scholarly journals Elective Tracheostomy During Mechanical Ventilation in Patients Affected by COVID-19: Preliminary Case Series From Lombardy, Italy

2020 ◽  
Vol 163 (1) ◽  
pp. 135-137 ◽  
Author(s):  
Mario Turri-Zanoni ◽  
Paolo Battaglia ◽  
Camilla Czaczkes ◽  
Paolo Pelosi ◽  
Paolo Castelnuovo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Health Care Workers ◽  
Surgical Techniques ◽  
Case Series ◽  
Test Results ◽  
First Case ◽  
Care Workers ◽  
Number Of Patients ◽  
Elective Tracheostomy ◽  
Source Of Information

The COVID-19 outbreak poses continued struggles due to the unprecedented number of patients admitted to intensive care units and the overwhelming need for mechanical ventilation. We report a preliminary case series of 32 patients with COVID-19 who underwent elective tracheostomies after a mean intubation period of 15 days (range, 9-21 days). The procedure was performed with percutaneous (10 cases) and open (22 cases) surgical techniques. Neither procedure-related complications nor viral transmission to health care workers was observed. Our preliminary experience supports the safety of tracheostomy, provided that appropriate protocols are strictly followed. The postoperative care is still debated, and, prudentially, our protocol includes tracheal tube change not before 2 weeks after tracheostomy, with cuff deflation and decannulation deferred until confirmation of negative SARS-CoV-2 test results. This is the first case series to report on such a rapidly evolving issue and might represent a source of information for clinicians worldwide who will soon be facing the same challenges.

scholarly journals Tips and Pearls for Tracheostomy during the Covid-19 Pandemic

2021 ◽  
Vol 25 (03) ◽  
pp. e459-e462
Author(s):  
Darwin Kaushal ◽  
Shilpa Goyal ◽  
Nithin Prakasan Nair ◽  
Kapil Soni ◽  
Bikram Choudhury ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Present Article ◽  
Critically Ill ◽  
Current Literature ◽  
Literature Search ◽  
Scientific Evidence ◽  
Early Tracheostomy ◽  
Life Saving ◽  
Number Of Patients ◽  
Elective Tracheostomy

AbstractThe number of critically-ill coronavirus disease 2019 (Covid-19) patients requiring mechanical ventilation is on the rise. Most guidelines suggest keeping the patient intubated and delay elective tracheostomy. Although the current literature does not support early tracheostomy, the number of patients undergoing it is increasing. During the pandemic, it is important that surgeons and anesthesiologists know the different aspects of tracheostomy in terms of indication, procedure, tube care and complications. A literature search was performed to identify different guidelines and available evidence on tracheostomy in Covid-19 patients. The purpose of the present article is to generate an essential scientific evidence for life-saving tracheostomy procedures.

scholarly journals Re-infection or Relapse of COVID-19 in Health Care workers; case series of 2 Patients from Pakistan

2021 ◽  
pp. 100896
Author(s):  
Abeera Ahmed ◽  
Fatima Sana ◽  
Aamer Ikram ◽  
Shagufta Yousaf ◽  
Aysha Khan
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Case Series ◽  
Care Workers

scholarly journals Neoadjuvant peptide receptor radionuclide therapy and modified multivisceral transplantation for an advanced small intestinal neuroendocrine neoplasm: an updated case report

2017 ◽  
Vol 2 (4) ◽  
pp. 247-253
Author(s):  
Ashley K. Clift ◽  
Henk Giele ◽  
Srikanth Reddy ◽  
Rubens Macedo ◽  
Adil Al-Nahhas ◽  
...  
Keyword(s):  
Radionuclide Therapy ◽  
Surgical Techniques ◽  
Peptide Receptor Radionuclide Therapy ◽  
Neuroendocrine Neoplasm ◽  
Peptide Receptor ◽  
Multivisceral Transplantation ◽  
First Case ◽  
Mesenteric Root ◽  
Number Of Patients ◽  
Small Intestinal

AbstractSmall intestinal neuroendocrine neoplasms (SI-NEN) frequently metastasise to regional lymph nodes, and surgery is the mainstay of therapy for such patients. However, despite the possible use of advanced surgical techniques, the resection of both primary and locoregional diseases is not always attainable. Intestinal and multivisceral transplantation has been performed in a small number of patients with conventionally nonresectable, slow-growing tumours threatening the mesenteric root but has remained controversial. The use of donor skin in “sentinel flaps” in transplantation theoretically offers advantages in tailoring immunosuppression and monitoring for rejection. We represent (with extended follow-up) the first case of a patient with inoperable extensive mesenteric metastases from SI-NEN, who underwent neoadjuvant peptide receptor radionuclide therapy before a modified multivisceral transplant with a concomitant vascularised sentinel forearm flap. At 48 months after transplantation, our patient remained at full physical activity with no evidence of disease recurrence on either tumour biochemistry or radiological imaging.

scholarly journals Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?

2020 ◽  
Vol 5 (4) ◽  
pp. 315-322 ◽  
Author(s):  
Luke Dixon ◽  
Cillian McNamara ◽  
Pritika Gaur ◽  
Dermot Mallon ◽  
Christopher Coughlan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Illness ◽  
Clinical Characteristics ◽  
Case Series ◽  
Severe Hypoxia ◽  
Related Phenomenon ◽  
Test Results ◽  
Secondary Effects ◽  
Preceding Period ◽  
Baseline Characteristics

BackgroundCerebral microhaemorrhages are increasingly being recognised as a complication of COVID-19. This observational retrospective study aims to further investigate the potential pathophysiology through assessing the pattern of microhaemorrhage and clinical characteristics of patients with COVID-19 and microhaemorrhage. By comparing with similar patterns of microhaemorrhage in other non-COVID-19 disease, this study aims to propose possible common pathogenic mechanisms.MethodsA retrospective observational case series was performed identifying all patients with COVID-19 complicated by cerebral microhaemorrhage on MRI. The distribution and number of microhaemorrhages were recorded using the microbleed anatomical scale, and patients’ baseline characteristics and salient test results were also recorded.ResultsCerebral microhaemorrhages were noted to have a predilection for the corpus callosum, the juxtacortical white matter and brainstem. All patients had a preceding period of critical illness with respiratory failure and severe hypoxia necessitating intubation and mechanical ventilation.DiscussionThis study demonstrates a pattern of cerebral microhaemorrhage that is similar to the pattern reported in patients with non-COVID-19 related critical illness and other causes of severe hypoxia. This raises questions regarding whether microhaemorrhage occurs from endothelial dysfunction due the direct effect of SARS-CoV-2 infection or from the secondary effects of critical illness and hypoxia.

scholarly journals Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Andrei Karpov ◽  
Anish R. Mitra ◽  
Sarah Crowe ◽  
Gregory Haljan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

The management of Elephant's Ear poisoning

2001 ◽  
Vol 20 (4) ◽  
pp. 189-192 ◽  
Author(s):  
D Tagwireyi ◽  
D E Ball
Keyword(s):  
Health Care ◽  
Developing Countries ◽  
Health Care Workers ◽  
Case Series ◽  
Developed Countries ◽  
Limited Resources ◽  
Retrospective Case ◽  
Inappropriate Use ◽  
Care Workers ◽  
Symptomatic Plant

The Araceae family of plants is the major cause of symptomatic plant ingestions in some developed countries (Dieffenbachia and Philodendron) and in Zimbabwe (Elephant's Ear), especially in children. A retrospective case series was carried out to evaluate the management of poisoning due to Elephant's Ear at the largest referral hospital in Zimbabwe for the period January 1995-December 1999. The study revealed inappropriate use of antibiotics, atropine, and antihistamines in the treatment of Elephant's Ear poisoning. This article also reviews the management of poisoning due to the Araceae family of plants as exemplified by Elephant's Ear. There is a need to educate health care workers on the clinical management of Elephant's Ear poisoning especially in developing countries where there are limited resources.

Oral health-care workers and HIV infection control practices in Nigeria

2005 ◽  
Vol 35 (3) ◽  
pp. 147-150 ◽  
Author(s):  
E O Ogunbodede ◽  
M O Folayan ◽  
M A Adedigba
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Infection Control ◽  
Hiv Infection ◽  
Health Care Workers ◽  
Oral Health Care ◽  
Oral Manifestations ◽  
First Case ◽  
Care Workers ◽  
Hiv Aids

The first case of HIV infection was reported in Nigeria in1986. Since then, the prevalence has risen from less than 0.1% in 1987 to 5.8% in 2002, and an estimated 3.6 million Nigerians now live with HIV/AIDS. More than 40 oral manifestations of HIV infection have been recorded and between 70% and 90% of persons with HIV infection will have at least one oral manifestation at sometime during the course of their disease. Oral health-care workers (OHCWS) are expected to play active roles in the prevention and control of HIV/AIDS. In this study, a one-day workshop was organized for 64 oral health workers in Ile-Ife, Nigeria, focusing on the epidemiology of HIV/AIDS, the oral manifestations, control and prevention of HIV in a dental environment, oral care of the infected patient and the ethical, legal and social aspects of HIV/AIDS. Participants' knowledge and practices of infection control were assessed with an infection control checklist administered pre- and post-workshop. Sixty (90.8%) respondents believed that HIV/AIDS was not yet a problem in Nigeria, and 58 (90.6%) believed that drugs have been developed which can cure HIV infection and AIDS. The men complied more with waste disposal regulations than women ( P=0.010). Twenty-nine of 58 (50.0%) did not discard gloves which were torn, cut or punctured. Seven (12.1%) did not change gloves between patients' treatment. Conscious efforts should be made to train OHCWS on all aspects of HIV/AIDS prevention and care. It must never be assumed that adequate information will be acquired through tangential sources.

scholarly journals Attitudes towards preventive tuberculosis treatment among hospital staff

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1738 ◽  
Author(s):  
Vidya Pathak ◽  
Zinta Harrington ◽  
Claudia C. Dobler
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Healthcare Workers ◽  
Significant Proportion ◽  
Hospital Staff ◽  
Test Results ◽  
Tb Treatment ◽  
Care Workers ◽  
Increased Risk ◽  
Latent Tb

Background.Healthcare workers have an increased risk of latent tuberculosis infection (LTBI), but previous studies suggested that they might be reluctant to accept preventive tuberculosis (TB) treatment. We aimed to examine doctors’ and nurses’ experience of TB screening and to explore their attitudes towards preventive TB treatment.Methods.We conducted a survey among randomly selected healthcare workers at a tertiary hospital in Sydney, Australia, using a paper-based questionnaire.Results.A total of 1,304 questionnaires were distributed and 311 (24%) responses were received. The majority of hospital staff supported preventive TB treatment in health care workers with evidence of latent TB infection (LTBI) in general (74%, 164/223) and for them personally (81%, 198/244) while 80 and 53 healthcare workers respectively had no opinion on the topic. Staff working in respiratory medicine were significantly less likely to support preventive TB treatment in health care workers in general or for them personally if they would have evidence of LTBI compared to other specialties (p= 0.001). Only 13% (14/106) of respondents with evidence of LTBI indicated that they had been offered preventive TB treatment. Twenty-one percent (64/306) of respondents indicated that they did not know the difference between active and latent TB. Among staff who had undergone testing for LTBI, only 33% (75/230) felt adequately informed about the meaning of their test results.Discussion.Hospital staff in general had positive attitudes towards preventive TB treatment, but actual treatment rates were low and perceived knowledge about LTBI was insufficient among a significant proportion of staff. The gap between high support for preventive TB treatment among staff and low treatment rates needs to be addressed. Better education on the concept of LTBI and the meaning of screening test results is required.

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