Cancer Screening During the COVID-19 Pandemic: A Systematic Review and Meta-analysis.

The purpose of this study was to assess the impact of measures designed to mitigate the spread of coronavirus disease 2019 (COVID-19) on worldwide cancer screening. We systematically searched PubMed, Ovid MEDLINE, the Cochrane COVID-19 Study Register, ClinicalTrials.gov, and EMBASE without language restrictions for studies published between January 1, 2021, and February 10, 2021. Studies selected for full-text review contained data on patients screened for any type of cancer during the COVID-19 pandemic and comparison data from a time interval just prior to the pandemic. Data were obtained through dual extraction. All the included studies were assessed for quality and risk of bias. A meta-analysis was performed on 13 studies: 7 on screening mammography, 5 on colon cancer screening, and 3 on cervical cancer screening. Two of our studies reported on more than one type of cancer screening. The screening outcomes were reported as pooled incidence rate ratios using the inverse variance method and random effects models. All studies included in our meta-analysis reported the number of patients screened for cancer in defined time intervals before and during the COVID-19 pandemic. We found that the pooled incidence rate ratios were significantly lower for screening during the COVID-19 pandemic for breast cancer (0.63; 95% CI, 0.53 to 0.77; P<.001), colon cancer (0.11; 95% CI, 0.05 to 0.24; P<.001), and cervical cancer (0.10; 95% CI, 0.04 to 0.24; P<.001). These findings may add further morbidity and mortality to this public health crisis.

Management of Hospitalized Asthmatic Children Before Transport.

Asthmatic children are at risk for respiratory failure and should be appropriately treated before transport. The objectives were to find out if the Pediatric Advanced Life Support guidelines for asthma treatment were followed in the emergency department (ED); to determine if additional treatment during transport or within the first 2 hours of admission was needed; and to compare the management of intubated asthmatics by the ED, transport team, and the intensive care unit (ICU) physician. The records for children diagnosed with acute asthma over 7 years who were transported by the intensive care transport team were reviewed. The use of albuterol, steroids, oxygen, heliox, continuous positive airway pressure or bilevel positive airway pressure, and ventilator settings was recorded. Two hundred seventy-nine children were 7 years (age, 5 mo-17 y), and 62% were male. Eighty percent received oxygen, albuterol, and steroids in the ED. Heliox was initiated more often by the transport team when compared with the ED or hospital physician (77% vs. 7.7% vs. 15.3%, P < .0001). Forty-five were mechanically ventilated and were more likely to receive volume control (P < .0001) and higher rates (P = .007) in the ED than the ICU. We conclude that most children with acute asthma were treated with oxygen, albuterol, and steroids in the ED. If used, heliox was most likely started during transport. Intubated children were more likely to receive volume control with higher rates compared with lower rates and pressure control in the ICU.

Cerebral "hyperoxygenation" with inhalational induction of anesthesia in children: a retrospective comparison between vasoparalytic sevoflurane vs. vasoneutral fentanyl.

BACKGROUND: The higher levels of oxygen in cerebrum may contribute to neuro-apoptosis, analogous to direct tissue injury induced by toxic levels of oxygen. Earlier report highlighted the possibility of cerebral "hyperoxygenation" secondary to inhalational induction of anesthesia with sevoflurane in small number of children. OBJECTIVE: The aim of this retrospective review was whether similar cerebral "hyperoxygenation" trends can be seen in larger and retrospective patients' database. METHODS: Data of patients who had undergone cardiac surgeries at Children's Hospital during the two-year period (2010-2011) was retrieved during this retrospective review: (a) stored computer data from INVOS Cerebral/Somatic Oximeter for oximetry numbers and total duration of oximetry monitoring, (b) paper chart perfusion records of the cardiac surgeries for age and sex of the patient, urgency of the surgery, type of induction (inhalational or intravenous), and total duration of cardiopulmonary bypass, (c) general medical records for inpatient setting vs. outpatient setting of the patient, and (d) anesthesia medical records for name of the medications used during induction of anesthesia to segregate the patients who had fentanyl as a lone induction agent and sevoflurane as a lone induction agent, for final statistical calculations and analysis. For the two-year period (2010-2011), data of 358 patients who had cardiac surgeries at Children's Hospital were reviewed. However, after deletions of various patients' data due to various reasons, only 69 patients (0-4 years of age) who had sevoflurane induction were analyzed for final statistical comparisons to 14 patients (0-4 years of age) who had fentanyl induction. RESULTS: Cerebral and renal "hyperoxygenation" occurred during the first 127 minutes with sevoflurane as compared to fentanyl though the percentage changes from pre-induction values in oximetry during this time did not reach level of significance. However, only cerebral "hyperoxygenation" persisted in the last 127 minutes when patients had been induced with sevoflurane as compared to fentanyl. CONCLUSION: Cerebral "hyperoxygenation" occurs with inhalational induction of anesthesia with vasoparalytic sevoflurane in children 0 to 4 years of age when compared to anesthesia induction with vasoneutral fentanyl.

Minimal/underreported but definite risk of death/bodily harm threats (DBHTs) to pain practitioners: results of nationwide survey from United States.

BACKGROUND: Many physicians have experienced or will experience patient who acts threateningly towards them at least once in their careers. However, there have been no studies to gauge the incidence rate and severity of patients' and/or patients' families' violence towards pain physicians. OBJECTIVES: This nationwide survey was completed to evaluate the incidence of death/bodily harm threats (DBHTs) against pain physicians. METHODS: A questionnaire along with online assent form was uploaded on SurveyMonkey Online Portal. The uploaded survey web-link was sent to pain fellowship programs in the United States so that pain physicians and pain fellows can respond to this survey. The respondents were expected to anonymously complete the survey containing various questions relating to confrontational patients' experiences, how these experiences affected them, how those situations were handled, and how the respondents would act differently in the future secondary to their victimization by the confrontational patients. RESULTS: The response rate to the nationwide survey was extremely low (5.2% of anticipated numbers), most likely secondary to underreporting. Out of total 26 respondents across the United States, seven respondents reported receiving DBHTs (incidence of 27%). The median number of absolute DBHTs received in lifetime by these seven respondents was three (range being 1 to 21-30). CONCLUSION: There is minimal/underreported but definite risk of DBHTs for pain practitioners and the improved reporting, awareness and discussions can help pain physician community to formulate efficacious strategies to the prevention and management of future DBHTs.