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Gómez Á, Lacasta D, Teresa Tejedor M, Ruiz de Arcaute M, Ramos JJ, Ruiz H, Ortín A, Villanueva-Saz S, Reina R, Quílez P, Navarro T, Verde M, Borobia M, Windsor PA. Use of a local anaesthetic and antiseptic wound formulation for the treatment of lambs naturally infected with Orf virus. Vet Microbiol 2024; 292:110037. [PMID: 38479302 DOI: 10.1016/j.vetmic.2024.110037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024]
Abstract
Contagious ecthyma (CE) is a worldwide highly contagious zoonotic viral skin disease of sheep and goats. Treatment for Orf virus (ORFV) infection usually involves topical and oral antibiotics. An anaesthetic and antiseptic topical gel (Multisolfen® or Tri-Solfen®; MS®, Medical Ethics, Australia) has been documented as an efficacious therapy for lesions from mucosal and epithelial viral infections in ruminants. The present study tested a new treatment protocol of MS® for CE therapy on-farm in 150 lambs naturally infected with ORFV. Lambs were divided into three cohorts of 50 lambs each (C, D and E). Cohort C was treated with MS® 3 times with an interval of 3 days between treatments, cohort D was treated daily with hypochlorous acid, whilst cohort E served as untreated controls. The lambs were examined clinically every two days, weight measured weekly, with whole blood and sterile swabs from ORFV lesions collected for haematological analysis and specific ORFV PCR. Cohort C presented fewer lambs displaying ORFV-associated lesions than other cohorts at different times of the experiment. Further, lesions treated with MS® were milder compared with other cohorts. However, following cessation of therapy, most of the lambs again developed ORFV-associated lesions. No differences between cohorts were observed in weight, haematological and PCR results. These findings suggest that topical treatment with MS® is effective for CE in field conditions, especially in the first stages of the clinical course, although treatment with MS® may need to be extended a minimum of 4 weeks.
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Affiliation(s)
- Álex Gómez
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain.
| | - Delia Lacasta
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain.
| | - María Teresa Tejedor
- Anatomy, Embryology and Animal Genetics Department, CIBER CV (Universidad de Zaragoza-IIS), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain.
| | - Marta Ruiz de Arcaute
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain
| | - Juan José Ramos
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain
| | - Héctor Ruiz
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain
| | - Aurora Ortín
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain
| | - Sergio Villanueva-Saz
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain
| | - Ramsés Reina
- Instituto de Agrobiotecnología, CSIC-Gobierno de Navarra, Mutilva 31192, Spain.
| | - Pablo Quílez
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain
| | - Teresa Navarro
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain
| | - Maite Verde
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain
| | - Marta Borobia
- Animal Pathology Department, Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Veterinary Faculty of Zaragoza, C/Miguel Servet 177, Zaragoza 50013, Spain
| | - Peter Andrew Windsor
- University of Sydney, Sydney School of. Veterinary Science, Camden, NSW 2570, Australia
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Karna ST, Ahmad Z, Thaware P, Trivedi S, Gouroumourty R, Singh P, Waindeskar V, Sharma JP, Kaushal A, Saigal S. Postoperative Outcomes After Emergency Surgery in COVID-19 Patients: An Ambispective Matched Cohort Study. Cureus 2024; 16:e55845. [PMID: 38590490 PMCID: PMC11001162 DOI: 10.7759/cureus.55845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose There is limited data from the Indian subcontinent regarding the surgical outcomes of coronavirus disease (COVID-19) patients. In this observational study, we aimed to evaluate the postoperative outcomes after emergency surgery in COVID-19 patients compared to concurrent age and gender-matched controls. We also sought to analyze the possible predictors of postoperative mortality in COVID-19 patients. Methods This matched cohort study was conducted in a tertiary care teaching hospital in central India, between 1st July 2021 and 30th June 2022. COVID-19-positive patients undergoing emergency surgery under anesthesia were recruited as cases. Age and gender-matched COVID-19-negative patients undergoing a similar nature of surgery in the same period served as concurrent controls. The cases and controls were compared for the 30-day mortality and perioperative complications. Results The COVID-19-positive surgical cohort had a 12.3 times greater 30-day postoperative overall mortality risk as compared to a matched cohort of patients with a negative COVID-19 test. A positive COVID-19 status was associated with more postoperative complications of acute respiratory distress syndrome (ARDS), sepsis, shock, and persistent hyperglycemia. On analysis of predictors of mortality, the presence of preoperative dyspnea, ARDS, American Society of Anesthesiologists Physical Status (ASA-PS) Class IIIE/IVE, increase in sequential organ failure assessment (SOFA) score, Quick SOFA>1, higher creatinine, bilirubin, and lower albumin were observed to be associated with increased mortality. Conclusions Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients undergoing emergency surgery is significantly associated with higher postoperative complications and increased 30-day postoperative mortality.
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Affiliation(s)
- Sunaina T Karna
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Zainab Ahmad
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pooja Thaware
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Saurabh Trivedi
- Anesthesiology, Chirayu Medical College and Hospital, Bhopal, IND
| | - Revadi Gouroumourty
- Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pooja Singh
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Vaishali Waindeskar
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Jai Prakash Sharma
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ashutosh Kaushal
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Saurabh Saigal
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Hsieh BH, Kuo YC, Yong SB, Tien HC, Hsu CC, Hsu CL, Tsou YA, Lin CD, Tai CJ, Wang JY, Shih LC. Efficacy of Adjuvant Sublingual Immunotherapy After Septomeatoplasty. Laryngoscope 2024. [PMID: 38372411 DOI: 10.1002/lary.31347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The efficacy of adjuvant sublingual immunotherapy (SLIT) in correcting structural problems in patients with allergic rhinitis (AR) caused by mite who have undergone septomeatoplasty (SMP) has not been studied. METHODS This non-randomized controlled study recruited patients with AR (caused by mite) and concurrent septal deviation and inferior turbinate hypertrophy, at a tertiary hospital in Taiwan. SMP was performed on all patients as a surgical intervention. The patients were then divided into two groups: the control group, which underwent surgery only, and the experimental group, which received SLIT as an adjuvant treatment. Demographic data and rhinitis control assessment test (RCAT) results were analyzed. RESULTS A total of 96 patients were enrolled in the study (SMP + SLIT group, n = 52; SMP only group, n = 44). No significant differences were observed in any of the variables between the two groups before and one month after surgery. However, during evaluations at the third and sixth month, the SMP + SLIT group showed significant improvement in the total RCAT scores compared to the SMP only group (28.6 ± 1.56 vs. 24.5 ± 3.66, p < 0.001; 27.1 ± 2.87 vs. 19.9 ± 5.56, p < 0.001). In addition, significantly better control of all RCAT sub-categories was observed in the SMP + SLIT group at the third and sixth month evaluations. CONCLUSIONS SLIT may serve as an ideal adjuvant therapy after SMP in patients with AR. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Bing-Han Hsieh
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chun Kuo
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Su-Boon Yong
- Center for Allergy, Immunology, and Microbiome (A.I.M.), China Medical University Hospital, Taichung, Taiwan
- Department of Allergy, Immunology, and Rheumatology (AIR), China Medical University Children's Hospital, Taichung, Taiwan
| | - Hui-Chi Tien
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
| | - Chun-Chieh Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
| | - Che-Lun Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Jiu-Yao Wang
- Center for Allergy, Immunology, and Microbiome (A.I.M.), China Medical University Hospital, Taichung, Taiwan
- Department of Allergy, Immunology, and Rheumatology (AIR), China Medical University Children's Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Liang-Chun Shih
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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Ulevicius J, Jasukaitiene A, Bartkeviciene A, Dambrauskas Z, Gulbinas A, Urboniene D, Paskauskas S. Dysregulation of Peripheral Blood Mononuclear Cells and Immune-Related Proteins during the Early Post-Operative Immune Response in Ovarian Cancer Patients. Cancers (Basel) 2023; 16:190. [PMID: 38201617 PMCID: PMC10778568 DOI: 10.3390/cancers16010190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Surgical treatment is a cornerstone of ovarian cancer (OC) therapy and exerts a substantial influence on the immune system. Immune responses also play a pivotal and intricate role in OC progression. The aim of this study was to investigate the dynamics of immune-related protein expression and the activity of peripheral blood mononuclear cells (PBMCs) in OC patients, both before surgery and during the early postoperative phase. The study cohort comprised 23 OC patients and 20 non-cancer controls. A comprehensive analysis of PBMCs revealed significant pre-operative downregulation in the mRNA expression of multiple immune-related proteins, including interleukins, PD-1, PD-L1, and HO-1. This was followed by further dysregulation during the first 5 post-operative days. Although most serum interleukin concentrations showed only minor changes, a distinct increase in IL-6 and HO-1 levels was observed post-operatively. Reduced metabolic and phagocytic activity and increased production of reactive oxygen species (ROS) were observed on day 1 post-surgery. These findings suggest a shift towards immune tolerance during the early post-operative phase of OC, potentially creating a window for treatment. Further research into post-operative PBMC activity could lead to the development of new or improved treatment strategies for OC.
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Affiliation(s)
- Jonas Ulevicius
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania; (A.J.); (A.B.); (Z.D.); (A.G.)
| | - Aldona Jasukaitiene
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania; (A.J.); (A.B.); (Z.D.); (A.G.)
| | - Arenida Bartkeviciene
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania; (A.J.); (A.B.); (Z.D.); (A.G.)
| | - Zilvinas Dambrauskas
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania; (A.J.); (A.B.); (Z.D.); (A.G.)
| | - Antanas Gulbinas
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania; (A.J.); (A.B.); (Z.D.); (A.G.)
| | - Daiva Urboniene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania;
| | - Saulius Paskauskas
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania;
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Diao S, Wang D, Chang Y, Ni C, Fu D, Liu J, Gao S, Jia X, Wang T, Nan X, Cao H, Liu Z, Zhang X. Clinical study of the combined use of dexmedetomidine and remifentanil in patients with coronary heart disease undergoing 3D laparoscopic surgery with EEG bispectral index monitoring. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2023; 16:378-385. [PMID: 38188350 PMCID: PMC10767478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE This study sought to investigate the safety and clinical outcomes associated with the combined administration of dexmedetomidine (Dex) and remifentanil (Rem) in patients with coronary heart disease undergoing three-dimensional (3D) laparoscopic surgery, with concurrent monitoring of the electroencephalography (EEG) bispectral index. METHODS This study is of a retrospective nature and involved a total of 60 patients with coronary heart disease who underwent 3D laparoscopic surgery at our hospital between June 2020 and September 2021. In a double-blind manner, these patients were randomly assigned to two groups: the control group (Group I), which consisted of 30 patients, and the treatment group (Group II) receiving a combination of Dex and Rem, also comprising 30 patients. The study's primary objective was to compare and assess the treatment outcomes in these two patient groups. RESULTS Patients in Group II who developed postoperative coronary heart disease experienced a significant reduction in blood pressure, heart rate, and electrocardiogram values (P<0.05). Additionally, Group II exhibited lower bispectral index (BIS) and visual analog scale (VAS) values (P<0.05). CONCLUSION In patients with coronary heart disease undergoing 3D laparoscopic surgery, the intraoperative use of Dex combined with Rem anesthesia offers several advantages. It helps stabilize hemodynamics, reducing the risk of myocardial ischemia, and significantly alleviates postoperative pain, all without increasing the likelihood of adverse postoperative reactions. Furthermore, this approach effectively dampens the intraoperative and postoperative stress response, facilitating enhanced recovery after surgery (ERAS). Overall, the clinical impact is positive, safe, and reliable.
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Affiliation(s)
- Shiqi Diao
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Dongxin Wang
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Ying Chang
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Chunyan Ni
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Dongmei Fu
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Jixin Liu
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Song Gao
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Xiunan Jia
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Tongrao Wang
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Xi Nan
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Hongling Cao
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Zongming Liu
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
| | - Xitong Zhang
- Department of Anesthesiology, Jilin Cancer Hospital Changchun 130000, Jilin, P. R. China
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Li H, Li J, Hao C, Luan H, Zhang X, Zhao Z. Effects of anesthetic depth on perioperative T lymphocyte subsets in patients undergoing laparoscopic colorectal cancer surgery: a prospective, parallel-controlled randomized trial. BMC Anesthesiol 2023; 23:165. [PMID: 37189020 DOI: 10.1186/s12871-023-02129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND During the perioperative period, the surgical stress response induced by surgical trauma tends to cause a decrease in peripheral lymphocytes. Anesthetics could reduce the stress response during surgery and prevent sympathetic nerve overexcitation. The goal of this study was to investigate how BIS-guided anesthetic depth affected peripheral T lymphocytes in patients undergoing laparoscopic colorectal cancer surgery. METHODS A total of 60 patients having elective laparoscopic colorectal cancer surgery were randomly assigned and analyzed (n = 30 for deep general anesthesia, BIS 35, n = 30 for light general anesthesia, BIS 55). Blood samples were collected immediately before anesthesia induction and immediately after operation, 24 h and 5 days postoperatively. The CD4+/CD8 + ratio, T lymphocyte subsets (including CD3 + T cells, CD4 + T cells, and CD8 + T cells), and natural killer (NK) cells were analyzed by flow cytometry. Serum interleukin-6 (IL-6), interferon -ɣ (IFN-ɣ), and vascular endothelial growth factor-α (VEGF-α) were also measured. RESULTS The CD4+/CD8 + ratio decreased 24 h after surgery in two groups, but the reduction did not differ between the two groups (P > 0.05). The concentration of IL-6 and the numerical rating scale (NRS) score in the BIS 55 group were significantly higher than that in the BIS 35 group 24 h after surgery (P = 0.001). There were no intergroup differences in CD3 + T cells, CD4 + T cells, CD8 + T cells, NK cells, VEGF-α, or the IFN-ɣ. Statistical analyses showed no differences between the two groups in the incidence of fever and surgical site infection during hospitalization. CONCLUSIONS Despite the fact that patients in deep general anesthesia group had low levels of the IL-6 24 h after surgery, the deep general anesthesia was not associated to a positive effect on patients' peripheral T lymphocytes during colorectal cancer surgery. We found no evidence that peripheral T lymphocyte subsets and natural killer cells were affected by the targeting a BIS of either 55 or 35 in patients undergoing laparoscopic colorectal cancer surgery in this trial. TRIAL REGISTRATION ChiCTR2200056624 ( www.chictr.org.cn ).
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Affiliation(s)
- Han Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Jiachi Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Conghui Hao
- Jinzhou Medical University, No.40 Songpo Road, Jinzhou, Jinzhou, 121010, China
| | - Hengfei Luan
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Xiaobao Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Zhibin Zhao
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China.
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Błaszczuk A, Sikora D, Kiś J, Stępień E, Drop B, Polz-Dacewicz M. Humoral Response after SARS-CoV-2 Vaccination in Prostate Cancer Patients. Vaccines (Basel) 2023; 11:vaccines11040770. [PMID: 37112682 PMCID: PMC10144447 DOI: 10.3390/vaccines11040770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Cancer is an important public health problem. Prostate cancer is one of the most common cancers among men. In Poland, the incidence of this type of cancer is constantly growing. Considering the appearance of a new coronavirus in December 2019 (SARS-CoV-2) and the fact that oncology patients, including those with prostate cancer, are particularly vulnerable to infection, it is recommended to get vaccinated against COVID-19. In our study, we determined the level and prevalence of antibodies against SARS-CoV-2 IgG in patients with prostate cancer compared to the control group and whether the patients’ ages affected the level of antibodies. PCa patients and controls were divided into two age groups: 50–59 years and 60–70 years. We also analyzed the level of antibodies in patients belonging to the relevant risk groups for prostate cancer (the European Society of Urology risk group classification of prostate cancer). For the study, we used the Microblot-Array COVID-19 IgG test to detect antibodies against the three main SARS-CoV-2 antigens: NCP, RBD, and S2. Our results showed that prostate cancer patients had significantly lower levels of anti-SARS-CoV-2 IgG antibodies compared to controls. In addition, age also affected the decrease in the number of IgG antibodies. The level of antibodies in the intermediate/high-risk group was lower compared to the low-risk group.
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Affiliation(s)
- Agata Błaszczuk
- SARS Laboratory, Department of Virology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Dominika Sikora
- SARS Laboratory, Department of Virology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jacek Kiś
- 1st Clinical Military Hospital with Outpatient Clinic in Lublin, 20-049 Lublin, Poland
| | - Ewa Stępień
- SARS Laboratory, Department of Virology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Bartłomiej Drop
- Department of Computer Science and Medical Statistics with the e-Health Laboratory, Medical University of Lublin, 20-090 Lublin, Poland
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Mocanu V, Verhoeff K, Dang J, Birch DW, Karmali S, Switzer NJ. Post-Operative but Not Pre-Operative COVID-19 Predicts Serious Complications and Mortality Following Elective Bariatric Surgery. Obes Surg 2023; 33:1202-1210. [PMID: 36808387 PMCID: PMC9938678 DOI: 10.1007/s11695-023-06506-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE We sought to characterize the prevalence and subsequent impact of pre- and post-operative COVID-19 diagnosis on bariatric surgery outcomes. COVID-19 has transformed surgical delivery, yet little is known regarding its implications for bariatric surgery. MATERIALS AND METHODS The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database was evaluated with three cohorts described: those diagnosed with COVID-19 pre-operatively (PRE), post-operatively (POST), and those without a peri-operative COVID-19 (NO) diagnosis. Pre-operative COVID-19 was defined as COVID-19 within 14 days prior to the primary procedure while post-operative COVID-19 infection was defined as COVID-19 within 30 days after the primary procedure. RESULTS A total of 176,738 patients were identified, of which 174,122 (98.5%) had no perioperative COVID-19, 1364 (0.8%) had pre-operative COVID-19, and 1252 (0.7%) had post-operative COVID-19. Patients who were diagnosed with COVID-19 post-operatively were younger than other groups (43.0 ± 11.6 years NO vs 43.1 ± 11.6 years PRE vs 41.5 ± 10.7 years POST; p < 0.001). Pre-operative COVID-19 was not associated with serious complications or mortality after adjusting for comorbidities. Post-operative COVID-19, however, was among the greatest independent predictors of serious complications (OR 3.5; 95% CI 2.8-4.2; p < 0.0001) and mortality (OR 5.1; 95% CI 1.8-14.1; p = 0.002). CONCLUSIONS Pre-operative COVID-19 within 14 days of surgery was not significantly associated with either serious complications or mortality. This work provides evidence that a more liberal strategy which employs early surgery after COVID-19 infection is safe as we aim to reduce the current bariatric surgery case backlog.
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Affiliation(s)
- Valentin Mocanu
- Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Dvorkin Lounge Mailroom 2G2, 8440 112 St. NW, EdmontonAlberta, T6G 2B7, Canada.
| | - Kevin Verhoeff
- grid.17089.370000 0001 2190 316XDepartment of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Dvorkin Lounge Mailroom 2G2, 8440 112 St. NW, EdmontonAlberta, T6G 2B7 Canada
| | - Jerry Dang
- grid.17089.370000 0001 2190 316XDepartment of Surgery, University of Alberta, Edmonton, AB Canada
| | - Daniel W. Birch
- grid.416087.c0000 0004 0572 6214Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB Canada
| | - Shahzeer Karmali
- grid.416087.c0000 0004 0572 6214Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB Canada
| | - Noah J. Switzer
- grid.416087.c0000 0004 0572 6214Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB Canada
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9
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Layton R, Layton D, Beggs D, Fisher A, Mansell P, Stanger KJ. The impact of stress and anesthesia on animal models of infectious disease. Front Vet Sci 2023; 10:1086003. [PMID: 36816193 PMCID: PMC9933909 DOI: 10.3389/fvets.2023.1086003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Stress and general anesthesia have an impact on the functional response of the organism due to the detrimental effects on cardiovascular, immunological, and metabolic function, which could limit the organism's response to an infectious event. Animal studies have formed an essential step in understanding and mitigating infectious diseases, as the complexities of physiology and immunity cannot yet be replicated in vivo. Using animals in research continues to come under increasing societal scrutiny, and it is therefore crucial that the welfare of animals used in disease research is optimized to meet both societal expectations and improve scientific outcomes. Everyday management and procedures in animal studies are known to cause stress, which can not only cause poorer welfare outcomes, but also introduces variables in disease studies. Whilst general anesthesia is necessary at times to reduce stress and enhance animal welfare in disease research, evidence of physiological and immunological disruption caused by general anesthesia is increasing. To better understand and quantify the effects of stress and anesthesia on disease study and welfare outcomes, utilizing the most appropriate animal monitoring strategies is imperative. This article aims to analyze recent scientific evidence about the impact of stress and anesthesia as uncontrolled variables, as well as reviewing monitoring strategies and technologies in animal models during infectious diseases.
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Affiliation(s)
- Rachel Layton
- Australian Centre for Disease Preparedness, CSIRO, Geelong, VIC, Australia,*Correspondence: Rachel Layton ✉
| | - Daniel Layton
- Australian Centre for Disease Preparedness, CSIRO, Geelong, VIC, Australia
| | - David Beggs
- Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Fisher
- Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Mansell
- Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Melbourne, VIC, Australia
| | - Kelly J. Stanger
- Australian Centre for Disease Preparedness, CSIRO, Geelong, VIC, Australia
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10
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Gao C, Tong YX, Zhu L, Dan Zeng CD, Zhang S. Short-term prognostic role of peripheral lymphocyte subsets in patients with gastric cancer. Int Immunopharmacol 2023; 115:109641. [PMID: 36584574 DOI: 10.1016/j.intimp.2022.109641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Immune function is associated with clinical outcomes in patients with gastric cancer. This study aimed to explore the prognostic role of peripheral lymphocyte subsets in patients with gastric cancer after curative surgery. METHODS This retrospective study was conducted at a single tertiary referral hospital. We included patients diagnosed with gastric cancer who had undergone surgery and met the inclusion criteria. Clinicopathological characteristics and preoperative peripheral lymphocyte subset data were collected for the analysis. Recurrence-free survival (RFS) and overall survival were analyzed using the Kaplan-Meier curve and Cox hazard regression model. We used the Whitney test and Spearman test to analyze the correlation between lymphocyte subsets and clinicopathological characteristics. RESULTS This study included 171 patients with gastric cancer who underwent curative surgery. Multivariate analysis revealed that carcinoembryonic antigen (p < 0.01), carbohydrate antigen 19-9 (p < 0.001), lymph node metastases (p < 0.001), total T-cell count (p = 0.02), B-cell count (p < 0.01), and regulatory T-cell percentage (p < 0.01) were independent predictive factors associated with RFS. CONCLUSIONS Impaired immune function may lead to early recurrence following curative surgery. Our study showed that the characteristics of peripheral lymphocyte subsets (T, B, and Treg cells) were independent predictive factors for recurrence in patients with gastric cancer after surgery.
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Affiliation(s)
- Chun Gao
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yi Xin Tong
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Li Zhu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Ci Dian Dan Zeng
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Sheng Zhang
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
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11
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Dhara V, Shetty SS, de Arruda JAA, Silva TA, Russo RC, Shetty NJ, Pidaparthi M, Wollenberg B, Rao VUS, Gopinath TPS. Decoding the influence of the immune system and immunotherapy targets on carcinomas: A hidden prism in oral cancer therapy. Dis Mon 2023; 69:101353. [PMID: 35311656 DOI: 10.1016/j.disamonth.2022.101353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In recent decades, understanding tumorigenesis and the complex interaction between the host and the immune system has been the pillar for significant advances in anticancer therapy. Conventional anticancer therapy (e.g., cut, burn, and cytotoxic drugs) involves multiple targeting of tumor cells. However, the tumor tissue microenvironment can present a dysregulated, stimulating, or subverted immune response which, in turn, reveals pro-tumor activities favoring tumor expansion and progression. Recently, new potential targets have been identified based on immunomodulatory therapies, which are crafted to re-establish the host anti-tumoral immune response. Clinicians should fully understand the intricate interactions between carcinogens, the tumor milieu, the immune system, and traditional anticancer therapies in order to progress and to overcome the refractory/recurrent challenges and morbidity of the disease. Thus, in this article, we highlight the complex milieu of the oral cancer immune response, pointing out potential therapeutic immunotargets for oral squamous cell carcinomas. The impact of traditional anticancer therapy on the immune system is also outlined.
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Affiliation(s)
- Vasantha Dhara
- Consultant Maxillofacial Surgeon, Hyderabad, Telangana, India
| | - Sameep S Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, A constituent of MAHE, Manipal, Karnataka, India.
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Remo Castro Russo
- Laboratory of Pulmonary Immunology and Mechanics, Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Neetha J Shetty
- Department of Periodontology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, A constituent of MAHE, Mangalore, Karnataka, India
| | | | - Barbara Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675 München, Germany
| | - Vishal U S Rao
- Department of Head and Neck Surgical Oncology, HealthCare Global Enterprises Ltd., Bangalore, Karnataka, India
| | - Thilak P S Gopinath
- Nitte (Deemed to be University) , AB Shetty Memorial Institute of Dental Sciences (ABSMIDS) , Department of Oral and Maxillofacial Surgery, Mangalore, India
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12
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Al Ani A, Tahtamoni R, Mohammad Y, Al-Ayoubi F, Haider N, Al-Mashhadi A. Impacts of severity of Covid-19 infection on the morbidity and mortality of surgical patients. Ann Med Surg (Lond) 2022; 79:103910. [PMID: 35698648 PMCID: PMC9176105 DOI: 10.1016/j.amsu.2022.103910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction One of the challenges of surgery on patients with active SARS-CoV-2(severe acute respiratory syndrome coronavirus 2) infection is the increased risk of postoperative morbidity and mortality. Aim This study will describe and compare the postoperative morbidity and mortality in asymptomatic patients or those with mild infection with those with severe COVID-19 infection undergoing elective or and emergency surgery. Materials and methods This is a retrospective study of 37 COVID19 patients who had the infection 7 days prior to and 30 days after emergency or elective surgery. Patients were divided to two groups. Group1: the asymptomatic or those with mild infection that is diagnosed just before surgery (14 patients). Group 2: those who were admitted to the hospital because of severe COVID-19 and were operated for COVID-19 related complications (23 patients). Morbidity and mortality of both groups was studied. Results There was no significant difference in gender between the two groups. There were 5 females (2 in group 1, and 3 in group 2) and 32 males (12 in group 1, and 20 in group 2). Mean age for all patients was 49.8years (38 for group 1 and 57 for group2). Median age for all patients was 50 years (37.5 for group 1 and 57 years for group 2). Sepsis developed in 7 patients (1 patient in group 1 and in 6 patients in group 2). Statistically there was no significant difference in occurrence of sepsis between the two groups. There was a significant difference in the intensive care stay between the two groups (higher in group 2). Four deaths were reported in group 1 and fourteen in group 2. Eighteen out of thirty-seven patients died. Conclusion Severity of COVID-19 infection will prolong the hospitalization and ICU stay in surgical patients with no significant effect on mortality.
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13
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Güler Y, Erbin A, Gozdas T. An outbreak of postoperative rapidly developing and multidrug-resistant Klebsiella pneumoniae urosepsis due to a contaminated ureteroscope. Folia Med (Plovdiv) 2022; 64:401-407. [PMID: 35856100 DOI: 10.3897/folmed.64.e62365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/15/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Outbreaks caused by microorganisms contaminating the inside of rigid ureteroscopes are extremely rare. Some of these outbreaks, especially those caused by multidrug-resistant (MDR) infections, can cause serious problems, even death. Among these serious infections, we have no data about Klebsiellapneumoniae outbreaks caused by rigid ureteroscopes and their management and consequences.
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Affiliation(s)
| | - Akif Erbin
- Haseki Traning and Research Hospital, Istanbul, Turkey
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14
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Morsy AG, Atallah MM, El-Motleb EAA, Tawfik MM. Different modalities of analgesia in open heart surgeries in Mansoura University. Int J Health Sci (Qassim) 2022:1846-1869. [DOI: 10.53730/ijhs.v6ns4.6375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background: Opioid usage in cardiac surgery is considered to be the corner stone in management. Inadequate pain control after cardiac surgery complicates patient recovery and increases the load on healthcare services. Multimodal analgesia can be used to achieve better analgesic effect and improves patient outcome. Material and methods: A total of 90 patients undergoing cardiac surgery with median sternotomy were randomly allocated equally into three groups intraoperatively where first group received continuous infusion of high dose opioids, second group received boluses of low dose opioids and third group received multimodal non opioid analgesics including dexmedetomidine, ketamine and magnesium sulphate. All patients received the same post-operative analgesic regimen consists of morphine patient controlled analgesia (PCA). Results: Patients in multimodal non opioid group had more stable hemodynamics intra and postoperatively. Also, patients in multimodal group had lower pain scores extubation, earlier extubation, shorter ICU stay, earlier mobilization and earlier return of bowel movements compared to patients of both groups received intraoperative higher opioid doses.
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15
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Cavaliere F, Allegri M, Apan A, Brazzi L, Carassiti M, Cohen E, DI Marco P, Langeron O, Rossi M, Spieth P, Turnbull D, Weber F. A year in review in Minerva Anestesiologica 2021. Anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2022; 88:206-216. [PMID: 35315631 DOI: 10.23736/s0375-9393.22.16429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Massimo Allegri
- Unit of Pain Therapy of Column and Athlete, Policlinic of Monza, Monza-Brianza, Italy.,Italian Pain Group, Milan, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Rome, Italy
| | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierangelo DI Marco
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic, and Geriatric Sciences, Faculty of Medicine, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), University Paris-Est Créteil (UPEC), Paris, France
| | - Marco Rossi
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
| | - Frank Weber
- Department of Anesthesiology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
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16
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Effect of major versus minor mastectomy on host immunity in canine mammary cancer. Vet Immunol Immunopathol 2022; 246:110403. [DOI: 10.1016/j.vetimm.2022.110403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
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17
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Altıntaş MM, Büyüközsoy AK, Aydıner Ö. Diagnosis and Management of Coronavirus Disease 2019 (COVID-19): Patients with Presented with Abdominal Pain, Fever and Shortness of Breath in Pandemic. TOHOKU J EXP MED 2021; 255:267-273. [PMID: 34853248 DOI: 10.1620/tjem.255.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of this study was to evaluate the admission chest and abdominal computed tomography (CT) findings of patients who presented to the emergency department with complaints of abdominal pain, fever, and shortness of breath and who had RT-PCR-confirmed COVID-19 infection. Seventy-five patients with RT-PCR-confirmed (in laboratory) COVID-19 infection who underwent chest and abdominal CT were included in the study. The radiological scales [the COVID-19 Reporting and Data System (CO-RADS) and severity score] of the chest and abdominal findings were examined on CT images. Forty-one (54.7%) patients were male and 34 (45.3%) were female. The mean age of the patients was 63.03 (range 24-89) years. The most frequently calculated CO-RADS score was found to be 5 (n = 53, 70.7%). Bilateral (72.0%) and multibolar (74.7%) involvement, peripheral (72.0%) and posterior (60.0%) distribution, and ground-glass opacity (66.7%) pattern were the most common pulmonary findings. A positive correlation was observed between CO-RADS and total severty score (p < 0.001). All patients were hospitalized. One (1.3%) patient was surgically treated because of acute appendicitis. Nine (12.0%) patients were admitted to the intensive care unit. Six (8.0%) patients died in the intensive care unit. Patients presenting to the emergency department with both abdominal and respiratory complaints during the pandemic should be evaluated for COVID-19. Patients can be diagnosed early with the data collected from CT without waiting for the PCR result. Hospital staff can take the necessary protective measures against virus transmission early, minimizing the in-hospital transmission of the virus.
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Affiliation(s)
| | | | - Ömer Aydıner
- Department of Radiology, İstanbul Kartal Dr. Lütfi Kırdar City Hospital
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18
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Arslan G, Saraçoğlu KT, Aydiner Ö, Demirhan R. Proposal to protect patients and healthcare professionals undergoing elective surgery during COVID-19 outbreak. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC8022618 DOI: 10.1186/s43055-021-00478-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background The aim of this study was to investigate the reliability of COVID-19 Reporting and Data System (CO-RADS) scale on chest computerized tomography (CT) in addition to the reverse transcriptase-polymerase chain reaction (RT-PCR) test in diagnosis of COVID-19 on patients who will undergo elective surgery to protect patients and healthcare professionals during the intense pandemic period and the correlation between CO-RADS scale and Total Severity Score (TSS). During the intensive pandemic until normalization, 253 patients aged ≥ 18 years who underwent elective surgery with two negative RT-PCR results within the last 5 days and CO-RADS scale ≤ 3 on chest CT were included in the study. Demographic characteristics, American Society of Anesthesiologists classification, type of anesthesia and surgery, department of clinic, chest CT findings, scale of CO-RADS and TSS on CT, patients’ postoperative hospital stay, follow-up time, and vital status (whether or not COVID-19 disease) at the hospital and discharge information were collected for each patient. Results The most frequently calculated CO-RADS score was found to be 1 (73.1%). It was followed by scale of CO-RADS 2 (20.9%). Regarding TSS, the most common TSS for the right and left lungs was 0 (91.7% and 92.5%, respectively). COVID-19 was not detected in any of the patients who were hospitalized for an average of 4.9 ± 6.4 days and followed-up for an average of 14.3 ± 8.2 days. It was observed that the CO-RADS score and TSS were positively and moderately correlated with each other (p < 0.001). Conclusion It was concluded that in early diagnostic of COVID-19, chest CT scans serve like a complementary diagnostic method in addition to RT-PCR testing to keep safe both the patients and health professionals and the scale of CO-RADS and TSS on CT are valuable in correlation with each other.
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19
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Comment on "Cancer Surgery During COVID-19: How We Move Forward". Ann Surg 2021; 274:e827-e828. [PMID: 33214437 DOI: 10.1097/sla.0000000000004544] [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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20
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Favaro E, Fernandes DR, Vieira LG, Margatho AS, Mendes KDS, Silveira RCDCP. Postoperative complications in adult patients undergoing surgery with confirmed infection by SARS-CoV-2: An integrative review. Rev Lat Am Enfermagem 2021; 29:e3496. [PMID: 34755777 PMCID: PMC8584806 DOI: 10.1590/1518-8345.5346.3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/20/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: to analyze the evidence available in the literature about postoperative
complications in adult patients undergoing surgical procedures with
confirmed infection by SARS-CoV-2. Method: an integrative literature review conducted in the CINAHL, EMBASE, LILACS,
PubMed, Scopus and Web of Science databases, as well as in the gray
literature. The references identified were exported to the EndNote manager
and, subsequently, to the Rayyan web application for study selection. The
stages of sampling, categorization of studies, evaluation of the studies
included, interpretation of the results and knowledge synthesis were
performed by two reviewers independently and in a masked manner. The data
were analyzed descriptively. Results: of the 247 articles identified, 15 were selected to comprise this review. The
prevalent postoperative complications in patients infected with SARS-CoV-2
were the following: cough, dyspnea and hypoxia, need for invasive mechanical
ventilation or not, admission to the intensive care unit and death. Conclusion: the most reported postoperative complications in the studies evaluated were
respiratory-related, followed by cardiovascular complications. The
importance of preoperative screening for COVID-19 is highlighted, as well as
of the monitoring and tracking of confirmed cases in the postoperative
period, as these actions exert an impact on reducing the occurrence of
complications related to SARS-CoV-2.
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Affiliation(s)
- Erica Favaro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Daiane Rubinato Fernandes
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - (CAPES), Brazil
| | - Leticia Genova Vieira
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico/Ministério da Ciência, Tecnologia e Inovações, Brazil
| | - Amanda Salles Margatho
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Karina Dal Sasso Mendes
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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21
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Bhargava K, Bhandari F, Board T, Andrade T, McBryde C, Conroy J, Bankes M, Khanduja V, Malviya A. Effect of COVID-19 pandemic on hip preservation surgery—a prospective surveillance from the UK Non-Arthroplasty Hip Registry. J Hip Preserv Surg 2021; 8:225-232. [PMID: 35411217 PMCID: PMC8689916 DOI: 10.1093/jhps/hnab082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/13/2021] [Accepted: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
A multi-centre, registry-based cohort study was conducted to assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on the provision of non-arthroplasty hip surgery (NAHS) in the UK by (i) comparing the number of NAHS performed during the pandemic to pre-pandemic levels, (ii) prospectively auditing compliance to established guidance and (iii) evaluating post-operative outcomes and their predictors. Patients who underwent NAHS during the pandemic/pre-pandemic were selected from the Non-Arthroplasty Hip Registry, which collects demographic, procedural and pre-operative outcome data. Patients during the pandemic period were emailed separate COVID-19 surveillance questionnaires, which evaluated adherence to guidelines and post-operative outcomes. Fisher’s exact tests and logistic regression were used to identify predictors for developing COVID-19 and being re-admitted into hospital, post-surgery. There was a 64% reduction of NAHS performed during the pandemic compared to the pre-pandemic period. Ninety-nine percent of participants self-isolated, and 96.8% received screening, pre-operatively. No participant was COVID-19-positive peri-operatively. Post-operatively, participants had an intensive care unit admission rate of 2%, median hospital stay of 1 day, hospital readmission rate of 4.2%, COVID-19 development rate of 2.3% and a thromboembolic complication rate of 0.32%. No COVID-19-positive patient developed adverse post-operative outcomes. Participants who developed COVID-19 post-operatively had greater odds of having undergone osteotomy in comparison to arthroscopic surgery (P = 0.036, odds ratio = 5.36). NAHS was performed with good compliance to established guidance, and adverse operative outcomes remained low. If guidance is followed, the risk of COVID-19 post-op development is low. Although bigger operations have a slightly higher risk, this does not impact their prognosis.
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Affiliation(s)
- Kartik Bhargava
- Translational and Clinical Research Institute, Newcastle University, Newcastle University, Framingham Place, Medical School, Newcastle upon Tyne NE2 4HH, UK
| | - Farzaan Bhandari
- Translational and Clinical Research Institute, Newcastle University, Newcastle University, Framingham Place, Medical School, Newcastle upon Tyne NE2 4HH, UK
| | - Tim Board
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Tony Andrade
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Callum McBryde
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jon Conroy
- Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, UK
| | - Marcus Bankes
- Guy’s and St Thomas’ Hospitals NHS Trust, London, UK
| | - Vikas Khanduja
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ajay Malviya
- Translational and Clinical Research Institute, Newcastle University, Newcastle University, Framingham Place, Medical School, Newcastle upon Tyne NE2 4HH, UK
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
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22
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Kuru B, Kale A, Basol G, Gundogdu EC, Yildiz G, Mat E, Usta T. Is it safe to perform elective gynaecologic surgery during the two peaks of COVID-19 pandemic? Int J Clin Pract 2021; 75:e14816. [PMID: 34486805 PMCID: PMC8646615 DOI: 10.1111/ijcp.14816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/10/2021] [Accepted: 09/03/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In December 2019, the COVID-19 pandemic started in China and spread around the World. Operations were postponed in most surgical clinics to reduce the risk of contamination and increase the number of beds available in hospitals. We investigate whether elective gynaecologic surgery is safe or not under safety measures. METHODS A total of 765 patients were operated on electively between 15 March and 30 October 2020 at our inpatient gynaecology clinic. We took the SARS-CoV-2 Reverse Transcriptase (RT) Polymerase Chain Reaction (PCR) test of the nasopharyngeal swab before and after the surgery. Patients were questioned for COVID-19 symptoms by phone calls on the 7th, 15th, 30th and 60th days postoperatively. RESULTS The average age of patients was 45.6 ± 11(19-81). Sixty-two (8.1%) operations were performed due to gynaecologic malignancies. Three patients (0.39%) were detected as SARS-CoV-2 RT PCR positive within 7 days after surgery. The patients did not need ICU admission or any further treatments. CONCLUSION Our study offers a novel perspective on elective surgery during a pandemic. The risk assessment of patients should be meticulously done and substantiated on objective variables. According to our study, in a carefully selected patient population, operating under appropriate precautions, elective gynaecologic surgical procedures during the two peaks of the COVID-19 pandemic do not pose a risk to the patients.
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Affiliation(s)
- Betul Kuru
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Ahmet Kale
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Gulfem Basol
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Elif Cansu Gundogdu
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Gazi Yildiz
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Emre Mat
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Taner Usta
- Department of Obstetrics and GynecologyUniversity of Acibadem HospitalIstanbulTurkey
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Investigating the Factors Associated with the Level of Expression of Estrogen and Progesterone Receptors in Patients Suffering from Colorectal Cancer. J Cancer Epidemiol 2021; 2021:4478155. [PMID: 34691180 PMCID: PMC8536452 DOI: 10.1155/2021/4478155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background The present study was performed to investigate the factors related to the expression level of estrogen and progesterone receptor in patients with colorectal cancer. Material and Methods. This crosssectional study was performed on 54 patients suffering from colorectal cancer referring to Imam Reza Hospital in Birjand during 2018-2019. After the biopsy performed during surgery, the specimen was sent for immunohistochemistry, and the status of receptors was determined. Eventually, the data were analyzed by SPSS 22. Results Out of the 54 patients studied, 64.8% were male. The mean age of the patients was 62.28 ± 14.03 years. The level of expression of beta-estrogen receptors and progesterone receptors had a significant relationship with age, consuming drugs of abuse, and familial history (P = 0.001). Also, the level of expression of estrogen and progesterone receptors of patients with a more advanced stage of cancer was significantly lower (P = 0.001). Conclusion The extent of expression of estrogen and progesterone receptors affects the progression and prognosis of disease. Thus, through hormone therapy, a step can be taken to reduce the progression and even to treat colorectal cancer.
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Gulinac M, Novakov IP, Antovic S, Velikova T. Surgical complications in COVID-19 patients in the setting of moderate to severe disease. World J Gastrointest Surg 2021; 13:788-795. [PMID: 34512902 PMCID: PMC8394377 DOI: 10.4240/wjgs.v13.i8.788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/30/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on the work of physicians and surgeons. The connection between the patient and the surgeon cannot be replaced by telemedicine. For example, the surgical staff faces more serious difficulties compared to non-surgical specialists during the COVID-19 pandemic. The primary concerns include the safest solutions for protecting healthcare staff and patients and the ability to provide adequate surgical care. Additionally, the adverse effects of any surgery delays and the financial consequences complicate the picture. Therefore, patients' admission during the COVID-19 pandemic should be taken into consideration, as well as preoperative measures. The COVID-19 situation brings particular risk to patients during surgery, where preoperative morbidity and mortality rise in either asymptomatic or symptomatic COVID-19 patients. This review discusses the recent factors associated with surgical complications, mortality rates, outcomes, and experience in COVID-19 surgical patients.
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Affiliation(s)
- Milena Gulinac
- Department of General and Clinical Pathology, Medical University, University Hospital "St George," Plovdiv 6000, Bulgaria
| | - Ivan P Novakov
- Department of Thoraco-abdominal Surgery, Medical University, Plovdiv 6000, Bulgaria
| | - Svetozar Antovic
- University Clinic for Digestive Surgery, Medical Faculty, Skopje 1000, Macedonia
| | - Tsvetelina Velikova
- Department of Clinical Immunology, University Hospital Lozenetz, Sofia 1407, Bulgaria
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
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25
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Clendenen N, Ahlgren B, Robitaille MJ, Christensen E, Morabito J, Grae L, Lyman M, Weitzel N. Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology. Semin Cardiothorac Vasc Anesth 2021; 25:94-106. [PMID: 33938302 PMCID: PMC10088871 DOI: 10.1177/10892532211013614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The year 2020 was marred by the emergence of a deadly pandemic that disrupted every aspect of life. Despite the disruption, notable research accomplishments in the practice of cardiothoracic anesthesiology occurred in 2020 with an emphasis on optimizing care, improving outcomes, and expanding what is possible for patients undergoing cardiac surgery. This year's edition of Noteworthy Literature Review will focus on specific themes in cardiac anesthesiology that include preoperative anemia, predictors of acute kidney injury following cardiac surgery, pain management modalities, anticoagulation strategies after transcatheter aortic valve replacement, mechanical circulatory support, and future directions in research.
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Affiliation(s)
| | - Bryan Ahlgren
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark J Robitaille
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Joseph Morabito
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lyndsey Grae
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew Lyman
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nathaen Weitzel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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26
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Kasivisvanathan R, Tilney HS, Jhanji S, O’Mahony M, Gruber P, Nicol D, Morgan D, Kipps E, Rasheed S. The 'hub and spoke model' for the management of surgical patients during the COVID-19 pandemic. Int J Health Plann Manage 2021; 36:1397-1406. [PMID: 34046937 PMCID: PMC8239827 DOI: 10.1002/hpm.3243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 01/10/2023] Open
Abstract
During the on-going COVID-19 pandemic a number of key public health services have been severely impacted. These include elective surgical services due to the synergetic resources required to provide both perioperative surgical care whilst also treating acute COVID-19 patients and also the poor outcomes associated with surgical patients who develop COVID-19 in the perioperative period. This article discusses the important principles and concepts for providing important surgical services during the COVID-19 pandemic based on the model of the RMCancerSurgHub which is providing surgical cancer services for a population of approximately 2 million people across London during the pandemic. The model focusses on creating local and regional hub centres which provide urgent treatment for surgical patients in an environment that is relatively protected from the burden of COVID-19 illness. The model extensively utilises the extended multidisciplinary team to allow for a flexible approach with core services delivered in 'clean' sites which can adapt to viral surges. A key requirement is that of a clinical prioritisation process which allows for equity in access within and between specialties ensuring that patients are treated on the basis of greatest need, while at the same time protecting those whose conditions can safely wait from exposure to the virus. Importantly, this model has the ability to scale-up activity and lead units and networks into the recovery phase. The model discussed is also broadly applicable to providing surgical services during any viral pandemic.
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Affiliation(s)
| | | | - Shaman Jhanji
- The Royal Marsden NHS Foundation Trust HospitalLondonUK
| | | | | | - David Nicol
- The Royal Marsden NHS Foundation Trust HospitalLondonUK
| | | | - Emma Kipps
- Royal Marsden Partners West London Cancer AllianceLondonUK
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27
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Kumar KK, Chandy T, Kumar MN, Ravishankar M, Rai C, Chetan A, Girish V, Kumar K, Battepati PS, Shivarathre DG, Puranik H, Naleen Kumar N, Harshvardhan, Deepu NK, Shetty M. COVID-19 and orthopaedic surgery in a large trauma centre in India. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211010320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: We are in the midst of a pandemic caused by the novel SARS-Cov-2 virus. A large percentage of the patients are asymptomatic and hospitals around the world are struggling to restart routine services. We report the results of a universal testing protocol of all patients who underwent orthopaedic surgery in the month of July 2020 in a large orthopaedic speciality hospital in Bangalore, India. Methods: A retrospective study of all patients who underwent orthopaedic surgery in the month of July 2020 at a tertiary care orthopaedic speciality hospital in Bangalore, India. All patients underwent nasopharyngeal swab test before surgery. A questionnaire was used to assess the patient before the RT-PCR nasopharyngeal swab test. Data regarding imaging, investigations and follow up was recorded. Results: In the month of July 2020, 168 patients underwent routine nasopharyngeal RT-PCR swab test for COVID-19 prior to planned orthopaedic surgical procedure (Both trauma and elective cases). 16 of the RT-PCR tests were positive. However vascular cases and absolute emergencies were done without a RT-PCR test with PPE and all universal precautions. 11 patients underwent emergency surgery without a RT-PCR test. All 16 cases who were positive were asymptomatic. The asymptomatic positive rate was 9.52%. Of the 11 patients who underwent emergency surgery without a RT-PCR test, only one patient had a positive test post-operatively. Conclusions: Routine nasopharyngeal RT-PCR testing revealed a high rate of asymptomatic cases. If the RT-PCR test is positive, it is best to defer the case till the test returns negative. All precautions must be taken while performing emergency surgeries. Our algorithm in managing patients has proven to be effective and can be replicated with ease to continue operating and taking care of orthopaedic patients during this pandemic.
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Affiliation(s)
| | | | - MN Kumar
- Hosmat Hospital, Bangalore, India
| | | | | | - A Chetan
- Hosmat Hospital, Bangalore, India
| | | | | | | | | | | | | | | | - NK Deepu
- Hosmat Hospital, Bangalore, India
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28
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Moslim MA, Hall MJ, Meyer JE, Reddy SS. Pancreatic cancer in the era of COVID-19 pandemic: Which one is the lesser of two evils? World J Clin Oncol 2021; 12:54-60. [PMID: 33680873 PMCID: PMC7918523 DOI: 10.5306/wjco.v12.i2.54] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic adenocarcinoma remains one of the deadliest malignancies affecting the older population. We are experiencing a paradigm shift in the treatment of pancreatic cancer in the era of coronavirus disease 2019 (COVID-19) pandemic. Utilizing neoadjuvant treatment and further conducting a safe surgery while protecting patients in a controlled environment can improve oncological outcomes. On the other hand, an optimal oncologic procedure performed in a hazardous setting could shorten patient survival if recovery is complicated by COVID-19 infection. We believe that oncological treatment protocols must adapt to this new health threat, and pancreatic cancer is not unique in this regard. Although survival may not be as optimistic as most other malignancies, as caregivers and researchers, we are committed to innovating and reshaping the treatment algorithms to minimize morbidity and maximize survival as caregivers and researchers.
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Affiliation(s)
- Maitham A Moslim
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Michael J Hall
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111 , United States
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Sanjay S Reddy
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
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29
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Wang K, Wu C, Xu J, Zhang B, Zhang X, Gao Z, Xia Z. Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis. EClinicalMedicine 2020; 29:100612. [PMID: 33169112 PMCID: PMC7641595 DOI: 10.1016/j.eclinm.2020.100612] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The 2019 novel coronavirus disease (COVID-19) can complicate the perioperative course to increase postoperative mortality in operative patients, and also is a serious threat to medical staff. However, studies summarizing the impact of COVID-19 on the perioperative mortality of patients and on the safety of medical staff are lacking. METHODS We searched PubMed, Cochrane Library, Embase and Chinese database National Knowledge Infrastructure (CNKI) with the search terms "COVID-19″ or "SARS-CoV-2″ and "Surgery" or "Operation" for all published articles on COVID-19 from December 1, 2019 to October 5, 2020. FINDINGS A total of 269 patients from 47 studies were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.91 years, and 49% were female. A total of 28 patients were deceased, with the overall mortality of 6%. All deceased patients had postoperative complications associated with operation or COVID-19, including respiratory failure, acute respiratory distress syndrome (ARDS), short of breath, dyspnea, fever, cough, fatigue or myalgia, cardiopulmonary system, shock/infection, acute kidney injury and severe lymphopenia. Patients who presented any or more of the symptoms of respiratory failure, ARDS, short of breath and dyspnea after operation were associated with significantly higher mortality (r = 0.891, p < 0.001), while patients whose symptoms were presented as fever, cough, fatigue or myalgia only demonstrated marginally significant association with postoperative mortality (r = 0.675, p = 0.023). Twenty studies reported the information of medical staff infection, and a total of 38 medical staff were infected, and medical staff who used biosafety level 3 (BSL-3) protective equipment did not get infected. INTERPRETATION COVID-19 patients, in particular those with severe respiratory complications, may have high postoperative mortality. Medical staff in close contact with infected patients is suggested to take high level personal protective equipment (PPE). FUNDING Heilongjiang postdoctoral scientific research developmental fund and the National Natural Science Foundation of China.
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Affiliation(s)
- Kun Wang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Changshuai Wu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Jian Xu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Baohui Zhang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Xiaowang Zhang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Zhenglian Gao
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Zhengyuan Xia
- Department of Anesthesiology, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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30
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Silveira LMVD, Guerreiro GP, Lisboa LAF, Mejía OAV, Dallan LRP, Dallan LAO, Jatene FB. Coronary Artery Bypass Graft During the COVID-19 Pandemic. Braz J Cardiovasc Surg 2020; 35:1003-1006. [PMID: 33113324 PMCID: PMC7731845 DOI: 10.21470/1678-9741-2020-0283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Since the beginning of the coronavirus disease (COVID-19) pandemic, in March 2020, the number of people infected with COVID-19 worldwide increases continuously. Brazil is being followed with great concern in the international media, as it can, very soon, be the epicenter of the pandemic. Initial surgical data suggest that patients who acquire COVID-19 in the perioperative period are prone to a higher morbidity and mortality, however, evidence in cardiac surgery is still scarce. This article aims to aggregate to the growing evidence suggesting that perioperative infection with severe acute respiratory syndrome coronavirus 2 contributes to a more morbid evolution of the case.
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Affiliation(s)
- Lucas Molinari Veloso da Silveira
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Gustavo Pampolha Guerreiro
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Augusto Ferreira Lisboa
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Omar Asdrúbal Vilca Mejía
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luís Roberto Palma Dallan
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luís Alberto Oliveira Dallan
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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An Investigation into Proteomic Constituents of Cerebrospinal Fluid in Patients with Chronic Peripheral Neuropathic Pain Medicated with Opioids- a Pilot Study. J Neuroimmune Pharmacol 2020; 16:634-650. [PMID: 33219474 DOI: 10.1007/s11481-020-09970-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022]
Abstract
The pharmacodynamics of opioids for chronic peripheral neuropathic pain are complex and likely extend beyond classical opioid receptor theory. Preclinical evidence of opioid modulation of central immune signalling has not been identified in vivo in humans. Examining the cerebrospinal fluid (CSF) of patients medicated with opioids is required to identify potential pharmacodynamic mechanisms. We compared CSF samples of chronic peripheral neuropathic pain patients receiving opioids (n = 7) versus chronic peripheral neuropathic pain patients not taking opioids (control group, n = 13). Baseline pain scores with demographics were recorded. Proteome analysis was performed using mass spectrometry and secreted neuropeptides were measured by enzyme-linked immunosorbent assay. Based on Gene Ontology analysis, proteins involved in the positive regulation of nervous system development and myeloid leukocyte activation were increased in patients taking opioids versus the control group. The largest decrease in protein expression in patients taking opioids were related to neutrophil mediated immunity. In addition, notably higher expression levels of neural proteins (85%) and receptors (80%) were detected in the opioid group compared to the control group. This study suggests modulation of CNS homeostasis, possibly attributable to opioids, thus highlighting potential mechanisms for the pharmacodynamics of opioids. We also provide new insights into the immunomodulatory functions of opioids in vivo.
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32
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Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices. J Glob Health 2020. [PMID: 33110590 PMCID: PMC7567431 DOI: 10.7189/jogh.10.020507] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study registration Registered in ClinicalTrials.gov: NCT04344197.
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Hoyos Mejía L, Romero Román A, Gil Barturen M, Córdoba Pelaez MDM, Campo-Cañaveral de la Cruz JL, Naranjo JM, Crolwey Carrasco S, Tanaka S, Sánchez Calle A, Varela de Ugarte A, Gómez de Antonio D. Thoracic surgery during the coronavirus disease 2019 (COVID-19) pandemic in Madrid, Spain: single-centre report. Eur J Cardiothorac Surg 2020; 58:991-996. [PMID: 33084869 PMCID: PMC7665479 DOI: 10.1093/ejcts/ezaa324] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES ![]()
We reviewed the incidence of coronavirus disease 2019 cases and the postoperative outcomes of patients who had thoracic surgery during the beginning and at the highest point of transmission in our community. METHODS We retrospectively reviewed patients who had undergone elective thoracic surgery from 12 February 2020 to 30 April 2020 and were symptomatic or tested positive for severe acute respiratory syndrome coronavirus 2 infection within 14 days after surgery, with a focus on their complications and potential deaths. RESULTS Out of 101 surgical procedures, including 57 primary oncological resections, 6 lung transplants and 18 emergency procedures, only 5 cases of coronavirus disease 2019 were identified, 3 in the immediate postoperative period and 2 as outpatients. All 5 patients had cancer; the median age was 64 years. The main virus-related symptom was fever (80%), and the median onset of coronavirus disease 2019 was 3 days. Although 80% of the patients who had positive test results for severe acute respiratory syndrome coronavirus 2 required in-hospital care, none of them were considered severe or critical and none died. CONCLUSIONS These results indicate that, in properly selected cases, with short preoperative in-hospital stays, strict isolation and infection control protocols, managed by a dedicated multidisciplinary team, a surgical procedure could be performed with a relatively low risk for the patient.
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Affiliation(s)
- Lucas Hoyos Mejía
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alejandra Romero Román
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Mariana Gil Barturen
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Maria Del Mar Córdoba Pelaez
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - José Manuel Naranjo
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Silvana Crolwey Carrasco
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Shin Tanaka
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alvaro Sánchez Calle
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Andrés Varela de Ugarte
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Gómez de Antonio
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Kasivisvanathan V, Lindsay J, Rakshani-Moghadam S, Elhamshary A, Kapriniotis K, Kazantzis G, Syed B, Hines J, Bex A, Ho DH, Hayward M, Bhan C, MacDonald N, Clarke S, Walker D, Bellingan G, Moore J, Rohn J, Muneer A, Roberts L, Haddad F, Kelly JD. A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site. Int J Surg 2020; 84:57-65. [PMID: 33122153 PMCID: PMC7584883 DOI: 10.1016/j.ijsu.2020.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/23/2022]
Abstract
Background Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. Methods During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days. Results 500 patients underwent surgery with median age 62.5 (IQR 51–71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19. Conclusion It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration. Priority surgeries are being cancelled every week due to the COVID-19 pandemic. A multicentre surgical referral network was set up as part of an NHS England approach to continuing safe surgery The referral network consisted of 14 NHS trusts and surgery was performed at a single COVID-19 ‘cold site’. After 500 surgeries performed, there was a 0% 30-day mortality from COVID-19. It is safe to continue cancer and priority surgery during the COVID-19 pandemic with appropriate service reconfiguration.
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Affiliation(s)
- Veeru Kasivisvanathan
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
| | - Jamie Lindsay
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Sara Rakshani-Moghadam
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ahmed Elhamshary
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Georgios Kazantzis
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Bilal Syed
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Hines
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Axel Bex
- Department of Urology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Daniel Heffernan Ho
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Chetan Bhan
- Department of General Surgery, Whittington Health NHS Trust, London, UK
| | - Nicola MacDonald
- Department of Gynaecology, University College London Hospital NHS Foundation Trust, London, UK
| | - Simon Clarke
- Department of Anaesthetics, University College London Hospital NHS Foundation Trust, London, UK
| | - David Walker
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK
| | - Geoff Bellingan
- Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK
| | - James Moore
- NHS England and NHS Improvement, England, UK
| | - Jennifer Rohn
- Centre for Urological Biology, Department of Renal Medicine, Division of Medicine, University College London, London, UK
| | - Asif Muneer
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; National Institute for Health and Research Biomedical Research Centre, University College London Hospital, London, UK
| | - Lois Roberts
- Division of Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Fares Haddad
- Division of Surgery and Interventional Science, University College London, London, UK
| | - John D Kelly
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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Batt J, Cook N, Nadeem M, Sahu A. Dilutional local anaesthetic techniques in oncoplastic breast surgery and potential benefits during the COVID-19 pandemic and beyond. J Perioper Pract 2020; 30:277-282. [PMID: 32869726 DOI: 10.1177/1750458920944080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION COVID-19 has changed the approach to operating on breast cancer for the benefit of patients, staff and the general population. One approach involves the switch from operating under general to local anaesthetic. We assess whether diluational local anaesthetic is as effective as the current standard approach. METHODS Postoperative pain was recorded in prospective, consecutive patients undergoing wide local excision under dilutional local anaesthetic (concentration < 1mg/ml). Pain scores were documented at 0, 30 and 60 minutes and compared to a control group consisting of combined general with local anaesthetic. RESULTS Pain significantly increased in the control group during the postoperative recovery. This was not seen in the dilutional local anaesthetic group that was non-inferior to the standard approach at 0, 30 and 60 minutes. CONCLUSION Dilutional local anaesthetic provides a safe and effective alternative approach to operating on breast cancer patients whilst avoiding risky general anaesthetic in a COVID-19 pandemic environment.
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Affiliation(s)
- Jeremy Batt
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury-On-Trym, UK
| | - Nicola Cook
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury-On-Trym, UK
| | - Muhammad Nadeem
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury-On-Trym, UK
| | - Ajay Sahu
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury-On-Trym, UK
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Wang J, Zhang J, Tu Y, Zhou X, Huang H, Shao L, Chen L, Zhao Y, Ge M. Cancer patients in SARS-CoV-2 infection: a single-center experience from Wuhan. J Cancer 2020; 11:6243-6247. [PMID: 33033507 PMCID: PMC7532501 DOI: 10.7150/jca.47065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background: The Coronavirus disease 2019 (COVID-19) global pandemic has posed unprecedented challenges to the health-care systems all over the world. Among the booming literatures about COVID-19, there is yet a paucity of study addressing the association between COVID-19 and cancer, which is a rare comorbidity of COVID-19, as well as consensus for treatment of cancer in this pandemic. Methods: In this retrospective, single-center cohort study, information of all inpatient cases with laboratory-confirmed COVID-19 who had treatment outcome were collected from the designated departments in Zhongnan Hospital of Wuhan University, Wuhan, China on March 10, 2020. Demographic data, clinical information, and treatment outcomes were extracted from electronic medical records. Severe events were defined as admission to intensive care unit (ICU), the use of mechanical ventilation, or death. Result: A total of 716 patients with laboratory-confirmed COVID-19 infection were identified. Among them, a total of 12 cases (1.7%, 95% CI: 0.7%-2.6%) had history of cancer with 4 cases (33%) experienced severe events. Compared with cases without cancer, patients with cancer have higher risks of severe events (33% vs 7.7%, p=0.012) and deaths (25% vs 3.6%, p=0.009). Multivariable logistic regression model showed that cancer was independently associated with increased odds of severe events after adjusting for other risk factors (OR 6.51, 95% CI 1.72-24.64; p=0.006). Among COVID-19 patients with cancer, we found that patients older than 60 years (75%), with other comorbidities (50%), or experiencing anticancer treatment in past month (42.9%) had a numerically higher incidence of severe events. Conclusion: Cancer is a rare comorbidity of patients with COVID-19; however, it cannot be overemphasized due to its poorer outcomes. We propose that personalized treatment recommendation for cancer patients should be addressed during COVID-19 pandemic, along with meticulous personal protective protocols for them to mitigate the risk of SARS-CoV-2 infection.
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Affiliation(s)
- Jiafeng Wang
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
- Medical Aiding Team for COVID-19 in Hubei, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Jun Zhang
- Medical Aiding Team for COVID-19 in Hubei, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
- Hangzhou Medical School People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Yuexing Tu
- Medical Aiding Team for COVID-19 in Hubei, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
- Hangzhou Medical School People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Xianlong Zhou
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
- Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Haijun Huang
- Medical Aiding Team for COVID-19 in Hubei, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
- Hangzhou Medical School People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Lina Shao
- Medical Aiding Team for COVID-19 in Hubei, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
- Hangzhou Medical School People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Legao Chen
- Medical Aiding Team for COVID-19 in Hubei, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
- Hangzhou Medical School People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Yan Zhao
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
- Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Minghua Ge
- Medical Aiding Team for COVID-19 in Hubei, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
- Hangzhou Medical School People's Hospital, Hangzhou, Zhejiang, 310014, China
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Peng Y, Yang J, Guo D, Zheng C, Sun H, Zhang Q, Zou S, Zhang Y, Luo K, Candiotti KA. Sufentanil postoperative analgesia reduce the increase of T helper 17 (Th17) cells and FoxP3 + regulatory T (Treg) cells in rat hepatocellular carcinoma surgical model: A randomised animal study. BMC Anesthesiol 2020; 20:212. [PMID: 32847505 PMCID: PMC7448519 DOI: 10.1186/s12871-020-01129-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 08/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background Surgery-related pain and opioids might exacerbate immune defenses in immunocompromised cancer patients which might affect postoperativd overall survival. Sufentanil is a good postoperative pain control drug,the present study aimed to figure out whether it effect T cell immunity in rat hepatocellular carcinoma surgical model. Methods A rat hepatocellular carcinoma (HCC) models was established by N-nitrosodiethylamine. Forty-eight of them were randomly divided into 3 equal groups: surgery without postoperative analgesia (Group C), surgery with morphine postoperative analgesia (Group M), surgery with sufentanil postoperative analgesia (Group S). Each animal underwent a standard left hepatolobectomy, and intraperitoneally implanted with osmotic minipumps filled with sufentanil, morphine or normal saline according to the different group. The food and water consumptions, body weight changes, locomotor activity and mechanical pain threshold (MPT) were observed. The ratio of CD4+/CD8+, proportions of Th1, Th2, Th17 and Treg cells in blood were detected using flow cytometry. The liver function and the rats’ survival situation of each group were observed. Results The food and water consumption, locomotor activity and MPT of group C declined than those of group S and M on d1, d2, d3 (P < 0.05). The CD4+/CD8+ ratio and the proportion of Th1 cells were significantly higher while the proportion of Th2, Th17 and Treg cells were significantly lower in group S and group M compared with group C. The rats of group S have higher CD4+/CD8+ ratio on d3, while lower proportion of Treg cells on d7 compared with group M. The plasma ALT and AST values in group C were significantly higher than that of group S and group M on both d3 and d7. There were not significant differences in mortality rate between 3 groups. Conclusions Sufentanil and morphine postoperative analgesia in HCC rats accepted hepatectomy could relieve postoperative pain, promote the recovery of liver function after surgery, alleviate the immunosuppressive effect of pain. Furthermore, Compared to morphine, sufentanil might have a slighter effect on CD4+/CD8+ ratio and Treg frequencies. Therefore, sufentanil postoperative analgesia is better than morphine in HCC hepatectomy rats.
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Affiliation(s)
- Yanhua Peng
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Jinfeng Yang
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China.
| | - Duo Guo
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Chumei Zheng
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Huiping Sun
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Qinya Zhang
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Shuangfa Zou
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Yanping Zhang
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami-Miller School of Medicine, Miami, FL, 33136, USA
| | - Ke Luo
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Keith A Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami-Miller School of Medicine, Miami, FL, 33136, USA
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Gruskay JA, Dvorzhinskiy A, Konnaris MA, LeBrun DG, Ghahramani GC, Premkumar A, DeFrancesco CJ, Mendias CL, Ricci WM. Universal Testing for COVID-19 in Essential Orthopaedic Surgery Reveals a High Percentage of Asymptomatic Infections. J Bone Joint Surg Am 2020; 102:1379-1388. [PMID: 32516279 DOI: 10.2106/jbjs.20.01053] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health-care institutions. The identification of infected individuals is vital to prevent the spread of illness to staff and other patients as well as to identify those who may be at risk for disease-related complications. This is particularly relevant with the resumption of elective orthopaedic surgery around the world. We report the results of a universal testing protocol for COVID-19 in patients undergoing orthopaedic surgery during the coronavirus pandemic and to describe the postoperative course of asymptomatic patients who were positive for COVID-19. METHODS A retrospective review of adult operative cases between March 25, 2020, and April 24, 2020, at an orthopaedic specialty hospital in New York City was performed. Initially, a screening questionnaire consisting of relevant signs and symptoms (e.g., fever, cough, shortness of breath) or exposure dictated the need for nasopharyngeal swab real-time quantitative polymerase chain reaction (RT-PCR) testing for all admitted patients. An institutional policy change occurred on April 5, 2020, that indicated nasopharyngeal swab RT-PCR testing for all orthopaedic admissions. Screening and testing data for COVID-19 as well as relevant imaging, laboratory values, and postoperative complications were reviewed for all patients. RESULTS From April 5, 2020, to April 24, 2020, 99 patients underwent routine nasopharyngeal swab testing for COVID-19 prior to their planned orthopaedic surgical procedure. Of the 12.1% of patients who tested positive for COVID-19, 58.3% were asymptomatic. Three asymptomatic patients developed postoperative hypoxia, with 2 requiring intubation. The negative predictive value of using the signs and symptoms of disease to predict a negative test result was 91.4% (95% confidence interval [CI], 81.0% to 97.1%). Including a positive chest radiographic finding as a screening criterion did not improve the negative predictive value of screening (92.5% [95% CI, 81.8% to 97.9%]). CONCLUSIONS A protocol for universal testing of all orthopaedic surgery admissions at 1 hospital in New York City during a 3-week period revealed a high rate of COVID-19 infections. Importantly, the majority of these patients were asymptomatic. Using chest radiography did not significantly improve the negative predictive value of screening. These results have important implications as hospitals anticipate the resumption of elective surgical procedures. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jordan A Gruskay
- Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY
| | - Aleksey Dvorzhinskiy
- Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY
| | - Maxwell A Konnaris
- Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY
| | - Drake G LeBrun
- Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY
| | - Gregory C Ghahramani
- Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY.,Department of Physiology & Biophysics, Weill Cornell Medical College, New York, NY
| | - Ajay Premkumar
- Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY
| | - Christopher J DeFrancesco
- Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY
| | - Christopher L Mendias
- Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY.,Department of Physiology & Biophysics, Weill Cornell Medical College, New York, NY
| | - William M Ricci
- Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY
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Prakash L, Dhar SA, Mushtaq M. COVID-19 in the operating room: a review of evolving safety protocols. Patient Saf Surg 2020; 14:30. [PMID: 32695225 PMCID: PMC7370871 DOI: 10.1186/s13037-020-00254-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has already infected more than 3 million people across the world. As the healthworkers man the frontlines, the best practices model is continuously evolving as literature concerning the Coronavirus develops. METHODS A systematic review of the available literature was performed using the keyword terms "COVID-19", "Coronavirus", "surgeon", "health-care workers", "protection" and "Orthopaedic Surgery". All peer-reviewed articles we could find were considered. Randomized controlled trials (RCTs), prospective trials and retrospective studies, as well as reviews and case reports, were included in this systematic review. RESULTS Even though surgical specialties including orthopedics are on the relative sidelines of the management of this pandemic but best practices models are inevitably developed for surgical specialties. The algorithm of postpone, delay, and operate only when life-threatening conditions exist is going to be useful up to a point. CONCLUSION The surgical staff needs to keep abreast of the latest literature concerning safety measures to be taken during surgical procedures. Review articles can go some distance in helping in this educational process. This knowledge must evolve as new information comes to light.
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40
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de Santiago J, Yelo C, F Chereguini M, Conde A, Galipienzo J, Salvatierra D, Linero M, Alonso S. COVID-19: gynecologic cancer surgery at a single center in Madrid. Int J Gynecol Cancer 2020; 30:1108-1112. [PMID: 32641394 PMCID: PMC7371485 DOI: 10.1136/ijgc-2020-001638] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 01/09/2023] Open
Abstract
Objectives While numerous medical facilities have been forced to suspend oncological surgery due to system overload, debate has emerged on using non-surgical options on cancer cases during the pandemic. The goal of our study was to analyze, in a retrospective cohort study, the results of gynecological cancer surgery and evaluate postoperative complications in a single center in one of the most affected areas in Europe. Methods We retrospectively analyzed the records of patients who were referred between March 2020 and May 2020 for primary surgical treatment of breast, endometrial, ovarian, cervical, or vulvar cancer. Results The study included a total of 126 patients. Median age was 60 years (range 29–89). Patients were referred with breast (76/126, 60.3%), endometrial (29/126, 23%), ovarian (14/126, 11.1%), cervical (5/126, 4%), or vulvar cancer (2/126, 1.6%). Polymerase chain reaction (PCR) test for detection of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) was only conducted in 50% of cases due to the low availability of tests during the first phase of our study, and was indicated only in suspected cases according to the healthcare authorities' protocol. Median hospital stay was 1 day (range 0–18). Excluding breast surgery, laparoscopy was the most used procedure (43/126, 34.1%). 15 patients had a postoperative complication (15/126, 11.9%); only in 2 patients (2/15 13.3%) were there reports of Clavien–Dindo grade 3 or 4 complications. 6 patients tested positive for COVID-19 following a PCR diagnostic test, and these surgeries were cancelled. Conclusions Adequate protective measures in the setting of COVID-19 free institutions enabled the continuity of cancer surgery without significant compromise of the safety of patients or healthcare workers.
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Affiliation(s)
| | - Carmen Yelo
- Gynecology, MD Anderson Cancer Center Madrid, Madrid, Spain
| | | | - Ana Conde
- Gynecology, MD Anderson Cancer Center Madrid, Madrid, Spain
| | | | | | - Manuel Linero
- Anesthesiology, MD Anderson Cancer Center Madrid, Madrid, Spain
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Sobti A, Memon K, Bhaskar RRP, Unnithan A, Khaleel A. Outcome of trauma and orthopaedic surgery at a UK District General Hospital during the Covid-19 pandemic. J Clin Orthop Trauma 2020; 11:S442-S445. [PMID: 32774009 PMCID: PMC7326431 DOI: 10.1016/j.jcot.2020.06.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There are suggestions that elective surgery performed during the incubation period of COVID-19 infection may cause an immediate impairment of cell-mediated immunity, leading to high morbidity and mortality. However is contrasting data about the associated mortality. Since the outbreak, our unit has maintained a prospective database recording Trauma and Orthopaedic surgical activity. Our aim was to share our experience of the first 3 months with prospective data on outcome of essential surgery during the covid-19 peak. Our focus in this report was on the mortality rate as services begin to open. Methods: We prospectively collected data during the peak of the pandemic in the UK, for fracture neck of femur patients (NOF) the most commonly performed surgical procedure and the most vulnerable during this period. We compared this Covid-19 cohort of NOFs against a cohort of NOF's during the same time in 2019 and another cohort of NOF's in 2020 outside the lockdown period to compare mortality rates and give a broader perspective. RESULTS During the period March 1, 2020 to May 31, 2020, total of 206 patients were operated. Ninety-four fracture NOF and another one hundred twelve essential surgical procedures were performed. In the NOF cohort, there were nine patients that died. Three of them were covid-19 positive, one was not tested and the rest five were covid-19 negative. There was no mortality reported in the non NOF group. Conclusion: In our unit, during the lock down period, mortality rate in patients undergoing fracture NOF was not significantly different from a similar cohort earlier in the year and similar period last year. We have not observed any mortality, to date in the Non NOF procedures carried out.
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Affiliation(s)
- Anshul Sobti
- Rowley Bristow Unit, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Guildford Rd, Lyne, Chertsey, KT16 0PZ, United Kingdom,Corresponding author.
| | - Kashif Memon
- Rowley Bristow Unit, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Guildford Rd, Lyne, Chertsey, KT16 0PZ, United Kingdom
| | - Rohit Reddy Pala Bhaskar
- Ashford and St. Peter’s Hospitals NHS Foundation Trust, Guildford Rd, Lyne, Chertsey, KT16 0PZ, United Kingdom
| | - Ashwin Unnithan
- Rowley Bristow Unit, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Guildford Rd, Lyne, Chertsey, KT16 0PZ, United Kingdom
| | - Arshad Khaleel
- Rowley Bristow Unit, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Guildford Rd, Lyne, Chertsey, KT16 0PZ, United Kingdom
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Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, Zhan LY, Jia Y, Zhang L, Liu D, Xia ZY, Xia Z. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine 2020; 21:100331. [PMID: 32292899 PMCID: PMC7128617 DOI: 10.1016/j.eclinm.2020.100331] [Citation(s) in RCA: 861] [Impact Index Per Article: 215.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The outbreak of 2019 novel coronavirus disease (COVID-19) in Wuhan, China, has spread rapidly worldwide. In the early stage, we encountered a small but meaningful number of patients who were unintentionally scheduled for elective surgeries during the incubation period of COVID-19. We intended to describe their clinical characteristics and outcomes. METHODS We retrospectively analyzed the clinical data of 34 patients underwent elective surgeries during the incubation period of COVID-19 at Renmin Hospital, Zhongnan Hospital, Tongji Hospital and Central Hospital in Wuhan, from January 1 to February 5, 2020. FINDINGS Of the 34 operative patients, the median age was 55 years (IQR, 43-63), and 20 (58·8%) patients were women. All patients developed COVID-19 pneumonia shortly after surgery with abnormal findings on chest computed tomographic scans. Common symptoms included fever (31 [91·2%]), fatigue (25 [73·5%]) and dry cough (18 [52·9%]). 15 (44·1%) patients required admission to intensive care unit (ICU) during disease progression, and 7 patients (20·5%) died after admission to ICU. Compared with non-ICU patients, ICU patients were older, were more likely to have underlying comorbidities, underwent more difficult surgeries, as well as more severe laboratory abnormalities (eg, hyperleukocytemia, lymphopenia). The most common complications in non-survivors included ARDS, shock, arrhythmia and acute cardiac injury. INTERPRETATION In this retrospective cohort study of 34 operative patients with confirmed COVID-19, 15 (44·1%) patients needed ICU care, and the mortality rate was 20·5%. FUNDING National Natural Science Foundation of China.
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Affiliation(s)
- Shaoqing Lei
- Department of anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fang Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, the University of Hong Kong, Hong Kong, China
- Department of anesthesiology, the University of Hong Kong, Hong Kong, China
| | - Wating Su
- Department of anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chang Chen
- Department of anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jingli Chen
- Department of anesthesiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Mei
- Department of anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li-Ying Zhan
- Department of anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yifan Jia
- Department of anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Liangqing Zhang
- Department of anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Danyong Liu
- Department of anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhong-Yuan Xia
- Department of anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhengyuan Xia
- State Key Laboratory of Pharmaceutical Biotechnology, the University of Hong Kong, Hong Kong, China
- Department of anesthesiology, the University of Hong Kong, Hong Kong, China
- Department of anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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The Effects of Preoperative Oral Carbohydrate on Frequency of T and NK Cells in Patients with Cervical Cancer Treated Using Neoadjuvant Chemotherapy and Surgery: A Prospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2101480. [PMID: 32309426 PMCID: PMC7103029 DOI: 10.1155/2020/2101480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022]
Abstract
Background Immune dysfunction can occur after neoadjuvant chemotherapy (NAC) and surgery for cancer. We investigated whether preoperative oral carbohydrate affected the postoperative percentages of T cells (CD4+ and CD8+) and natural killer (NK) cells in patients with cervical cancer treated with NAC and surgery. Methods This prospective cohort study enrolled consecutive patients with cervical cancer treated by radical hysterectomy with PLND at the Gynecologic Oncology Department of Fujian Provincial Cancer Hospital (China) between January 2018 and December 2018. Patients were divided into three groups according to the treatment method: NAC (two cycles, surgery 1 month later), NAC+CHO (chemotherapy and surgical methods same as with the NAC group but with 300 mL of oral carbohydrate administered 2 h before surgery), and non-NAC (surgery alone). Percentages of NK, CD3+, CD4+, and CD8+ cells were evaluated by flow cytometry the day after the first admission, just before surgery, immediately after tracheal tube removal, and the day after surgery. This trial is registered with NCT03872635 at clinicaltrials.com. Results The final analysis included 77 patients (non-NAC group, n = 26; NAC group, n = 25; and NAC-CHO group, n = 26). Baseline characteristics and preoperative NK, CD3+, CD4+, and CD8+ cell percentages were similar between groups. Postoperatively, all groups exhibited reductions in NK, CD3+, and CD4+ cell percentages and increases in CD8+ cell percentages (all P < 0.05). The changes in NK, CD3+, CD4+, and CD8+ cell percentages were attenuated in the NAC-CHO group (P < 0.05 vs. both other groups). Conclusion Preoperative oral carbohydrate can improve the postoperative populations of NK and T cells after the treatment of cervical cancer by NAC and surgery.
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Alverdy JC, Hyman N, Gilbert J. Re-examining causes of surgical site infections following elective surgery in the era of asepsis. THE LANCET. INFECTIOUS DISEASES 2020; 20:e38-e43. [PMID: 32006469 DOI: 10.1016/s1473-3099(19)30756-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 11/29/2019] [Accepted: 12/20/2019] [Indexed: 02/07/2023]
Abstract
The currently accepted assumption that most surgical site infections (SSIs) occurring after elective surgery under standard methods of antisepsis are due to an intraoperative contamination event, remains unproven. We examined the available evidence in which microbial cultures of surgical wounds were taken at the conclusion of an operation and determined that such studies provide more evidence to refute that an SSI is due to intraoperative contamination than support it. We propose that alternative mechanisms of SSI development should be considered, such as when a sterile postoperative wound becomes infected by a pathogen originating from a site remote from the operative wound-eg, from the gums or intestinal tract (ie, the Trojan Horse mechanism). We offer a path forward to reduce SSI rates after elective surgery that includes undertaking genomic-based microbial tracking from the built environment (ie, the operating room and hospital bed), to the patient's own microbiome, and then to the surgical site. Finally, we posit that only by generating this dynamic microbial map can the true pathogenesis of SSIs be understood enough to inform novel preventive strategies against infection following elective surgery in the current era of asepsis.
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Affiliation(s)
- John C Alverdy
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Neil Hyman
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Jack Gilbert
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
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Kosciuczuk U, Knapp P, Lotowska-Cwiklewska AM. Opioid-induced immunosuppression and carcinogenesis promotion theories create the newest trend in acute and chronic pain pharmacotherapy. Clinics (Sao Paulo) 2020; 75:e1554. [PMID: 32215455 PMCID: PMC7074583 DOI: 10.6061/clinics/2020/e1554] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/30/2020] [Indexed: 11/18/2022] Open
Abstract
Opioids are the main group of pharmacological agents used during the perioperative period and provide a sedative and analgesic component. The observations of opioid consumption in West Europe indicate that this group of drugs is widely used in chronic noncancer pain therapy. Nearly 20 years ago, the first publications indicating that opioids, as an element of perioperative pharmacotherapy in oncologic patients, increase the risk of tumor recurrence and affect further prognosis were presented. The actual publications suggest that there are multifactorial, complex mechanisms underlying the immunological impact and carcinogenesis promotion of opioids and that the intensity varies depending on the type of opioid. There are also questions about the immunosuppressive effects among patients receiving opioids in the treatment of chronic noncancer pain. The aim of the review article is to present information about the action of opioids on the immune system in carcinogenic settings and to define the clinical usefulness of this pharmacological phenomenon.
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Affiliation(s)
- Urszula Kosciuczuk
- Department of Anesthesiology and Intensive Therapy, Medical University of Bialystok, Department of Anesthesiology and Intensive TherapyMedical University of BialystokPolandPoland
- *Corresponding author. E-mail:
| | - Pawel Knapp
- Department of Gynecology and Gynecological Oncology, Medical University of Bialystok, Department of Gynecology and Gynecological OncologyMedical University of BialystokPolandPoland
| | - Anna Maria Lotowska-Cwiklewska
- Department of Anesthesiology and Intensive Therapy, Medical University of Bialystok, Department of Anesthesiology and Intensive TherapyMedical University of BialystokPolandPoland
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Franchi S, Moschetti G, Amodeo G, Sacerdote P. Do All Opioid Drugs Share the Same Immunomodulatory Properties? A Review From Animal and Human Studies. Front Immunol 2019; 10:2914. [PMID: 31921173 PMCID: PMC6920107 DOI: 10.3389/fimmu.2019.02914] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
Suppression of the immune system has been constantly reported in the last years as a classical side effect of opioid drugs. Most of the studies on the immunological properties of opioids refer to morphine. Although morphine remains the "reference molecule," other semisynthetic and synthetic opioids are frequently used in the clinical practice. The primary objective of this review is to analyze the available literature on the immunomodulating properties of opioid drugs different from morphine in preclinical models and in the human. A search strategy was conducted in PubMed, Embase, and the Cochrane databases using the terms "immunosuppression," "immune system," "opioids," "Natural killer cells," "cytokines," and "lymphocytes." The results achieved concerning the effects of fentanyl, methadone, oxycodone, buprenorphine, remifentanil, tramadol, and tapentadol on immune responses in animal studies, in healthy volunteers and in patients are reported. With some limitations due to the different methods used to measure immune system parameters, the large range of opioid doses and the relatively scarce number of participants in the available studies, we conclude that it is not correct to generalize immunosuppression as a common side effect of all opioid molecules.
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Affiliation(s)
| | | | | | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Sciences, University of Milano, Milan, Italy
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DeMarco GJ, Nunamaker EA. A Review of the Effects of Pain and Analgesia on Immune System Function and Inflammation: Relevance for Preclinical Studies. Comp Med 2019; 69:520-534. [PMID: 31896389 PMCID: PMC6935697 DOI: 10.30802/aalas-cm-19-000041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
One of the most significant challenges facing investigators, laboratory animal veterinarians, and IACUCs, is how to balance appropriate analgesic use, animal welfare, and analgesic impact on experimental results. This is particularly true for in vivo studies on immune system function and inflammatory disease. Often times the effects of analgesic drugs on a particular immune function or model are incomplete or don't exist. Further complicating the picture is evidence of the very tight integration and bidirectional functionality between the immune system and branches of the nervous system involved in nociception and pain. These relationships have advanced the concept of understanding pain as a protective neuroimmune function and recognizing pathologic pain as a neuroimmune disease. This review strives to summarize extant literature on the effects of pain and analgesia on immune system function and inflammation in the context of preclinical in vivo studies. The authors hope this work will help to guide selection of analgesics for preclinical studies of inflammatory disease and immune system function.
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Key Words
- cb,endocannabinoid receptor
- cd,crohn disease
- cfa, complete freund adjuvant
- cgrp,calcitonin gene-related peptide
- cox,cyclooxygenase
- ctl, cytotoxic t-lymphocytes
- damp,damage-associated molecular pattern molecules
- drg,dorsal root ganglion
- dss, dextran sodium sulphate
- ecs,endocannabinoid system
- ibd, inflammatory bowel disease
- ifa,incomplete freund adjuvant
- las, local anesthetics
- pamp,pathogen-associated molecular pattern molecules
- pge2, prostaglandin e2
- p2y, atp purine receptor y
- p2x, atp purine receptor x
- tnbs, 2,4,6-trinitrobenzene sulphonic acid
- trp, transient receptor potential ion channels
- trpv, transient receptor potential vanilloid
- tg,trigeminal ganglion
- uc,ulcerative colitis
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Affiliation(s)
- George J DeMarco
- Department of Animal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts;,
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Nasser SA, Afify EA. Sex differences in pain and opioid mediated antinociception: Modulatory role of gonadal hormones. Life Sci 2019; 237:116926. [PMID: 31614148 DOI: 10.1016/j.lfs.2019.116926] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/18/2019] [Accepted: 09/30/2019] [Indexed: 12/14/2022]
Abstract
Sex-related differences in pain and opioids has been the focus of many researches. It is demonstrated that women experience greater clinical pain, lower pain threshold and tolerance, more sensitivity and distress to experimentally induced pain compared to men. Sex differences in response to opioid treatment revealed inconsistent results. However, the etiology of these disparities is not fully elucidated. It is, therefore, conceivable now that this literature merits to be revisited comprehensively. Possible multifaceted factors seem to be associated. These include neuroanatomical, hormonal, neuroimmunological, psychological, social and cultural aspects and comorbidities. This review aims at providing an overview of the substantial literature documenting the sex differences in pain and analgesic response to opioids from animal and human studies within the context of the modulatory effects of the aforementioned factors. A detailed and critical discussion of the cellular and molecular signaling pathways underlying the modulatory actions of gonadal hormones in the sexual dimorphism in pain processing and opioid analgesia is extensively presented. It is indicated that sexual dimorphic activation of certain brain regions contributes to differential pain sensitivity between females and males. Plausible crosstalk between sex hormones and neuroimmunological signaling pertinent to toll-like and purinergic receptors is uncovered as causal cues underlying sexually dimorphic pain and opioid analgesia. Conceivably, a thorough understanding of these factors may aid in sex-related advancement in pain therapeutic management.
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Affiliation(s)
- Suzanne A Nasser
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Elham A Afify
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
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Wang W, Xiao J, Shen S, Wang S, Chen M, Hu Y. Emerging effect of anesthesia on post-operative tumor recurrence and metastasis. J Int Med Res 2019; 47:3550-3558. [PMID: 31296069 PMCID: PMC6726782 DOI: 10.1177/0300060519861455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Post-operative recurrence and metastasis of malignant tumors are difficult to control, which probably results from multiple factors that affect the prognosis and the undefined mechanism. Anesthesia may be an influential factor. Researchers have performed many meaningful studies on the relationship between anesthetic drugs/methods and tumor growth/immune function, which provide important references for the anesthetic selection and peri-operative management of tumor patients. Anesthetics, analgesics, and sedatives should be used with caution because their effects in post-operative patients remain controversial. This review summarizes the emerging progress on the effect of anesthesia on post-operative tumor recurrence and metastasis, particularly focusing on the effects of anesthetic drugs, anesthetic methods, and post-operative analgesia on tumor growth and metastasis. Future studies should provide strict criteria for the proper use of anesthetics in patients with malignant tumors and provide experimental evidence for the improvement and development of novel anesthetics and anesthetic methods that have the important clinical significance.
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Affiliation(s)
- Weilian Wang
- 1 Department of Anesthesia, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, P.R. China
| | - Jinliang Xiao
- 1 Department of Anesthesia, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, P.R. China
| | - Shuwei Shen
- 1 Department of Anesthesia, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, P.R. China
| | - Shu Wang
- 2 Department of Anesthesia, Benxi Central Hospital, Benxi, Liaoning, P.R. China
| | - Minghao Chen
- 3 Department of Anesthesia, Weihai Municipal Hospital, Weihai, Shandong, P.R. China
| | - Ya Hu
- 4 Department of Pharmacology, Health Science Center, Yangtze University, Jingzhou, Hubei, P.R. China
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Wilson RB. Morpheus and the Underworld-Interventions to Reduce the Risks of Opioid Use After Surgery: ORADEs, Dependence, Cancer Progression, and Anastomotic Leakage. J Gastrointest Surg 2019; 23:1240-1249. [PMID: 30937715 DOI: 10.1007/s11605-019-04167-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/08/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Perioperative pain management is a key element of enhanced recovery after surgery (ERAS) programs. A multimodal approach to analgesia as part of a coordinated ERAS includes the reduction of opioid use. This review aims to discuss opioid-related adverse events, strategies to reduce opioid use after surgery, and the relevance to the present "opioid crisis" in North America. METHODS A literature review of the pharmacology of opioid drugs, perioperative opioid reduction strategies, and the potential public health benefit was performed. This included current ERAS guidelines on multimodal analgesia, randomized controlled trials on perioperative analgesia, and intervention studies to decrease opioid use, misuse, and diversion in North America. RESULTS Reduction of perioperative opioid usage has been endorsed by joint clinical practice guidelines on the management of postoperative pain from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists. Interventions as part of an "opioid bundle" that can be incorporated into ERAS protocols include multimodal analgesia, regional anesthesia, opioid sparing drugs, carbon dioxide humidification during laparoscopy, changing opioid prescription practices, patient and physician education, and proper disposal of unused opioid medications. CONCLUSION There are substantial benefits in incorporating opioid reduction strategies into ERAS and clinical practice guidelines. These include faster return of function and mobility, and decreased opioid-related adverse drug events (ORADEs), postoperative morbidity and mortality, and length of hospital stay. Improved oncological outcomes after cancer surgery may be an additional benefit. Evidence-based interventions can also reduce opioid abuse and diversion in the community.
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Affiliation(s)
- Robert Beaumont Wilson
- Department of Upper Gastrointestinal Surgery, Liverpool Hospital, Suite 6, Level 2, 171 Bigge St, Liverpool, Sydney, NSW, 2170, Australia.
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