptoms in surgical nurses.

Conclusion

These findings suggest that targeted psychological interventions to promote mental health of surgical nurses need to be immediately implemented.

Self-quarantine programme and pre-operative SARS-CoV-2 PCR screening for orthopaedic elective surgery: experience from Japan

PURPOSE

This study aimed to evaluate the acceptability of 14 days of self-quarantine and the positivity rate of pre-operative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) screening for patients undergoing elective orthopaedic surgery.

METHODS

The self-quarantine programme and pre-operative SARS-CoV-2 PCR screening were initiated for patients who were scheduled for admission later than 7 May 2020 for elective orthopaedic surgery on admission. On the day of admission, the patients declared compliance with self-quarantine regulations. The admission was refused in cases of non-compliance. After admission, the patients underwent SARS-CoV-2 PCR screening. If PCR results were negative, isolation was terminated. If PCR results were positive, the surgery was postponed. If the patients had symptoms suspicious of coronavirus disease (COVID-19) after surgery, the PCR test was repeated.

RESULTS

Overall, 308 patients (age: 63.2 ± 18.8 years, 197 female and 111 male) were scheduled for elective orthopaedic surgery. Two patients did not agree with the requirements of self-quarantine, and two other procedures were cancelled. No non-compliance was reported; thus, the completion rate of the self-quarantine programme was 304/308 (98.7%). Finally, 304 patients underwent PCR testing, and there were no positive PCR results. After cancellations of four operations due to reasons other than COVID-19, 300 surgical procedures were performed. No patients developed COVID-19 during hospitalisation.

CONCLUSIONS

Although this system is based on trusting the good behaviour of patients, accompanied by PCR screening, we believe that the results showed the efficacy of the system in safely performing orthopaedic surgery during the COVID-19 pandemic.

Current Recommendations for Airway Management Techniques in COVID-19 Patients without Respiratory Failure Undergoing General Anaesthesia: A Nonsystematic Literature Review

Summary Background

Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged, many articles have been published on airway management for coronavirus disease 2019 (COVID-19) patients. However, there is a lack of clear and concise conceptual framework for working with infected patients without respiratory failure undergoing general anaesthesia compared to noninfected patients. The aim of this article is to review current literature data on new challenges for anaesthesia providers, compare standard airway management techniques protocols with new data, and discuss optimisation potential.

Materials and methods

Literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: anaesthesia, preoxygenation, airway management, difficult airway, SARS-CoV-2, COVID-19. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 41 articles were chosen for detailed analysis. Summarised and analysed data are presented in the article.

Results

SARS-CoV-2 has unique implications for airway management techniques in patients without respiratory failure undergoing general anesthesia. Main differences with the standard practice include: institutional preparedness, team composition principles, necessary skills, equipment, drugs, intubation and extubation strategies. Failed or difficult intubation is managed with predominance of emergency front of neck access (FONA) due to increased aerosol generation.

Conclusions

Airway management techniques in COVID-19 patients without respiratory failure are more challenging than in noninfected patients undergoing general anaesthesia. Safe, accurate and swift actions avoid unnecessary time delay ensuring the best care for patients, and reduce risk of contamination for staff. Appropriate airway strategy, communication, minimisation of time for aerosol generating procedures and ramped-up position aid to achieve these goals. During the pandemic, updated available literature data may change clinical practice as new evidence emerges.