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Overview

MeSH Disease

Human Phenotype

Transmission

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Seroprevalence

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    The Impact of COVID-19 pandemic Lockdown on the utilization of acute surgical care, retrospective, multicenter analysis

    Authors: Jaroslav Presl; Martin Varga; Christof Mittermaier; Stefan Mitterwallner; Michael Weitzendorfer; Kurosch Borhanian; Andreas Heuberger; Helmut Weiss; Klaus Emmanuel; Burkhard von Rahden; Oliver Owen Koch

    doi:10.21203/rs.3.rs-70079/v1 Date: 2020-09-01 Source: ResearchSquare

    Background: The emergency general surgery encompasses the care of critically ill MESHD patients, with a potentially high mortality if delayed. As some medical disciplines have reported a strong decrease of emergencies during the COVID-19 pandemic, remains the effect of the Lockdown on the general surgery emergencies unclear. Methods:This study is a retrospective, multicentre analysis of the general surgery emergency operations performed during the 2020 Lockdown and in the same period of 2019 in three centers covering the surgical care of the area Salzburg-North, Austria. Results: In total 165 emergency surgeries were performed in the study period of 2020 compared to 287 in Year 2019. This is a significant decrease of 122 (42.5%) emergency surgeries during the COVID-19 Lockdown (p=0.005). The average length of hospital stay in the 2019 was in median 4 days and was reduced to 3 days during the Lockdown. Appendectomy remained the most performed emergency surgery for the both periods but the operations count reduced to less than a half with 72 cases in 2019 and 33 cases in 2020 (p=0.118). Considering the ration of appendectomy vs all emergency surgeries, it represented 25 % in 2019 and 20% in 2020. The emergency colon surgery observed the strongest decrease of 75% from 17 cases in 2019 to 4 in 2020. In addition, the emergency abdominal wall hernia HP, cholecystectomies for acute cholecystitis MESHD cholecystitis HP, small surgeries and proctological emergencies recorded drops of 70%, 39%, 33% and 47% respectively. A strongest reduction in frequency of 6 of 13 main categories of emergency surgeries was reported from Center 1, which was the only COVID designed Center (“Hot” hospital) in the examined region.Conclusions:The emergency general surgery is an essential service that continues to run under any circumstances. Our data showed that the COVID-19 related restriction and the fear of being infected with COVID-19 in the hospital result in a significant decrease of the utilization of acute surgical care. Policies and modern alternatives are needed to ensure continued access to specialized services to prevent patients from harm. 

    COVID-19 Outbreak and Acute Cholecystitis MESHD Cholecystitis HP in a Hub Hospital in Milan: Wider Indications for Percutaneous Cholecystostomy.

    Authors: Matteo Barabino; Gaetano Piccolo; Arianna Trizzino; Veronica Fedele; Carlo Ferrari; Vincenzo Nicastro; Andrea Pisani Ceretti; Enrico De Nicola; Nicolò Maria Mariani; Marco Giovenzana; Giovanna Scifo; Massimiliano Mazza; Ruggero Vercelli; Roberto Santambrogio; Carmelo Luigiano; Enrico Opocher

    doi:10.21203/rs.3.rs-69267/v1 Date: 2020-08-31 Source: ResearchSquare

    BACKGROUND.COVID-19 pandemic has impacted the Italian national health care system at many different levels, causing a complete reorganization of surgical wards. In this context, in this study we retrospectively analyzed our management strategy for patients with acute cholecystitis MESHD cholecystitis HP.METHODS.We analyzed all patients admitted to our Emergency Department for acute cholecystitis MESHD cholecystitis HP from February 27th to April 30th, 2020. We graded each case according to the 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. RESULTS.Thirty-seven patients were admitted for acute cholecystitis MESHD cholecystitis HP (13 grade I, 16 grade II and 8 grade III). According to Tokyo Guidelines 2018, patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in 29.7%, 21.6 % and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous drainage was of 87.5%, the mean post-procedural hospitalization length was 9 days, and no related adverse event were observed.CONCLUSIONS.Bedside cholecystostomy has shown to be an effective and safe treatment, which acquired an increased relevance in the present acute phase of the pandemic. This strategy will potentially be taken into consideration in future phases, when the coexistence with the virus will require us to respond in an even more virtuous fashion. 

    COVID-19 outbreak and acute cholecystitis MESHD cholecystitis HP in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy.

    Authors: Barabino Matteo; Piccolo Gaetano; Trizzino Arianna; Fedele Veronica; Ferrari Carlo; Nicastro Vincenzo; Pisani Ceretti Andrea; De Nicola Enrico; Mariani Nicolò Maria; Giovenzana Marco; Scifo Giovanna; Mazza Massimiliano; Vercelli Ruggero; Santambrogio Roberto; Luigiano Carmelo; Opocher Enrico

    doi:10.21203/rs.3.rs-65752/v1 Date: 2020-08-25 Source: ResearchSquare

    BACKGROUND.COVID-19 pandemic has impacted the Italian national health care system at many different levels, causing a complete reorganization of surgical wards. In this context, in this study we retrospectively analyzed our management strategy for patients with acute cholecystitis MESHD cholecystitis HP.METHODSWe analyzed all patients admitted to our Emergency Department for acute cholecystitis MESHD cholecystitis HP from February 27th to April 30th, 2020. We graded each case according to the 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. RESULTSThirty-seven patients were admitted for acute cholecystitis MESHD cholecystitis HP (13 grade I, 16 grade II and 8 grade III). According to Tokyo Guidelines 2018, patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in 29.7%, 21.6 % and 48.7% of cases respectively.  Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous drainage was of 87.5%, the mean post-procedural hospitalization length was 9 days, and no related adverse event were observed.CONCLUSIONS.Bedside cholecystostomy has shown to be an effective and safe treatment, which acquired an increased relevance in the present acute phase of the pandemic. This strategy will potentially be taken into consideration in future phases, when the coexistence with the virus will require us to respond in an even more virtuous fashion. 

    Acute acalculous cholecystitis MESHD cholecystitis HP on a COVID-19 patient: a case report

    Authors: Edoardo Mattone; Maria Sofia; Elena Schembari; Valentina Palumbo; Rosario Bonaccorso; Valentina Randazzo; Gaetano La Greca; Carmelo Iacobello; Domenico Russello; Saverio Latteri

    doi:10.21203/rs.3.rs-42230/v1 Date: 2020-07-13 Source: ResearchSquare

    Background coronavirus disease-19 (COVID-19) has spread to several countries around the world and has become an unprecedented pandemic. We report an extremely rare case of acute acalculous cholecystitis MESHD cholecystitis HP on a COVID-19 patient. In our knowledge, this is the first report of laparoscopic cholecystectomy performed on a COVID-19 patient.Case presentation: a COVID-19 patient was diagnosed with acute acalculous cholecystitis MESHD cholecystitis HP and a multidisciplinary team decided to perform a percutaneous transhepatic biliary drainage (PTBD) as the first treatment. SARS-CoV-2 RNA was not found in the bile fluid. Because of deterioration of the patient’s clinical conditions, laparoscopic cholecystectomy had to be performed and since the gallbladder was gangrenous MESHD, the severe inflammation MESHD made surgery difficult to perform.Conclusions acalculous cholecystitis MESHD cholecystitis HP was related with mechanical ventilation and prolonged total parenteral nutrition, in this case the gangrenous MESHD histopathology pattern and the gallbladder wall ischemia MESHD was probably caused by vascular insufficiency MESHD secondary to severe acute respiratory distress syndrome MESHD respiratory distress HP syndrome of COVID-19 pneumonia MESHD pneumonia HP. The percutaneous transhepatic gallbladder drainage (PTBD) was performed according to Tokyo Guidelines because of high surgical risk. Laparoscopic cholecystectomy was next performed due to no clinical improvement. The absence of viral RNA in the bile highlights that SARS-CoV-2 is not eliminated with the bile while it probably infects MESHD small intestinal enterocytes which is responsible of gastrointestinal symptoms such as anorexia HP anorexia MESHD, nausea, vomiting HP nausea, vomiting MESHD vomiting MESHD, and diarrhea HP diarrhea MESHD. Although the lack of evidence and guidelines about the management of patient with acute cholecystitis MESHD cholecystitis HP during COVID-19 pandemic, laparoscopic cholecystectomy, at most preceded by PTGBD on high surgical risk patients, remains the gold standard for the treatment of acute cholecystitis MESHD cholecystitis HP on COVID-19 patients.

    Effects of COVID-19 pandemic on general surgical emergencies: Are some emergencies really urgent? Level 1 Trauma MESHD center experience

    Authors: Ahmet Surek; Sina Ferahman; Eyup Gemici; Ahmet Cem Dural; Turgut Donmez; Mehmet Karabulut

    doi:10.21203/rs.3.rs-37618/v1 Date: 2020-06-23 Source: ResearchSquare

    Purpose: We aimed to investigate the effect of COVID-19 pandemic on general surgical emergencies. On the other hand, we analyzed the effectiveness of the measures we have taken and the incidence of COVID-19 of patients and healthcare professionals.Method: In the pandemic period between March 14 and May 15, 2020, and in the same period of the previous year, the files of patients who underwent emergency surgery and followed up nonoperatively were reviewed retrospectively. The incidence of COVID-19 was questioned in patients operated on in the pandemic period and in health professionals working in the general surgery department.Results: Demographic data were similar between the two groups. The number of patients operated on in the pandemic group (n = 103) was lower than during the control group (n = 252) (p = 0.001). In the pandemic group, there was a significant decrease in the number of surgeries of uncomplicated appendicitis MESHD, acute cholecystitis MESHD cholecystitis HP and incarcerated hernia HP (p=0.001, p=0.005, p=0.001, respectively). Others surgeries were similar in both groups. In the pandemic group, nonoperatively follow-up rates were significantly lower in acute mechanical intestinal obstruction MESHD intestinal obstruction HP and acute cholecystitis MESHD cholecystitis HP (p=0.001, p=0.011, respectively). The findings of COVID-19 were positive in 6(6/103, %5.82) patients undergoing emergency surgery. None of our doctors had COVID-19 infection (0/20). The findings were positive only in 2 nurses from the general surgery department(2/24, %8,33).Conclusion: In these and similar pandemics, we think that a new algorithm is needed to approach emergencies and the results of this study can help for that.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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