Clinical Features of Patients with Probable 2019 Novel Coronavirus Infected Pneumonia in Rasht, Iran: A Retrospective Case Series

BACKGROUND: Coronavirus disease-19 (COVID-19) is the first pandemic infectious disease caused by a novel coronavirus. Viral pneumonia is a severe complication of COVID-19. AIM: Due to the high prevalence of this disease globally, especially in Iran, the aim of this study was to determine the clinical features of seven patients with probable COVID-19 infected pneumonia in Rasht, North Iran. MATERIALS AND METHODS: In this retrospective case series study, we described the clinical, laboratory, and radiological features of seven patients with probable COVID-19 infected pneumonia at Razi Hospital, Rasht, north of Iran, from February 27 to March 16, 2020. RESULTS: In this study, the most common clinical symptoms during hospitalization in patients with COVID-19 were poor appetite (seven cases), dehydration (seven cases), cough (six cases), dyspnea (six cases), fatigue (six cases), fever above 38°C (five cases), myalgia (five cases), Chills (five cases), feeling fever (five cases), sore throat (five cases), and nausea (five cases), respectively. The average body temperature in these patients was 39.32°C. In laboratory findings, erythrocyte sedimentation rate was elevated in three patients. Contrary to most of the evidence, C-reactive protein was not elevated in five patients. All patients received antibiotic and antiviral medications and received symptomatic treatment. Finally, four patients responded to the treatments and were discharged from the hospital; two patients were still hospitalized and only one patient died. CONCLUSION: Patients with COVID-19 associated pneumonia can be treated by evaluating and implementing appropriate therapeutic management. However, at the moment the disease progression for patients with COVID-19 cannot be accurately predicted

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Organ procurement and transplantation during the COVID-19 pandemic in Iran

Minimally invasive surgery reduces perioperative pain and morbidity, facilitating rapid recovery. However, the field of kidney transplantation has lagged in this regard, its customary open surgical techniques going nearly unchanged until recently. Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. In Korea, the first RKT performed (November 2019) involved a 30-year-old man (body mass index, 22 kg/m2) with end-stage hypertensive nephrosclerosis. A left donor kidney from his 28-year-old sister was successfully transplanted using the daVinci Robotic Surgical System. Transperitoneal regional hypothermia (Vattikuti Urology Institute-Medanta technique) was also implemented across the main periumbilical incision (up to 6 cm). Total operative time was 260 minutes (cold ischemia, 34 minutes; rewarming, 54 minutes), with 50 mL of blood loss. There was immediate graft function, unencumbered by surgical complications (e.g., postoperative bleeding, leakage, or lymphocele). The patient was discharged on postoperative day 8, with serum creatinine at 1.27 mg/dL. RKT with regional hypothermia may be a viable, minimally invasive intervention that is safe and effective in select patients, showing good surgical results

Effect of Cold Dialysate on Hemodynamic Status of Patients during Hemodialysis: A Quasi-Experimental Study

Background and purpose: Hypotension is the most common serious complication during hemodialysis. The aim of this study was to evaluate the effect of cold dialysate on hemodynamic status of patients undergoing hemodialysis. Materials and methods: A before/after study using a quasi-experimental design was carried out in 99 patients undergoing hemodialysis attending Rasht Razi Hospital, 2019. All patients received hemodialysis using a dialysate at 37°C for three consecutive sessions and the next three sessions were performed using a cool temperature dialysate (35.5°C). Blood pressure and pulse rate were monitored in all sessions. Data were analyzed in SPSS V16 using independent t-test and paired t-test. Results: Systolic and diastolic blood pressure changes were significantly different between the two dialysate temperatures (P<0.001). At 35.5°C, the mean systolic/diastolic blood pressure changes were higher than at 37°C from pre-dialysis to post-dialysis. Also, pre-dialysis and post-dialysis pulse changes were significantly different between the two temperatures (P<0.001). Conclusion: According to this study, cold dialysis solution can stabilize the hemodynamic status of patients during dialysis.   (Clinical Trials Registry Number: IRCT20080825001083N9

Examining Side Effects of the Sputnik V COVID-19 Vaccine: Side effects of Sputnik V vaccine

Background: As a result of the COVID-19 pandemic, many vaccines were developed to counter the disease, including the vector-based Sputnik V vaccine. This study aims to identify the side effects of the Sputnik V COVID–19 vaccine in a medical center and compare the results with the previous reports.Methods: A questionnaire-based study was performed after the injection of the first and second doses of the vaccine to assess the side effects experienced by the participants. It was performed by reviewing similar previous studies.Results: Injection site pain, muscle pain, fever, fatigue, chills, and headache were the most common side effects of the vaccine. The incidence of major side effects decreased with age and was lower in men. In our study and others, the incidence of side effects was decreased in the second dose. In some studies, participants with a previous history of Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCOV-2) infection developed more side effects, especially injection site pain, muscle pain, and fatigue. Conclusion: Most studies agree with our reported results. Serious side effects of this vaccine are rare and may be considered tolerable in adults