Innovative Draping Method to Mitigate Aerosolization During Coronavirus Pandemic

2020 ◽  
Vol 3 (2) ◽  
pp. 73-76
Author(s):  
Kripa Dongol ◽  
Yogesh Neupane ◽  
Dipesh Shakya
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Operating Room ◽  
Healthcare Workers ◽  
Operative Procedure ◽  
High Viral Load ◽  
Upper Airways ◽  
Self Confidence ◽  
Additional Form

Otolaryngologists are at high risk of acquiring coronavirus because most of the procedures are aerosol generating and we have to deal with upper airways which contain high viral load. The objective of this study is to elaborate the draping technique which diminishes aerosol in the operating room. Use of a framework and a drape with customized hand insertion ports help to contain the aerosol generated during the operative procedure. The draping technique acts as an additional form of protection from aerosol along with an increase in self-confidence to the healthcare workers during this pandemic.

scholarly journals Management of epistaxis during COVID-19 pandemic

2021 ◽  
Vol 11 (42) ◽  
pp. 50-52
Author(s):  
Rahul Mishra ◽  
Anjan Kumar Sahoo ◽  
Priyanka Gosain
Keyword(s):  
Emergency Department ◽  
Viral Load ◽  
High Risk ◽  
Healthcare Workers ◽  
Healthcare Providers ◽  
High Viral Load ◽  
Protective Equipment ◽  
Special Focus ◽  
Bleeding Control ◽  
Upper Airways

Abstract Epistaxis represents a commonly encountered manifestation in the ENT Emergency Department. Healthcare providers working in the ENT Emergency Department are at high risk of COVID-19 infection both because of the high viral load in the upper airways and because of the asymptomatic presentation of COVID-19 disease. Special focus is needed for managing the balance between appropriate patient care and ensuring the safety of healthcare workers. Adequate preparation and modification of the procedures for bleeding control to minimize risk of spread is necessary. While managing, attention should be kept on less invasive methods with avoidance of aerosol-generating activities. Nonetheless, proper use and disposal of personal protective equipment is of utmost importance in stopping the spread of COVID-19.

scholarly journals Povidone iodine ‘WET’ technique: adenotonsillectomy in COVID era

2021 ◽  
Vol 7 (3) ◽  
pp. 563
Author(s):  
Nithya Venkataramani ◽  
Ravi Sachidananda ◽  
Nidhi R. Sachidananda
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Service Delivery ◽  
Operating Room ◽  
Healthcare Workers ◽  
Povidone Iodine ◽  
Minimal Risk ◽  
Risk Of Infection ◽  
Operating Room Personnel ◽  
Increasing Demand

<p>COVID-19 pandemic has significantly changed ENT practice. Most elective ENT (ear, nose, throat) surgeries possess a risk of infection, as well as potentially increasing complication.<sup>1</sup> With the current pandemic slowly evolving and ever-increasing demand for elective services to restart, service delivery with minimal risk to healthcare workers is a challenge. ENT procedures like adenotonsillectomy, microdebrider FESS and mastoidectomy and many more are aerosol generating procedures. Adenotonsillectomy is particularly challenging with high risk to the operating room personnel as the viral load is significantly high in the nasopharynx and oropharynx. Evidence from China shows us that the pandemic could last for at least six months<sup>2</sup> and modifications of techniques and adapting to the new norm is the key.</p>

scholarly journals Evaluation of saliva sampling procedures for SARS-CoV-2 diagnostics reveals differential sensitivity and association with viral load

2020 ◽  
Author(s):  
Pieter Mestdagh ◽  
Michel Gillard ◽  
Marc Arbyn ◽  
Jean-Paul Pirnay ◽  
Jeroen Poels ◽  
...  
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Health Professionals ◽  
High Viral Load ◽  
Sampling Procedure ◽  
Differential Sensitivity ◽  
Collection Method ◽  
Viral Loads ◽  
Saliva Collection ◽  
Sampling Procedures

AbstractNasopharyngeal sampling has been the preferential collection method for SARS-CoV-2 diagnostics. Alternative sampling procedures that are less invasive and do not require a healthcare professional would be more preferable for patients and health professionals. Saliva collection has been proposed as such a possible alternative sampling procedure. We evaluated the sensitivity of SARS-CoV-2 testing on two different saliva collection devices (spitting versus swabbing) compared to nasopharyngeal swabs in over 2500 individuals that were either symptomatic or had high-risk contacts with infected individuals. We observed an overall poor sensitivity in saliva for SARS-CoV-2 detection (30.8% and 22.4% for spitting and swabbing, respectively). However, when focusing on individuals with medium to high viral load, sensitivity increased substantially (97.0% and 76.7% for spitting and swabbing, respectively), irrespective of symptomatic status. Our results suggest that saliva cannot readily replace nasopharyngeal sampling for SARS-CoV-2 diagnostics but may enable identification of cases with medium to high viral loads.

scholarly journals Distribution of cervical lesions in high-risk HPV (hr-HPV) positive women with ASC-US: a retrospective single-center study in China

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Zhiling Wang ◽  
Ying Gu ◽  
Hui Wang ◽  
Junyu Chen ◽  
Yawen Zheng ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Viral Load ◽  
High Risk ◽  
High Viral Load ◽  
Single Infection ◽  
Multiple Infections ◽  
Trend Test ◽  
Cervical Lesions ◽  
Increased Risk ◽  
High Risk Hpv

Abstract Background To investigate distributions of cervical lesions and factors associated with the severity of the cervical lesions in high-risk HPV (hr-HPV) positive women with atypical squamous cells of undetermined significance (ASC-US) cytology. Methods Clinical information of 250,000 women who underwent HPV and cytological test was collected from January 2012 to January 2019. The association between the severity of the cervical lesions and hr-HPV genotypes, hr-HPV viral load, and ages, were analyzed in hr-HPV-positive/ASC-US women. Results 3459 hr-HPV-positive/ASC-US women were enrolled in this study. Overall, 43.51% of women with ASC-US had normal histological results, 34.35% had high-grade squamous intraepithelial lesion (HSIL), and 1.30% had cervical cancer. The rate of HSIL or worse (HSIL+) in women with single HPV16 infection (63.09%) was the highest, followed by HPV33 (57.50%), HPV51 (36.11%), HPV58 (36.11%), HPV52 (28.28%), HPV18 (26.37%), HPV66 (19.35%), HPV39 (18.92%), HPV53 (15.00%), and HPV56 (8.51%). Detection rate of HSIL+ in low, intermediate and high viral-load groups were 15.87% (n = 30), 34.91% (n = 74) and 40.68% (n = 214) (Cochran-Armitage Trend test χ2 = 35.03, p < 0.0001). Compared with the 51–60-year-old group (21.65%), the women in ≤ 30 (40.52%), 31–40 (39.67%), and 41–50 (34.22%) year-old groups had significantly higher risk of HSIL+. The women in ≤ 51–60 (2.68%) and > 60 (3.41%) year-old groups were at increased risk for cervical cancer, compared with the ≤ 30-year-old group (0.61%). Conclusions ASC-US women with HPV 16/18/33/51/52/58 single infection and multiple infections, as well as high HPV viral loads, have high risk of HSIL+.

scholarly journals Significance of the Viral Load of High-risk Hpv in the Diagnosis and Prediction of Cervical Lesions: A Retrospective Study

2020 ◽  
Author(s):  
Yang Liu ◽  
Changjun Xu ◽  
Jing Pan ◽  
Chunyi Sun ◽  
Honglin Zhou
Keyword(s):  
Cervical Cancer ◽  
Viral Load ◽  
Retrospective Study ◽  
High Risk ◽  
High Viral Load ◽  
Control Group ◽  
Cervical Lesions ◽  
Hpv Dna ◽  
Cin Iii ◽  
Hpv Viral Load

Abstract Background: The significance of HPV viral load in the detection of cervical lesions is still controversial. This study analyzed the correlation between the high-risk (HR)-HPV viral load and different cervical lesion degrees.Methods: This was a retrospective study of the patients who first visited the hospital between January 2015 and June 2018. Patients with positive HR-HPV were screening for cervical cancer. The HR-HPV DNA load was measured by the second generation hybrid capture (HC2) technology. The patients grouped as normal, CIN I, CIN II, CIN III, and cervical cancer. Multivariable logistic regression was performed to explore the association between HR-HPV DNA load and cervical lesions.Results: Finally, 265 patients were grouped as normal (n=125), CIN I (n=51), CIN II (n=23), CIN III (n=46), and cervical cancer (n=20). Among them, 139 (52.5%) had a low viral load, 90 (34.0) had a moderate viral load, and 36 (13.4%) had a high viral load. Taking the normal control group as a reference, a high viral load was an independent factor for CIN I (CIN I: OR=3.959, 95%CI: 1.300-12.059, P=0.015) CIN II (OR=6.211, 95%CI: 1.641-23.513, P=0.007), CIN III (OR=7.002, 95%CI: 2.308-21.244, P=0.001), and cervical cancer (OR=9.439, 95%CI: 2.394-37.22, P=0.001).Conclusion: Cervical lesions are closely related to HR-HPV infection. Higher HR-HPV viral load in cervical lesions was associated with a higher risk of high-grade cervical lesions.

scholarly journals Subcutaneous REGEN-COV Antibody Combination for Covid-19 Prevention

2021 ◽  
Author(s):  
Meagan P O'Brien ◽  
Eduardo Forleo Neto ◽  
Bret J Musser ◽  
Flonza Isa ◽  
Kuo-Chen Chan ◽  
...  
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Risk Reduction ◽  
Infected Individual ◽  
High Viral Load ◽  
Primary Efficacy ◽  
Symptomatic Disease ◽  
Assessment Period ◽  
Efficacy Assessment ◽  
To Receive

Background: Casirivimab and imdevimab (REGEN-COV) markedly reduces risk of hospitalization or death in high-risk individuals with Covid-19. Here we explore the possibility that subcutaneous REGEN-COV prevents SARS-CoV-2 infection and subsequent Covid-19 in individuals at high risk of contracting SARS-CoV-2 by close exposure in a household with a documented SARS-CoV-2-infected individual. Methods: Individuals ≥12 years were enrolled within 96 hours of a household contact being diagnosed with SARS-CoV-2 and randomized 1:1 to receive 1200 mg REGEN-COV or placebo via subcutaneous injection. The primary efficacy endpoint was the proportion of participants without evidence of infection (SARS-CoV-2 RT-qPCR-negative) or prior immunity (seronegative) who subsequently developed symptomatic SARS-CoV-2 infection during a 28-day efficacy assessment period. Results: Subcutaneous REGEN-COV significantly prevented symptomatic SARS-CoV-2 infection compared with placebo (81.4% risk reduction; 11/753 [1.5%] vs. 59/752 [7.8%], respectively; P<0.0001), with 92.6% risk reduction after the first week (2/753 [0.3%] vs. 27/752 [3.6%], respectively). REGEN-COV also prevented overall infections, either symptomatic or asymptomatic (66.4% risk reduction). Among infected participants, the median time to resolution of symptoms was 2 weeks shorter with REGEN-COV vs. placebo (1.2 vs. 3.2 weeks, respectively), and the duration of time with high viral load (>10^4 copies/mL) was lower (0.4 vs. 1.3 weeks, respectively). REGEN-COV was generally well tolerated. Conclusions: Administration of subcutaneous REGEN-COV prevented symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection in uninfected household contacts of infected individuals. Among individuals who became infected, REGEN-COV reduced the duration of symptomatic disease, decreased maximal viral load, and reduced the duration of detectable virus.

scholarly journals 1161. Infection Control After Debridement of Brucella melitensis Hardware Infection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S349-S349
Author(s):  
Amanda Novack
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Operating Room ◽  
Healthcare Workers ◽  
Brucella Melitensis ◽  
Risk Exposure ◽  
Post Exposure Prophylaxis ◽  
Operating Room Personnel ◽  
Infectious Dose ◽  
High Index Of Suspicion

Abstract Background Brucellosis is the most common laboratory-acquired bacterial infection, according to the Centers for Disease Control and Prevention (CDC), despite the rare incidence of Brucellosis in the population at large. A 34-year-old man presented with pain and swelling of the left leg, where he had previously sustained an open tibia fracture 1 year prior. After the initial injury, he underwent four corrective surgeries (including bone graft and internal-fixation) and was asymptomatic for 6 months before these new symptoms developed. MRI revealed a 6.5 × 5.1 × 2.7 cm abscess and tibial osteomyelitis. Surgical staff performed an aggressive incision and drainage (I&D) with saucerization of the tibia, to treat what seemed to be a routine hardware infection. Five days later, tissue cultures grew Brucella melitensis. Upon further questioning, the patient described butchering a wild boar 10 days prior to symptom onset. Methods The CDC provides guidance on serological testing and post-exposure prophylaxis (PEP) for persons exposed to Brucella in the laboratory setting. Upon identification of this patient’s Brucella isolates, infection control staff identified all laboratory workers that met CDC criteria for “high risk” exposure, as well as other healthcare workers (HCW) exposed to aerosolized infectious material (including those workers in the operating room during pulse lavage of the abscess). Results Staff identified 34 HCW with presumed high-risk exposure, including 19 laboratory personnel, 13 operating room personnel, and two patient care technicians. Baseline serology was obtained on all 34 HCW, and PEP with rifampin and doxycycline was prescribed for each. Nine of the exposed employees changed PEP therapy due to intolerance, and follow-up serology was obtained on 32 of the 34 healthcare workers, with zero seroconversions found. Conclusion Brucellosis is a rare disease in clinical practice, so a high index of suspicion is necessary to enact appropriate precautions before widespread exposures. When exposure is identified after the fact, efficient protocols should be in place to identify all susceptible individuals. Due to the low infectious dose of Brucella melitensis, CDC guidance should be expanded to include aerosolizing procedures outside of the laboratory. Disclosures All authors: No reported disclosures.

scholarly journals Significance of the viral load of high-risk HPV in the diagnosis and prediction of cervical lesions: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yang Liu ◽  
Changjun Xu ◽  
Jing Pan ◽  
Chunyi Sun ◽  
Honglin Zhou ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Viral Load ◽  
Retrospective Study ◽  
High Risk ◽  
High Viral Load ◽  
Control Group ◽  
Cervical Lesions ◽  
Hpv Dna ◽  
High Risk Hpv ◽  
Hpv Viral Load

Abstract Background The significance of HPV viral load in the detection of cervical lesions is still controversial. This study analyzed the correlation between the high-risk HPV viral load and different cervical lesion degrees. Methods This retrospective study included women positive for high-risk HPV DNA and screened for cervical lesions between 01/2015 and 06/2018. The high-risk HPV DNA load was measured by the second-generation Hybrid Capture technology and classified as low, moderate, and high. Colposcopy and biopsy were performed in all patients. The patients were grouped as normal, cervical intraepithelial neoplasia (CIN) grade 1, CIN grade 2, CIN grade 3, and cervical cancer. Multivariable logistic regression was performed to explore the association between high-risk HPV DNA load and cervical lesions. The odds ratios (ORs) represent the odds for increasing from low to high viral load. Results Finally, 265 patients were grouped as normal (n = 125), CIN 1 (n = 51), CIN 2 (n = 23), CIN 3 (n = 46), and cervical cancer (n = 20). Among them, 139 (52.5%) had a low viral load, 90 (34.0) had a moderate viral load, and 36 (13.4%) had a high viral load. Taking the normal control group as a reference, a high viral load was an independent factor for CIN 1 (OR = 3.568, 95% CI: 1.164–10.941, P = 0.026), CIN 2 (OR = 6.939, 95% CI: 1.793–26.852, P = 0.005), CIN 3 (OR = 7.052, 95% CI: 2.304–21.586, P = 0.001), and cervical cancer (OR = 8.266, 95% CI: 2.120–32.233, P = 0.002). Conclusions Among women who underwent cervical biopsy, higher high-risk HPV viral load in cervical lesions was associated with a higher risk of high-grade cervical lesions.

scholarly journals THE FEATURES OF THE COURSE OF PREGNANCY, DELIVERY, POSTPARTUM PERIOD AND STATE OF NEW-BORNS IN WOMEN WITH GENITAL HPV INFECTION

2016 ◽  
pp. 59-65
Author(s):  
S. S. Kravchenko ◽  
T. N. Zakharenkova ◽  
O. A. Teslova
Keyword(s):  
Viral Load ◽  
Postpartum Period ◽  
Clinical Manifestations ◽  
High Viral Load ◽  
Perinatal Transmission ◽  
Hpv Infection ◽  
Upper Airways ◽  
Birth Canal ◽  
Pregnancy And Delivery ◽  
Anemia During Pregnancy

Objective : to define the features of the course of pregnancy, delivery, postpartum period and state of newborns in female patients with genital HPV infection, depending on its form and viral load; to assess the factors of the course of gestation and delivery in the vertical transmission of neonatal persistence of HPV infection. Material and methods. The study involved 132 pregnant women with genital HPV infection, their babies immediately after birth (n = 107) and at the age of 6 months (n = 106). The comparison group included pregnant patients, women in delivery and postpartum period who were under supervision and who gave childbirth in Gomel region over 2011-2012 (30087 pregnancies, 33477 births). Results. Pregnancy in women with HPV infection is frequently complicated by the threat of miscarriage (p = 0.0016). The clinical manifestations of HPV infection showed no effect on the gestation. Patients with high HPV load (5 lg GE per 100,000 cells) had birth canal injuries (p = 0.029) 3 times more often. Pregnancy complicated by gestosis and anemia, as well as vaginal childbirth were risk factors for perinatal transmission of HPV. The course of pregnancy and delivery were not determining factors in the persistence of HPV in the baby`s upper airways. Conclusion. We have defined the features of the course of pregnancy and delivery in women with genital HPV infection (the threat of miscarriage, birth canal injury with high viral load of HPV), the factors of perinatal transmission (gestosis and anemia during pregnancy, vaginal delivery).

scholarly journals Distribution of cervical lesions in high-risk HPV (hr-HPV) positive women with ASC-US: A retrospective single-center study in China

2020 ◽  
Author(s):  
Zhiling Wang ◽  
Ying Gu ◽  
Hui Wang ◽  
Junyu Chen ◽  
Yawen Zheng ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Viral Load ◽  
High Risk ◽  
High Viral Load ◽  
Single Infection ◽  
Multiple Infections ◽  
Trend Test ◽  
Cervical Lesions ◽  
Increased Risk ◽  
High Risk Hpv

Abstract Background To investigate distributions of cervical lesions and factors associated with the severity of the cervical lesions in high-risk HPV (hr-HPV) positive women with atypical squamous cells of undetermined significance (ASC-US) cytology. Methods Clinical information of 250,000 women who underwent HPV and cytological test was collected from January 2012 to January 2019. The association between the severity of the cervical lesions and hr-HPV genotypes, hr-HPV viral load, and ages, were analyzed in hr-HPV-positive/ASC-US women. Results 3459 hr-HPV-positive/ASC-US women were enrolled in this study. Overall, 43.51% of women with ASC-US had normal histological results, 34.35% had high-grade squamous intraepithelial lesion (HSIL), and 1.30% had cervical cancer. The rate of HSIL or worse (HSIL+) in women with single HPV16 infection (63.09%) was the highest, followed by HPV33 (57.50%), HPV51 (36.11%), HPV58 (36.11%), HPV52 (28.28%), HPV18(26.37%), HPV66 (19.35%), HPV39 (18.92%), HPV53 (15.00%), and HPV56 (8.51%). Detection rate of HSIL + in low, intermediate and high viral-load groups were 15.87% (n = 30), 34.91% (n = 74) and 40.68% (n = 214) (Cochran-Armitage Trend test χ2 = 35.03, P < 0.0001). Compared with the 51-60-year-old group (21.65%), the women in ≤ 30 (40.52%), 31–40 (39.67%), and 41–50 (34.22%) year-old groups had significantly higher risk of HSIL+. The women in ≤ 51–60 (2.68%) and > 60 (3.41%) year-old groups were at increased risk for cervical cancer, compared with the ≤ 30-year-old group (0.61%). Conclusions ASC-US women with HPV 16/18/33/51/52/58 single infection and multiple infections, as well as high HPV viral loads, have high risk of HSIL+.

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