Project description:Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID-19. We created an international observational registry to collect airway management outcomes in children with COVID-19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID-19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test-confirmed or suspected COVID-19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first-pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID-19 negative and 329 confirmed or presumed COVID-19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID-19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70-4.10)). Children who had symptoms of COVID-19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5-9.1)). Children with confirmed or presumed COVID-19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.
Project description:BackgroundAfter the 2002/2003 severe acute respiratory syndrome outbreak, 30% of survivors exhibited persisting structural pulmonary abnormalities. The long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) are yet unknown, and comprehensive clinical follow-up data are lacking.MethodsIn this prospective, multicentre, observational study, we systematically evaluated the cardiopulmonary damage in subjects recovering from COVID-19 at 60 and 100 days after confirmed diagnosis. We conducted a detailed questionnaire, clinical examination, laboratory testing, lung function analysis, echocardiography and thoracic low-dose computed tomography (CT).ResultsData from 145 COVID-19 patients were evaluated, and 41% of all subjects exhibited persistent symptoms 100 days after COVID-19 onset, with dyspnoea being most frequent (36%). Accordingly, patients still displayed an impaired lung function, with a reduced diffusing capacity in 21% of the cohort being the most prominent finding. Cardiac impairment, including a reduced left ventricular function or signs of pulmonary hypertension, was only present in a minority of subjects. CT scans unveiled persisting lung pathologies in 63% of patients, mainly consisting of bilateral ground-glass opacities and/or reticulation in the lower lung lobes, without radiological signs of pulmonary fibrosis. Sequential follow-up evaluations at 60 and 100 days after COVID-19 onset demonstrated a vast improvement of symptoms and CT abnormalities over time.ConclusionA relevant percentage of post-COVID-19 patients presented with persisting symptoms and lung function impairment along with radiological pulmonary abnormalities >100 days after the diagnosis of COVID-19. However, our results indicate a significant improvement in symptoms and cardiopulmonary status over time.
Project description:IntroductionDuring the COVID-19 pandemic many non-acute elective surgeries were cancelled or postponed around the world. This has created an opportunity to study the effect of delayed surgery on health conditions prior to surgery and postsurgical outcomes in patients with postponed elective surgery. The control group of the Routine Postsurgical Anesthesia Visit to Improve Patient Outcome (TRACE I) study, conducted between 2016 and 2019, will serve as a control cohort.Methods and analysisTRACE II is an observational, multicentre, prospective cohort study among surgical patients with postponed surgery due to COVID-19 in academic and non-academic hospitals in the Netherlands. We aim to include 2500 adult patients. The primary outcome will be the 30-day incidence of major postoperative complications. Secondary outcome measures include the 30-day incidence of minor postoperative complications, 1 year mortality, length of stay (in hospital, medium care and intensive care), quality of recovery 30 days after surgery and postoperative quality of life up to 1 year following surgery. Multivariable logistic mixed-effects regression analysis with a random intercept for hospital will be used to test group differences on the primary outcome.Ethics and disseminationEthical approval was obtained from the Institutional Review Board of Maastricht University Medical Centre+ and Amsterdam UMC. Findings will be presented at national and international conferences, as well as published in peer-reviewed scientific journals, with a preference for open access journals. Data will be made publicly available after publication of the main results.Trial registration numberNL8841.
Project description:To understand and analyse the global impact of COVID-19 on outpatient services, inpatient care, elective surgery, and perioperative colorectal cancer care, a DElayed COloRectal cancer surgery (DECOR-19) survey was conducted in collaboration with numerous international colorectal societies with the objective of obtaining several learning points from the impact of the COVID-19 outbreak on our colorectal cancer patients which will assist us in the ongoing management of our colorectal cancer patients and to provide us safe oncological pathways for future outbreaks.
Project description:The extraordinary spread of the novel coronavirus (COVID-19) has dramatically and rapidly changed the way in which we provide medical care for patients with all diagnoses. Conservation of resources, social distancing, and the risk of poor outcomes in COVID-19-positive cancer patients have forced practitioners and surgeons to completely rethink routine care. The treatment of patients with rectal cancer requires both a multidisciplinary approach and a significant amount of resources. It is therefore imperative to rethink how rectal cancer treatment can be aligned with the current COVID-19 pandemic paradigms. In this review, we discuss evidence-based recommendations to optimize oncological outcomes during the COVID-19 pandemic.
Project description:There have been many problems generated by the COVID-19 pandemic. One of them is the worrying increase in the generation of medical waste due to the great risk they represent for health. Therefore, this work proposes a mathematical model for optimal solid waste management, proposing a circular value chain where all types of waste are treated in an intensified industrial park. The model selects the processing technologies and their production capacity. The problem was formulated as a mixed-integer linear programming problem to maximize profits and the waste processed, minimizing environmental impact. The proposed strategy is applied to the case study of the city of New York, where the increase in the generation of medical waste has been very significant. To promote recycling, different tax rates are proposed, depending on the amount of waste sent to the landfill. The results are presented on a Pareto curve showing the trade-off between profits and processed waste. We observed that the taxes promote recycling, even of those wastes that are not very convenient to recycle (from an economic point of view), favoring profits, reducing the environmental impact, and the risk to health inherent to the medical waste.
Project description:New cases of the novel coronavirus, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are increasing around the world. Currently, health care services are mainly focused on responding to and controlling the unique challenges of the coronavirus disease 2019 (COVID-19) pandemic. These changes, along with the higher susceptibility of patients with cancer to infections, have profound effects on other critical aspects of care and pose a serious challenge for the treatment of such patients. During the COVID-19 pandemic, it is important to provide strategies for managing the treatment of patients with cancer to limit COVID-19-associated risks at this difficult time. The present study set out to summarize the latest research on epidemiology, pathogenesis, and clinical features of COVID-19. We also address some of the current challenges associated with the management of patients with cancer during the COVID-19 pandemic and provide practical guidance to clinically deal with these challenges.
Project description:La pandémie à coronavirus 2019 (COVID-19) a contraint les pouvoirs publics français à instaurer un confinement à domicile de la population, avec un impact potentiel sur l’équilibre glycémique des patients diabétiques. Dans ce contexte, la télémédecine semble être un outil pertinent pour assurer le suivi de ces patients. Nous avons réalisé une étude prospective observationnelle, aux hôpitaux universitaires de Strasbourg, ainsi que dans un cabinet libéral de la ville, afin d’évaluer l’équilibre glycémique à 3 mois de 491 patients diabétiques, suivis par téléconsultation (n = 338) ou dont la consultation en présentiel a été reportée à 6 mois (n = 153). Des questionnaires de satisfaction patients et médecins ont été recueillis pour apprécier l’impact des actions de télémédecine. À 3 mois, une réduction moyenne non significative de ?0,33 % du taux d’hémoglobine glyquée (HbA1c) était observée dans le groupe suivi par téléconsultation (n = 175) contre ?0,13 % dans le groupe sans téléconsultation (n = 92). Dans le groupe téléconsultation, l’HbA1c diminuait de 7,65 ± 1,19 % à 7,18 ± 0,9 % pour les patients suivis à l’hôpital (n = 97), et de 7,28 ± 0,80 % à 7,11 ± 0,79 % pour les patients suivis en ville (n = 78). Quatre-vingt-douze pour cent des patients se sont déclarés satisfaits de leur téléconsultation, positionnant la téléconsultation comme une alternative à une consultation en présentiel et la recommanderaient à un autre patient diabétique. Alors que sept diabétologues sur huit n’avaient jamais effectué de téléconsultation, tous souhaitent continuer cette modalité de suivi après la crise sanitaire. Au regard des données manquantes — en lien avec les difficultés de recueil pendant la pandémie — la tendance à l’amélioration de l’équilibre glycémique observée dans le groupe téléconsultation doit être confirmée par une évaluation à 6 mois de l’équilibre glycémique des patients.