Care of patients with hemoglobin disorders during the COVID-19 pandemic: An overview of recommendations.

The outbreak of Coronavirus Disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a global health emergency.1 Compared to the general population, patients with hemoglobin disorders such as sickle cell disease (SCD) or thalassemia are expected to be more severely affected by COVID-19 due to their preexisting chronic morbidities.2 The Centers for Disease Control and Prevention does not report any specific indications for patients with hemoglobinopathies. However, it can be hypothesized that the rapid spread of the virus may render these patients fragile when fighting the infection. SCD, a hematological condition with functional asplenia, puts patients at a greater risk to develop acute pulmonary complications, including viral infections.2 A study by Hussain et al reported four SCD cases that tested positive for COVID-19.3 These cases initially presented to the emergency department for a typical vaso-occlusive crisis (VOC), and the clinical course of their SARS-CoV-2 infection was rather mild. Patients had a history of respiratory complications, such as acute chest syndrome (ACS), asthma, or pulmonary embolism, which may be potential risk factors for progressive COVID-19 pulmonary disease in patients with SCD.3 A series of isolated cases of ACS in SCD patients positive for COVID-19 has been recently reported.4,5 Therefore, very little clinical experience of infected patients with SCD currently exists. For this reason, we believe that certain recommendations must be followed by healthcare professionals treating any SCD patient infected with SARS-CoV-2

Staffing in the Lebanese American University Library: the human resource management issues

Staffing in the Lebanese American University Library: the human resource management issue

Do routine clinic visits prevent de-stabilization in patients awaiting coronary revascularization?

We examined retrospectively the usefulness of routine clinic visits in preventing adverse cardiac events in 115 patients awaiting coronary surgery or angioplasty. Mean waiting time from angiography to revascularization was 126 days. A total of 126 visits were made by 80 patients. No deaths occurred, but one patient, despite three visits, suffered myocardial infarction at 316 days post-angiography. Eight patients required admission for unstable angina, five having been on the waiting list for less than 5 weeks. The mean number of clinic visits, number of diseased vessels and proportion on triple anti-ischaemic therapy were similar in the patients suffering such events and those remaining stable. In conclusion, the inherent unpredictability of coronary disease greatly limits the role of interim clinic visits in the prevention of adverse cardiac events in patients awaiting revascularization