scholarly journals Evaluating the Strategies for Orthopedic and Spine Surgeries during COVID-19 Pandemic in India- a Retrospective Analysis of 24 Patients in a Multispecialty Hospital- Are We Heading to a New Normal?

2020 ◽  
Author(s):  
Hitesh N. Modi ◽  
Utsab Shrestha ◽  
Yatin J. Desai ◽  
Rukesh Patel ◽  
Vipul Kuvad ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Multidisciplinary Approach ◽  
Healthcare Providers ◽  
Average Hospital ◽  
New Normal ◽  
Admission Time ◽  
Screening Protocol ◽  
Precautionary Measures ◽  
Hospital Bill

Abstract Study Design: Retrospective study.Purpose: To present precautionary measures for the orthopedic and spine surgery patients, operating them as per the protocol and analyze findings that can be implemented in non-urgent surgeries during Covid-19 pandemic. Other aim was to analyze the role of multidisciplinary approach, average hospital stay, additional cost behind investigations and hospital bill to guide the patients.Overview of Literature: The literature mentioned to postpone or delay all non-urgent surgeries related to orthopedic and spine conditions till Covid-19 pandemic continues. However, it is not predicted when will this end. No study focusing to conduct essential but non-urgent orthopedic and spine surgeries during this pandemic. Methods: Between March 11, 2020 and May 8, 2020, information on 24 operated orthopedic and spine surgeries were prospectively collected at our institution. Patients were examined in either designated Flu Clinic or out patient department (OPD) after completing screening protocol for Covid-19. Flu clinic team examined all patients and blood investigations, x-ray chest and additional high resolution CT scan were ordered before admission. Patients with symptoms were investigated with RT-PCR for Covid-19. Standardized protocols using multidisciplinary approach were followed for outpatient clinic, admission, surgery and hospital stay regarding Covid-19. Analysis of patients’ hospital stay, hospital bill, admission time and their results of surgeries were performed.Results: 24 patients were operated for orthopedic and spine surgeries with triage as urgent surgeries. 8 and 16 patients were admitted through flu clinic and OPD, respectively; which caused average admission time 179.4+/-138.5 minutes from presentation to admission. All patients managed orthopedic and spine surgeries with improved VAS from average 8.5+/-0.6 preoperatively to 2.7+/-1.0 postoperatively. There was average increase of 5.4+/-2.4% in the overall cost compared to final bill pertaining to Covid-19 precautionary measures. There was no patient or healthcare worker who developed symptoms related to Covid-19.Conclusions: Surgeries should be conducted during Covid-19 pandemics according to their need either to save lives or to provide improved quality of life. Multidisciplinary approach following strict precautionary measures can make it a new-normal norm for the healthcare providers.

Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia patients requiring hospitalization (MAC-19 PRO): a case series

2020 ◽  
Vol 3 (3) ◽  
pp. 297-310 ◽  
Author(s):  
Rafael Ricafranca Castillo ◽  
Gino Rei A. Quizon ◽  
Mario Joselito M. Juco ◽  
Arthur Dessi E. Roman ◽  
Donnah G De Leon ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Hospital Stay ◽  
Clinical Improvement ◽  
Case Series ◽  
High Dose ◽  
Chest Imaging ◽  
Imaging Findings ◽  
Rt Pcr ◽  
Average Hospital ◽  
Sleeping Problems

 Treatment for coronavirus disease 2019 (COVID19) pneumonia remains empirical and the search for therapies that can improve outcomes continues. Melatonin has been shown to have anti-inflammatory, antioxidant, and immune-modulating effects that may address key pathophysiologic mechanisms in the development and progression of acute respiratory distress syndrome (ARDS), which has been implicated as the likely cause of death in COVID19. We aimed to describe the observable clinical outcomes and tolerability of high-dose melatonin (hdM) given as adjuvant therapy in patients admitted with COVID19 pneumonia. We conducted a retrospective descriptive case series of patients who: 1) were admitted to the Manila Doctors Hospital in Manila, Philippines, between March 5, 2020 and April 4, 2020; 2) presented with history of typical symptoms (fever, cough, sore throat, loss of smell and/or taste, myalgia, fatigue); 3) had admitting impression of atypical pneumonia; 4) had history and chest imaging findings highly suggestive of COVID19 pneumonia, and, 5) were given hdM as adjuvant therapy, in addition to standard and/or empirical therapy. One patient admitted to another hospital, who one of the authors helped co-manage, was included. He was the lone patient given hdM in that hospital during the treatment period. Main outcomes described were: time to clinical improvement, duration of hospital stay from hdM initiation, need for mechanical ventilation (MV) prior to cardiopulmonary resuscitation, and final outcome (death or recovery/discharge). Of 10 patients given hdM at doses of 36-72mg/day per os (p.o.) in 4 divided doses as adjuvant therapy, 7 were confirmed COVID19 positive (+) by reverse transcription polymerase chain reaction (RT-PCR) and 3 tested negative  (-), which was deemed to be false (-) considering the patients’ typical history, symptomatology, chest imaging findings and elevated bio-inflammatory parameters.  In all 10 patients given hdM, clinical stabilization and/or improvement was noted within 4-5 days after initiation of hdM. All hdM patients, including 3 with moderately severe ARDS and 1 with mild ARDS, survived; none required MV. The 7 COVID19(+) patients were discharged at an average of 8.6 days after initiation of hdM. The 3 highly probable COVID19 patients on hdM were discharged at an average of 7.3 days after hdM initiation. Average hospital stay of those not given hdM (non-hdM) COVID19(+) patients who were admitted during the same period and recovered was 13 days. To provide perspective, although the groups are not comparable, 12 of the 34 (35.3%) COVID19(+) non-hdM patients admitted during the same period died, 7/34 (20.6%) required MV; while 6 of 15 (40%) non-hdM (-) by RT-PCR but highly probable COVID19 pneumonia patients also died, 4/15  (26.7%) required MV. No significant side-effects were noted with hdM except for sleepiness, which was deemed favorable by all patients, most of whom had anxiety- and symptom-related sleeping problems previously. HdM may have a beneficial role in patients treated for COVID19 pneumonia, in terms of shorter time to clinical improvement, less need for MV, shorter hospital stay, and possibly lower mortality. HdM was well tolerated. This is the first report describing the benefits of hdM in patients being treated for COVID19 pneumonia.  Being a commonly available and inexpensive sleep-aid supplement worldwide, melatonin may play a role as adjuvant therapy in the global war against COVID19. 

scholarly journals Engineering Solutions to COVID-19 and Racial and Ethnic Health Disparities

2021 ◽  
Author(s):  
Gilda A. Barabino
Keyword(s):  
Health Disparities ◽  
Black Community ◽  
Systems Approach ◽  
Healthcare Providers ◽  
Structural Racism ◽  
Communities Of Color ◽  
Collective Response ◽  
Design Skills

AbstractThe role of engineers in response to the COVID-19 pandemic and in the elimination of health disparities, while not always visible, has important implications for the attainment of impactful solutions. The design skills, systems approach, and innovative mindset that engineers bring all have the potential to combat crises in novel and impactful ways. When a disparities lens is applied, a lens that views gaps in access, resources, and care, the engineering solutions are bound to be more robust and equitable. The disproportionate impact of COVID-19 on the Black community and other communities of color is linked to inequities in health rooted in a centuries long structural racism. Engineers working collaboratively with physicians and healthcare providers are poised to close equity gaps and strengthen the collective response to COVID-19 and future pandemics.

scholarly journals Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort

2021 ◽  
Vol 29 (1) ◽  
pp. 1932702
Author(s):  
Lashanda Skerritt ◽  
Alexandra de Pokomandy ◽  
Nadia O’Brien ◽  
Nadia Sourial ◽  
Ann N Burchell ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Patient Comfort ◽  
Women Living With Hiv ◽  
Living With Hiv

Facilitating Change in Anorexia Nervosa: The Role of Occupational Therapy

1992 ◽  
Vol 55 (9) ◽  
pp. 334-339 ◽  
Author(s):  
Priscilla Harries
Keyword(s):  
Anorexia Nervosa ◽  
Occupational Therapy ◽  
Multidisciplinary Approach ◽  
Projective Art

Patients with anorexia nervosa benefit from a multidisciplinary approach. This article gives a brief description of, first, the illness and its treatment and, secondly, the occupational therapy techniques used at the Maudsley Unit. It then demonstrates the progress of patients through examples of projective art.

scholarly journals 321 Role of Antibiotics in Acute uncomplicated diverticulitis, A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A A Tahir ◽  
K M Ali ◽  
A U Khan ◽  
S Kamal ◽  
A Hussain ◽  
...  
Keyword(s):  
Systematic Review ◽  
Statistical Analysis ◽  
Treatment Failure ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Dietary Advice ◽  
Duration Of Hospital Stay ◽  
Uncomplicated Diverticulitis ◽  
Acute Uncomplicated Diverticulitis

Abstract Introduction Diverticular disease is a common health problem with a wide clinical spectrum. About 75% of the patients would have uncomplicated diverticulitis. Cornerstones of treatment are antibiotics, analgesia, and dietary advice. Recent evidence has shown that its treatment is controversial, questioning the use of antibiotics. Aim is to assess the role of antibiotics in the treatment of acute uncomplicated diverticulitis. Method This is a systematic review and Meta-analysis. Literature review of the available studies was conducted using search engines like Pubmed, Medline, Embase, Google Scholar, and Cochrane databases. Statistical analysis was conducted using RevMan5.4. Results Out of 1754 records 1324 were duplicates, 430 studies were screened. 395 were further excluded.35 full text articles were assessed and in the final review 10 studies were included. PRISMA guidelines were used. Pooled OR for recurrence = 0.92 (95% CI = 0.74 to 1.13). Pooled OR for Hospital stay= -0.66 (95% CI= -1.12 to -0.21). Pooled OR for complications = 1.06 (95% CI = 0.69 to 1.64). Pooled OR for treatment failure= 1.24 (95% CI = 0.90-1.69). Conclusions We conclude that from the available evidence antibiotics have no role in reducing recurrence, complications, treatment failure, and duration of hospital stay in acute uncomplicated diverticulitis.

scholarly journals Nutritional Optic Neuropathies: State of the Art and Emerging Evidences

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2653
Author(s):  
Matilde Roda ◽  
Natalie di Geronimo ◽  
Marco Pellegrini ◽  
Costantino Schiavi
Keyword(s):  
Bariatric Surgery ◽  
Optic Neuropathy ◽  
Multidisciplinary Approach ◽  
State Of The Art ◽  
Signs And Symptoms ◽  
Therapeutic Strategies ◽  
Scientific Interest ◽  
Optic Nerve Atrophy ◽  
Prompt Diagnosis

Nutritional optic neuropathy is a cause of bilateral, symmetrical, and progressive visual impairment with loss of central visual acuity and contrast sensitivity, dyschromatopsia, and a central or centrocecal scotoma. The clinical features are not pathognomonic, since hereditary and toxic forms share similar signs and symptoms. It is becoming increasingly common due to the widespread of bariatric surgery and strict vegetarian or vegan diets, so even the scientific interest has recently increased. In particular, recent studies have focused on possible pathogenetic mechanisms, and on novel diagnostic and therapeutic strategies in order to prevent the onset, make a prompt diagnosis and an accurate nutritional supplementation, and to avoid irreversible optic nerve atrophy. Nowadays, there is clear evidence of the role of cobalamin, folic acid, thiamine, and copper, whereas further studies are needed to define the role of niacin, riboflavin, and pyridoxine. This review aims to summarize the etiology, diagnosis, and treatment of nutritional optic neuropathy, and it is addressed not only to ophthalmologists, but to all physicians who could come in contact with a patient with a possible nutritional optic neuropathy, being a fundamental multidisciplinary approach.

scholarly journals The Abstruse Side of Type I Interferon Immunotherapy for COVID-19 Cases with Comorbidities

2021 ◽  
Vol 1 (1) ◽  
pp. 49-59
Author(s):  
Selvakumar Subbian
Keyword(s):  
Infectious Diseases ◽  
Disease Severity ◽  
Type I Interferon ◽  
Host Factors ◽  
Type I ◽  
The Novel ◽  
Inflammatory Drugs ◽  
Precautionary Measures ◽  
Inducible Genes

The Coronavirus Disease-2019 (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has claimed 1.2 million people globally since December 2019. Although the host factors underpinning COVID-19 pathology are not fully understood, type I interferon (IFN-I) response is considered crucial for SARS-CoV-2 pathogenesis. Perturbations in IFN-I signaling and associated interferon-inducible genes (ISG) are among the primary disease severity indicators in COVID-19. Consequently, IFN-I therapy, either alone or in- combination with existing antiviral or anti-inflammatory drugs, is tested in many ongoing clinical trials to reduce COVID-19 mortality. Since signaling by the IFN-I family of molecules regulates host immune response to other infectious and non-infectious diseases, any imbalance in this family of cytokines would impact the clinical outcome of COVID-19, as well as other co-existing diseases. Therefore, it is imperative to evaluate the beneficial-versus-detrimental effects of IFN-I immunotherapy for COVID-19 patients with divergent disease severity and other co-existing conditions. This review article summarizes the role of IFN-I signaling in infectious and non-infectious diseases of humans. It highlights the precautionary measures to be considered before administering IFN-I to COVID-19 patients having other co-existing disorders. Finally, suggestions are proposed to improve IFN-I immunotherapy to COVID-19.

scholarly journals The Role of Self-Perceptions of Aging for Recovery of Older Adults After a Hospital Stay

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 588-588
Author(s):  
Anne Blawert ◽  
Ellen Freiberger ◽  
Susanne Wurm
Keyword(s):  
Older Adults ◽  
Hospital Stay ◽  
Physical Function ◽  
Fear Of Falling ◽  
Health Events ◽  
Self Perceptions ◽  
Perceptions Of Aging ◽  
One Year ◽  
Psychological Pathway

Abstract For older adults, a hospital stay can lead to loss of physical function and frailty. It is therefore important to investigate factors for recovery after hospitalization. Recent studies suggest negative self-perceptions of aging (SPA) as a potential risk factor in the context of serious health events. This ongoing longitudinal study investigates how negative SPA might contribute to worse physical recovery (assessed with the Short Physical Performance Battery) after hospital stay in a sample of 244 German adults aged 75 to 96. Preliminary mediation analysis based on available data of the first 50 participants indicate that negative SPA is related to increased fear of falling after 6 months, which predicts worse physical function one year after hospitalization (indirect effect: B = -0.70, SE = 0.41, p = .09). The results stress the importance of SPA for health recovery in old age and introduce fear of falling as a psychological pathway.

Sign in / Sign up

Export Citation Format

Share Document