The Impact of the Protective Measures on Healthcare Workers During Covid-19 Pandemic in Tertiary University Hospital

Background: A novel coronavirus “SARS-CoV-2” causes the disease COVID-19. A high transmission rate within healthcare workers was reported. We aimed to determine effect of our protective measures on infection rate, related risk factors and measures that can be taken among healthcare professionals in our university hospital. Methods: We conducted a retrospective cohort study to analyse the data of infected healthcare providers. Demographic data of the patients, computed tomography (CT) scan findings, laboratory parameters and any symptoms related with Covid-19 disease were recorded. The real‐time reverse transcription Polymerase Chain Reaction (PCR) results were evaluated. Results: The infection rate was 3.8% (143 of 3700 healthcare workers). Of 143 infected healthcare workers, 91 were female and 52 were male. Mean age of these patients was 32.5±8.6 years (Table 1). First PCR tests of 99 symptomatic healthcare staff were positive. Second tests of 84 of them were negative. The most common symptom was dry cough (47 patients, 32.8%). Treatment of 117 healthcare staff has been completed and they returned to work. Mortality or intensive care unit stay have not been observed. Conclusion: The transmission rate was relatively low in our university hospital. Our protective measures of increased awareness of personal protection, adherence to algorithms, supportive attitudes of hospital management, proper preparation and intervention play a critical role in reducing infection risk for healthcare workers. Public Interest Summary. Corona Virus (COVID 19) pandemic may continue for more time. To prevent its spread within health workers personnel, should follow a strict preventive measure. Increased awareness of personal protection equipment, adherence to algorithms, supportive attitudes of hospital management, proper preparation and intervention play a critical role in reducing infection risk for healthcare workers. Supportive behaviours of hospital administration and managers are essential to increase the enthusiasm of the staff. The Ministry of Health (MOH) should design a flexible working hours system and prevent long working hours under extreme pressure. All meetings are better to be held with a teleconference to prevent face-to-face transmission.

Preventive measures against 2019 Coronavirus infection in healthcare personnel: experience of a healthcare structure dedicated to covid 19 in Morocco

In March 2, 2020, the novel coronavirus disease 19 pandemic, declared in China at the end of 2019, made 88,948 confirmed cases worldwide, including 80,174 cases and 2,915 deaths in China, on this date Morocco recorded the first confirmed case. Given the magnitude of this pandemic, the World Health Organization has highlighted growing problems in the supply of personal protective equipment (PPE). Front-line health personnel are dangerously under-equipped to treat patients suffering from COVID-19. Morocco has learned from the evolution of the pandemic across various countries and has developed a National vigilance and Response Plan for covid 2019 aimed at upgrading hospital structures and supplying equipment for prevention and diagnosis In Morocco, deaths from covid 19 are few, At the level of the military field hospital where the study is being carried out, no case of infection has occurred. This observation shows the need for vigilance in the face of health epidemics and emergencies. The role of national institutions is devoted to the implementation of monitoring and response strategies that allow the management of human and logistical resources. Regarding care staff, continuous training and the provision of protection equipement and support is a fundamental point for proper functioning and better performance.

Malignant Hyperthermia - A Case Report of a Paediatric Patient

We encountered a case of malignant hyperthermia (MH) in a 3-year-old boy during general anesthesia induction for laparotomy. It has been generally reported that sevoflurane can induce the delayed onset of MH in the absence of succinylcholine. Our case of MH was elicited after about 90 mins of sevoflurane administration with 50/50% Air/O2 mixture. However the patient was successfully treated by early recognition of his condition and supportive treatment.

Anesthesia for Awake Craniotomy in Patients with Metastatic Brain Tumor in Ibadan, Nigeria

Introduction: Craniotomies can be performed under general anaesthesia or with the patients awake known as awake craniotomy. Awake craniotomy requires that the patients be conscious and cooperative during intraoperative neurological testing. Methods: This was a retrospective study of the anaesthetic protocol and the complications encountered during the perioperative management of patients who had awake craniotomy for metastatic brain resection in a developing country over a 3- year period. The information retrieved were demographic data, tumor location, anaesthetic technique and perioperative complications. Results: There were ten patients comprising of 9 (90%) females and 1 (10%) male. The age ranged from 33 to 66 years with a mean age of 44.00 ± 12.02 years. Eight patients had metastatic brain tumor from the breast carcinoma, one from the lung and the last patient had metastasis from the colon. Four patients had tumor excision from the frontal lobe while 6 patients had excision from the parietal lobe. They all had solitary brain tumor. The anaesthetic technique used was conscious sedation and scalp block. Propofol and fentanyl were used for the conscious sedation while 0.25% Plain Bupivacaine and 1% Lidocaine with adrenaline (1: 200,00) were used for the scalp block. Patients were allowed to breathe spontaneously 100% oxygen. Two patients had respiratory depression with oxygen saturation less than 95% and laryngeal mask airway was inserted. Hypertension and tachycardia were seen in 4 patients, focal seizure in 2 patients and aphasia in 1 patient. Intensive care unit admission was for 24 hours and the today length of hospital stay was 2-7 days. No mortality in this series. Conclusion: Conscious sedation with scalp block is a safe and a tolerable technique for awake craniotomy. The complications observed were minimal and can be treated to obtain a good outcome.

Measurement of Inferior Ven Cava Collapsibility Index and Its Correlation to Central Venous Pressure in Adult Critically Ill Patients a Prospective Observational Study

Fluid therapy is an essential component part management of critically ill patients. Proper estimation of the amount of needed fluids is of great importance due to the well-established adverse effects of marked negative and positive fluids balance. Central venous pressure has been widely used by ICU physicians for volume status assessment. Several methods have been postulated for volume status assessment, among which is the inferior vena cava collapsibility index. As the inferior vena cava is a thin-walled capacitance vessel that adjusts to the body’s volume status by changing its diameter depending on the total body fluid volume. Giving the fact that bed-side ultrasonographic measurement of inferior vena cava diameters is an available, non-invasive, reproducible and quiet easy-to-learn technique, it can provide a safe and quiet reliable replacement of central venous pressure measurement for assessment of volume status assessment. The aim of this study was to find statistical correlation between central venous pressure and caval index, as a step towards validating the above mentioned replacement. 86 critically ill patients from ICU population were enrolled. Simultaneous measurements of central venous pressure and inferior vena cava collapsibility index were observed and recorded on four sessions. Patients were also grouped based on their mode of ventilation and central venous pressure values in order to compare the strength of correlation between various populations. The results showed that Inferior vena cava collapsibility index has significant inverse correlation with CVP value (r= -85, p value ˂0.001 at 95% CI) and it better correlated with mean arterial blood pressure and lactate clearance as compared to central venous pressure. However it correlated better with CVP in spontaneously breathing patients (r= -0.86, p value ˂0.001) than in mechanically ventilated patients (r= -0.84, p value ˂0.001). Inferior vena cava collapsibility index has shown to correlate better with CVP value in lower values (˂ 10 cmH2O) (r= -0.8, p value ˂0.001) than in higher values (≥ 10 cmH2O) (r= -0.6, p value ˂0.001). In addition, an inferior vena caval collapsibility index cut-off value of 29% was shown to discriminate between CVP values ˂10 cmH2O and values ≥10 cmH2O with high Sensitivity (88.6%) and specificity (80.4%). In conclusion, inferior vena cava collapsibility index has a strong inverse relationship with central venous pressure which is more pronounced at low central venous pressure values. Point-of-care ultrasonographically-measured inferior vena cava collapsibility index is very likely to be a good alternative to central venous pressure measurement with a high degree of precision and reproducibility. However, Wide scale studies are needed to validate its use in different patient populations.

The Influence of Magnetic Resonance Imaging and Adjunct Acupuncture on LongTerm Pain Improvement for Patients with Trigeminal Neuralgia

Trigeminal neuralgia is a debilitating disease characterized by neuropathic facial pain which significantly impact on the patient’s quality of life and socioeconomic function. For patients with trigeminal neuralgia, Magnetic Resonance Imaging (MRI) is a routine investigation recommended in recent clinical guidelines but it remains unclear whether its use has any impact on patient-reported clinical outcomes. Acupuncture as an adjunct therapy has been shown to provide short term pain relief but its longer-term benefits remain unknown. The aims of the study are to examine whether the use of MRI and/ or adjunct acupuncture is associated with the long-term pain improvement for trigeminal neuralgia patients, and thus to inform on prognosis of trigeminal neuralgia. Methods: In this retrospective cohort study using data from routine clinical practice, we included all adult patients diagnosed with trigeminal neuralgia and managed at the Pain Management Centre, Singapore General Hospital between 2011 and 2017. Patients who have incomplete clinical data or lost to follow up are excluded. Logistic regression model was used to examine the association between the uses of MRI or adjunct MRI and pain symptom improvement at 6-12 months follow up. Results: Fifty-three patients were identified and included in this study. Neither the use of MRI nor acupuncture was found to be significantly associated with pain improvement for patients with trigeminal neuralgia at 6 to 12 months follow up after the initial diagnosis. Conclusion: The use of MRI or adjunct acupuncture did not seem to be related to long-term pain improvement for patients with trigeminal neuralgia and thus has limited prognostic value. These findings would have to be confirmed by further studies of larger sample size, and ideally with prospective randomized clinical trials.

A Case of Acute Lung Failure: Administration of Exogenous Surfactant As A Successful Treatment

We are describing a case of acute lung injury associated with uraemia and haemorrhagic shock. The treatment has consisted of the administration of repeated and equal doses of exogenous surfactant for 72 hours, starting within 48 hours from the beginning of the symptoms. A rapid improvement in the lung function has been detected, with consequent weaning from mechanical ventilation. The CT scan has confirmed the enhancement of atelectasis and hypoventilation. This case highlights the pivotal role of the administration of exogenous surfactant in selected cases of acute lung injury. If an anti-inflammatory effect is needed, we suppose that a repeated treatment with fractional dose is more effective.

The Effectiveness of Bupivacaine in Decrease Post-Operative Pain After Lumbar Decompression Surgery

Aim: There are many reports about the efficacy of analgesics in reducing postoperative pain after lumbar decompressive surgery. This study aimed to investigate the effect of subdermal and intramuscular injection of bupivacaine on the severity of postoperative pain after lumbar decompression surgery. Material and Methods: in this randomized double-blind trial, 50 patients who candidate for lumbar decompressive surgery elective for this them. Bupivacaine (0.25%) in the intervention group and normal saline (40 ml) in the control group were injected subcutaneously and intramuscularly. Factors of age, size of surgical cutting, number of operating space, duration of operation, the rate of need to analgesia, and the severity of pain at times of 3,12 and 24 hours after surgery were assessed. Results: The severity of pain in Bupivacaine group, in hours 3, 12 and 24 after postoperative surgery was less than control group (P value<0.05). Also There was no significant difference between the two groups in terms of mean pain intensity using repeated measure design (P value<0.05). But within Bupivacaine group, pain severity significantly decreased during the 24 hours after surgery. (p<0.05) Conclusion: Although bupivacaine (0.25%) results in reducing pain after surgery, more studies are recommended to investigate the effect of bupivacaine in combination with other drugs in cases of lumbar decompressive surgery. Also, it reduces pain during the 24 hours after surgery is very important.

Aetiology of Neuropathic Pain (NP) Along with Role of Gabapentinoids Like Pregabalin and Gabapentin in Treating the Excruciating Pain Besides Other Newer Alternatives-a Systematic Review

Neuropathic pain (NP) by definition is a problem that involves the somatosensory system either as a manifestation as disease or as a lesion. Lot of differing causes either of central/peripheral origin can stimulate NP and that might affect life’s quality badly. Worldwide prevalence of NP varies from 6.9-10% with spinal cord injury (SCI) explaining 40% of them. The 2nd commonest cause is diabetic peripheral neuropathy (DPN) that accounts for 22-28% of type 2 diabetes mellitus (T2DM). After having reviewed thoroughly how to manage diabetic neuropathic pain here we decided to conduct a systematic review on varying causes of NP and the role of gabapentenoids in managing the excruciating pain. Besides newer opioid analogues not having addictive potential like fentanyl matrix with its availability in intradermal formulations, delta opioid receptor agonist BBI-11008, an innovative analog N-(1-benzylpiperidin-4-yl)-4-fluorobenzamide (LMH2), that is like haloperidol, along with advantages of Gabapentin-ER as well as therapy of trigeminal neuralgia with anticonvulsants like carbamazepine and use in Immunotherapy utilizing 14,18 anti GD2 antibody (ch14.18) associated excruciating pain and in Meralgia paraesthetica (MP) is discussed besides alternative therapies when gabapentenoids fail.

Excellence in Professional Peak Performance Hope to Believe and a Goal to Achieve “Part 1”

We have crises of professionalism in medical practice which undermines humanism. “The first do no harm” principal stated by Hippocrates more than 2400 years ago is violated. Health care system is a risky domain as the third leading cause of death in America is medical errors, and, half of the mortalities are in the operating room, intensive care unit, as well as in emergency department. Superior knowledge and clinical skills are not sufficient in themselves; as achievement of excellence and professionalism depends on successful interplay of personal qualities and the environment in which they work. We aim to code and categorize the cognitive and mental skills required for excellence and professionalism associated with exceptional peak performance which are poorly defined and rarely incorporated into clinical and anesthetic curriculum. We hope to facilitate education of this tacit dimension of practice needed for patient safety and serenity. We may counteract this defect in health care system through a Multi-Dimensional Protective Vision which is composed of knowledge of human factors, catalogue of cognitive errors with overemphasis on correcting those thought-process errors. We will define Non-Technical Skills which are cognitive, behavioral and interpersonal abilities that are not specific to one profession, but crucial to safety. They are expressed as; art of decision making, task management, situation awareness, communication, and team work in addition to stress management. We will explain the science of High Reliability Organizations which are those organizations like commercial aviation flight and nuclear power stations which are running high risk tasks with excellent safety records. We are going to show the behavioral markers of Crises Resource Management and the coordination strategies that are used to improve safety profile in anesthetic and surgical teams. We suggest audio-video record in risky domain to detect peak performance to learn from, and correct poor performance.