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1.
Pediatr Blood Cancer ; : e28318, 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32240567

RESUMO

The rapid spread of COVID-19 epidemic in Italy, in particular in the Milan focal point, required drastic measures and led to panic in the population. While in our centre we did not change our approach to the treatment of our young cancer patients, we developed a qualitative survey to assess their perception of the risk and level of stress. The survey showed that a relatively large proportion of them felt personally at risk of severe complications. We believe that we need to adequately inform our patients, focusing on hygienic measures and personal protection and prompt reporting of any suspicious symptoms. This article is protected by copyright. All rights reserved.

2.
Lancet Oncol ; 21(4): 467, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32240603
3.
Artigo em Inglês | MEDLINE | ID: mdl-32240755

RESUMO

Cancer patients have an increased risk of developing severe forms of COVID-19, and advanced cancer patients who are followed at home, represent a particularly frail population. Although with substantial differences, the challenges which cancer care professionals have to face with during a pandemic are quite similar to those posed by natural disasters. Some of us have already managed the oncological home care service after the 2009 earthquake in L'Aquila (middle Italy). With this letter, we want to share with the medical community the procedures and tools that we have started using at the home care service of the Tuscany Tumor Association during the COVID-19 pandemic.

4.
J Am Coll Surg ; 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32240770

RESUMO

The novel coronavirus (COVID-19) was first diagnosed in Wuhan, China in December 2019 and has now spread throughout the world, being verified by the World Health Organization as a Pandemic on March 11th. This had led to the calling of a national emergency on March 13th in the United States. Many hospitals, healthcare networks, and specifically Departments of Surgery are asking the same questions of how to cope and plan for surge capacity, personnel attrition, novel infrastructure utilization, and resource exhaustion. Herein, we present a tiered plan for surgical department planning based on incident command levels. This includes Acute Care Surgeon deployment (given their critical care training and vertically integrated position in the hospital), recommended infrastructure and transfer utilization, triage principles, and faculty, resident and advanced care practitioner deployment.

5.
Zhonghua Wai Ke Za Zhi ; 58(4): 273-277, 2020 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-32241056

RESUMO

In this paper, the mechanism of destroying human alveolar epithelial cells and pulmonary tissue by 2019 novel coronavirus (2019-nCoV) was discussed firstly. There may be multiple mechanisms including killing directly the target cells and hyperinflammatory responses. Secondly, the clinical features, CT imaging, short-term and long-term pulmonary function damage of the 2019 coronavirus disease (COVID-19) was analyzed. Finally, some suggestions for thoracic surgery clinical practice in non-epidemic area during and after the epidemic of COVID-19 were provided, to help all the thoracic surgery patients receive active and effective treatment.

11.
Ann Oncol ; 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32224151

RESUMO

BACKGROUND: Cancer patients are regarded as a highly vulnerable group in the current Coronavirus Disease 2019 (COVID-19) pandemic. To date, the clinical characteristics of COVID-19-infected cancer patients are largely unknown. PATIENTS AND METHODS: In this retrospective cohort study, we included cancer patients with laboratory confirmed COVID-19 from three designated hospitals in Wuhan, China. The clinical data were collected from medical records from Jan 13, 2020, to Feb 26, 2020. Univariate and multivariate analyses were performed to assess the risk factors associated with severe events defined as a condition requiring admission to an intensive care unit, the use of mechanical ventilation, or death. RESULTS: 28 COVID-19-infected cancer patients were included; 17 (60.7%) patients were male. Median age was 65.0 years (IQR:56.0-70.0). Lung cancer was the most frequent cancer type (7, 25.0%). 8 (28.6%) patients were suspected to be from hospital-associated transmission. The following clinical features were shown in our cohort: fever (23, 82.1%), dry cough (22, 81%) and dyspnoea (14, 50.0%), along with lymphopaenia (23, 82.1%), high level of high-sensitivity C-reactive protein (23, 82.1%), anaemia (21, 75.0%) and hypoproteinaemia (25, 89.3%). The common chest CT findings were ground-glass opacity (21, 75.0%) and patchy consolidation (13, 46.3%). 15 (53.6%) patients had severe events and mortality was 28.6%. If the last anti-tumour treatment was within 14 days, it significantly increased the risk of developing severe events (HR=4.079, 95%CI 1.086-15.322, P=0.037). Furthermore, patchy consolidation on CT on admission was associated with a higher risk for developing severe events (HR=5.438, 95%CI 1.498-19.748, P=0.010). CONCLUSIONS: Cancer patients show deteriorating conditions and poor outcomes from the COVID-19 infection. It is recommended that cancer patients receiving anti-tumour treatments should have vigorous screening for COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19 co-infection.

12.
Prog Urol ; 2020 Mar 28.
Artigo em Francês | MEDLINE | ID: mdl-32224294

RESUMO

AIM: The French population is facing the COVID-19 pandemic and the health systems have been reoriented in emergency for the care of patients with coronavirus. The management of cancers of the urinary and male genital tracts must be adapted to this context. MATERIAL AND METHOD: An expert opinion documented by a literature review was formulated by the Cancerology Committee of the French Association of Urology (CCAFU). RESULTS: The medical and surgical management of patients with any cancers of the urinary and male genital tracts must be adapted by modifying the consultation methods, by prioritizing interventions according to the intrinsic prognosis of cancers, taking into account the patient's comorbidities. The protection of urologists from COVID-19 must be considered. CONCLUSION: The CCAFU issues an expert opinion on the measure to be taken to adapt the management of cancers of the male urinary and genital tract to the context of pandemic by COVID-19. [[[fr]]]Résumé Objectif: La population française est confrontée à la pandémie de COVID-19 et le systèmes de santé a été réorienté en urgence pour la prise en charge des patients atteint du coronavirus. La prise en charge des cancers de l'appareil urinaire et génital masculin doit être adaptée à ce contexte. Matériel et méthode: Un avis d'experts documenté par une revue de la littérature a été formulé par le Comité de Cancérologie de l'Association Française d'Urologie (CCAFU). Résultats: La prise en charge médicale et chirurgicale des patients atteint de cancers de l'appareil urinaire et génital masculin doit être adaptée en modifiant les modalités de consultation, en priorisant les interventions en fonction du pronostic intrinsèque des cancers en tenant compte des comorbidités du patient. La protection des urologues vis-à-vis du COVID-19 doit être prise en considération. CONCLUSION: Le CCAFU émet un avis d'experts quant aux mesures à prendre pour adapter la prise en charge des cancers de l'appareil urinaire et génital masculin au contexte de pandémie par COVID-19.

13.
Minerva Urol Nefrol ; 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32225135

RESUMO

The public health emergency caused by the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a significant reallocation of health resources with a consequent reorganization of the clinical activities also in several urological centers. A panel of Italian urologists has agreed on a set of recommendations on pathways of pre-, intra- and post-operative care for urological patients undergoing urgent procedures or non-deferrable oncological interventions during the COVID-19 pandemic. Simplification of the diagnostic and staging pathway has to be prioritized in order to reduce hospital visits and consequently the risk of contagion. In absence of strict uniform regulations that impose the implementation of nasopharyngeal swabs, we recommend that an accurate triage for possible COVID-19 symptoms be performed both by telephone at home before hospitalization and at the time of hospitalization. We recommend that during hospital stay patients should be provided with as many instructions as possible to facilitate their return to, and stay at, home. Patients should be discharged under stable good conditions in order to minimize the risk of readmission. It is advisable to reduce or reschedule post-discharge controls and implement an adequate system of communication for telemonitoring discharged patients in order to reduce hospital visits.

14.
J Card Surg ; 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32227511

RESUMO

A 57-year-old man was diagnosed with acute aortic dissection (AAD), but had marked infiltration shadows in his right lung. Intraoperative findings showed that large subadventitial hematomas had spread from the ascending aorta to the right pulmonary artery, which may have caused the infiltration of the lung. Subadventitial hematoma must be considered in rare cases of AAD with pulmonary infiltration. This article is protected by copyright. All rights reserved.

15.
Colorectal Dis ; 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32227609

RESUMO

The COVID-19 outbreak in Italy is stopping access to elective benign disease treatment and changing the approach to malignant disease as well as the outpatients care of those patients treated for colorectal cancer. The lack of knowledge about the possible implications of the spread of the infection during surgery could extend to infect surgeons, surgery nurses and also the anesthesiologists, the results will become evident in the long term. The surgical approach may change going towards less invasive procedures to minimize the aerosolized biological fluids, this approach could reduce the access to first level hospitals changing the entire health care system in the future.

18.
Colorectal Dis ; 2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32233064

RESUMO

AIM: The current COVID-19 pandemic is challenging healthcare systems at a global level. We provide a practical strategy to reorganize pathways of emergency and elective colorectal surgery during the COVID-19 pandemic. METHOD: The authors, all from areas affected by the COVID-19 emergency, brainstormed remotely to define the key-points to be discussed. Tasks were assigned, concerning specific aspects of colorectal surgery during the pandemic, including the administrative management of the crisis in Italy. The recommendations (based on experience and on the limited evidence available) were collated and summarized. RESULTS: Little is known about the transmission of COVID-19, but it has shown a rapid spread. It is prudent to stop non-cancer procedures and prioritize urgent cancer treatment. Endoscopy and proctological procedures should be performed highly selectively. When dealing with colorectal emergencies, a conservative approach is advised. Specific procedures should be followed when operating on COVID-19-patients, using dedicated personal protective equipment and adhering to specific rules. Some policies are described, including minimally-invasive surgery. These policies outline the strict regulation of entry/ exit into theatres and operating building as well as advice on performing procedures safely to reduce risk spreading the virus. It is likely that a reorganization of health system is required, both at central and local levels. A description of the strategy adopted in Italy is provided. CONCLUSION: Evidence on the management of patients needing surgery for colorectal conditions during the COVID-19 pandemic is currently lacking. Lessons learnt from healthcare professionals that have managed high volumes of surgical patients during the pandemic could be useful to mitigate some risks and reduce exposure to other patients, public and healthcare staff.

19.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(0): E029, 2020 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-32234130

RESUMO

The outbreak of 2019 novel coronavirus (2019-nCoV) infection poses a serious threat to global public health. Vaccination is an effective way to prevent the epidemic of the virus. 2019-nCoV along with severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) belong to the same ß-genus of coronavirus family. Base on the previous experience and the technical platform of developing SARS-CoV and MERS-CoV vaccines, scientists from all over the world are working hard and quickly on the related fields. There are substantial progress in these fields including the characterizing the 2019-nCoV virus, identification of candidate antigens and epitopes, establishment of animal models, characterizing the immune responses, and the design of vaccines. The development of 2019-nCoV vaccines cover all types: inactivated virus vaccine, recombinant protein vaccine, viral vector-based vaccine, mRNA vaccine, and DNA vaccine, et al. As of March 2020, two 2019-nCoV vaccines have entered phase I clinical trials. One is named as Ad5-nCoV developed by the Chinese Institute of Biotechnology of the Academy of Military Medical Sciences and Tianjin Cansino Biotechnology Inc. Ad5-nCoV is based on the replication-defective adenovirus type 5 as the vector to express 2019-nCoV spike protein. The another vaccine is mRNA-1273 developed by the National Institute of Allergy and Infectious Diseases and Moderna, Inc.. RNA-1273 is an mRNA vaccine expressing 2019-nCoV spike protein. Although the rapid development of 2019-nCoV vaccine, it still faces many challenges with unknown knowledge, including the antigenic characteristics of the 2019-nCoV, the influence of antigenic variation, the protective immune response of host, the protection of the elderly population, and the downstream manufacturing process of the new vaccine. The safety and efficacy of vaccines are the first priority for vaccine development and should be carefully evaluated.

20.
Br J Anaesth ; 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32234250

RESUMO

BACKGROUND: The safety of performing spinal anaesthesia for both patients and anaesthetists alike in the presence of active infection with the novel coronavirus disease 2019 (COVID-19) is unclear. Here, we report the clinical characteristics and outcomes for both patients with COVID-19 and the anaesthetists who provided their spinal anaesthesia. METHODS: Forty-nine patients with radiologically confirmed COVID-19 for Caesarean section or lower-limb surgery undergoing spinal anaesthesia in Zhongnan Hospital, Wuhan, China participated in this retrospective study. Clinical characteristics and perioperative outcomes were recorded. For anaesthesiologists exposed to patients with COVID-19 by providing spinal anaesthesia, the level of personal protective equipment (PPE) used, clinical outcomes (pulmonary CT scans), and confirmed COVID-19 transmission rates (polymerase chain reaction [PCR]) were reviewed. RESULTS: Forty-nine patients with COVID-19 requiring supplementary oxygen before surgery had spinal anaesthesia (ropivacaine 0.75%), chiefly for Caesarean section (45/49 [91%]). Spinal anaesthesia was not associated with cardiorespiratory compromise intraoperatively. No patients subsequently developed severe pneumonia. Of 44 anaesthetists, 37 (84.1%) provided spinal anaesthesia using Level 3 PPE. Coronavirus disease 2019 infection was subsequently confirmed by PCR in 5/44 (11.4%) anaesthetists. One (2.7%) of 37 anaesthetists who wore Level 3 PPE developed PCR-confirmed COVID-19 compared with 4/7 (57.1%) anaesthetists who had Level 1 protection in the operating theatre (relative risk reduction: 95.3% [95% confidence intervals: 63.7-99.4]; P<0.01). CONCLUSIONS: Spinal anaesthesia was delivered safely in patients with active COVID-19 infection, the majority of whom had Caesarean sections. Level 3 PPE appears to reduce the risk of transmission to anaesthetists who are exposed to mildly symptomatic surgical patients.

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