Otitis Media Practice During the COVID-19 Pandemic

The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens.

Evaluation of the COVID-19 Infection Rate in the Perioperative Period of Elective Surgeries of the Hand and Microsurgery

Background: After the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (coronavirus disease 2019 [COVID-19]), the world started reducing the number of elective surgeries to reduce the transmission of the coronavirus. Some priority elective surgeries were performed, and there was no increase in contagion rates due to safety protocols and protection measures. The study aims to present the coronavirus infection rate of elective hand surgeries and microsurgery performed during pandemics. Methods: A retrospective study evaluating 188 patients submitted to elective surgical procedures. The exclusion criteria were patients infected by COVID-19 before the surgery and patients who submitted to trauma surgery. Only 108 patients were eligible for this study. The mean age was 47.8 years (range: 15 days-81 years). There were 63 females and 45 males. They were divided into 2 groups: outpatient (n = 49) and inpatient (n = 59) procedures. Results: The overall COVID infection rate was 6.48%. The outpatient infection rate was 2.08%, whereas the inpatient infection rate was 10.17% (Student t test: P = .089). The main factor correlated with infection in the postoperative period was the number of postoperative outpatient visits (Student t test: P = .089). No statistical differences were observed between the variables studied, but there was a tendency for patients who submitted to inpatient surgery to get infected by COVID-19 ( P = .089). The statistical power was 0.8 (Cohen’s d test), showing that large samples are needed to analyze the correlation better. Conclusion: We concluded that the safety of performing elective hand surgery during the pandemic remains unclear, and more studies with larger samples are needed.

How the COVID-19 pandemic changed postoperative infections in urology wards: A retrospective cohort study from two urology departments

Introduction: We aimed to compare the rate of postoperative infection and drug-resistant organism (DRO) before and during the COVID-19 pandemic in urology departments. Methods: A retrospective cohort study was carried out. Data from all elective surgical procedures carried out in two urology departments between April and June 2018 and the homologous period in 2020 were collected. Main outcomes were the number of postoperative infections during the pandemic, and the number of DROs. Sample size was calculated based on a 50% relative reduction of infections during the pandemic. Variables were compared by Chi-squared test, and multivariable logistic regression was used to estimate predictors. Results: A total of 698 patients undergoing elective surgery were included. The postoperative infection rate during the pre-pandemic period was of 14.1% compared to 12.1% during the pandemic (p=0.494). DROs were lower during the pandemic (92.3% vs. 52.4%, p=0.002). The pandemic period was the main predictor for reduced multi-drug-resistant isolates, with an odds ratio of 0.10 (p=0.010, 95% confidence interval 0.016–0.57). Conclusions: Postoperative infection rates were not significantly reduced during the COVID-19 pandemic, despite the adoption of enhanced infection preventive measures. There was, however, a decrease in the rate of DROs during this period, suggesting a secondary benefit to enhanced infection prevention practices adopted during the COVID-19 era.

The Practices of Anaesthesiologists in the Management of Patients with Sickle Cell Disease: Empirical Evidence from Cameroon

Patients with sickle cell disease are more likely to undergo surgery during their lifetime, especially given the numerous complications they may develop. There is a paucity of data concerning the management of patients with sickle cell disease by anaesthesiologists, especially in Africa. This study aimed to describe the practices of anaesthesiologists in Cameroon concerning the perioperative management of patients with sickle cell disease. A cross-sectional study was carried out over four months and involved 35 out 47 anaesthesiologists working in hospitals across the country, who were invited to fill a data collection form after giving their informed consent. The data were analysed using descriptive statistics and a binary logistic regression model. Among the 35 anaesthesiologists included in the study, most (29 (82.9%)) had managed patients with sickle cell disease for both emergency and elective surgical procedures. Most of them had never asked for a haematology consultation before surgery. Most participants (26 (74.3%)) admitted to having carried out simple blood transfusions, while 4 (11.4%) carried out exchange transfusions. The haemoglobin thresholds for transfusion varied from one practitioner to another, between < 6 g/dl and < 9 g/dl. Only 6 (17.1%) anaesthesiologists had a treatment guideline for the management of patients with sickle cell disease in the hospitals where they practiced. Only 9 (25.7%) prescribed a search for irregular agglutinins. The percentage of haemoglobin S before surgery was always available for 5 (14.3%) of the participants. The coefficient (0.06) of the occurrence of a haematology consultation before surgery had a significant influence on the probability of management of post-operative complications (coefficient 0.06, 10% level of probability). This study highlights the fact that practices in the perioperative management of patients with sickle cell disease in Cameroon vary greatly from one anaesthesiologist to another. We disclosed major differences in the current recommendations, which support the fact that even in Sub-Saharan countries, guidelines applicable to the local settings should be published.

Practical Recommendations for the Preoperative Screening and Protective Protocols in Cancer Surgeries During COVID-19: A Systematic Review

Introduction: The new coronavirus (COVID-19) has posed many new challenges to the health care and the timing of surgical care. At the beginning of the pandemic many guidelines recommended postponing elective surgical procedures to reallocate resources. As regards, delay in cancer treatment could be effective on cancer progression. The aim of this systematic review was to outline a guideline for preoperative screening before cancer surgeries and protecting health care workers during the pandemic.Materials and Methods: This study was conducted through a search in electronic databases up to August 2020. PubMed, EMBASE, Web of Science, Scopus, Science Direct, and Google Scholar databases were searched without time limitation. The keywords were a combination of preoperative, cancer surgery, COVID-19, and their synonyms.Results: The most commonly used ways to triage preoperatively were telephone pre-assessment for suspicious symptoms and history of contact or travel, 14-day self-isolation, in- hospital queries at admission, temperature monitoring, and isolation in a single room COVID-free ward or physical distancing. Reverse transcription-polymerase chain reaction (RT-PCR) test 24–72 h before operation was recommended commonly, except in inaccessible centers, but non-contrast chest-CT scan is not routinely advised for elective surgeries to salvage medical resources. Recommended personal protective equipment (PPE) for staffs were wearing N95 mask in addition to gown, gloves, eye protection in aerosol-generating procedures (AGPs), and wearing gloves, hats, and disposable surgical masks, practice distancing, and hand hygiene for all staffs. Meanwhile team separation of hospital staffs caring for COVID-19 patients, segregated areas for COVID-19 clean and contact, restriction of visitors and family members, and personal distancing are mostly recommended.Conclusion: We hope this review would be a guidance for triage, preoperative testing, and summarizing safety principles during COVID-19 pandemic alongside with surgical reintegration.

Use of Homeopathic Arnica montana 30cH for Postoperative Analgesia in Female Dogs Undergoing Elective Ovariohysterectomy

Background Ovariohysterectomy (OH) is one of the most frequent elective surgical procedures in routine veterinary practice. Arnica montana is a well-known medicine in phytotherapy, with proven analgesic, anti-inflammatory, antiseptic, healing, antioxidant and immunomodulatory activity. However, there is still a shortage of studies on the action and effects of the homeopathic formulation of the medicine on animals. The aim of this study was to evaluate analgesia with Arnica montana 30cH during the postoperative period after elective OH. Methods Thirty healthy female dogs, aged 1 to 3 years, weighing 7 to 14 kg, were selected at the Veterinary Hospital in Campo Mourão, Paraná, Brazil. The dogs underwent the surgical procedure with an anaesthetic protocol and analgesia that had the aim of maintaining the patient's wellbeing. After the procedure, they were randomly divided into three groups of 10. One group received Arnica montana 30cH; another received 5% hydroalcoholic solution; and the third group, 0.9% NaCl saline solution. All animals received four drops of the respective solution sublingually and under blinded conditions, every 10 minutes for 1 hour, after the inhalational anaesthetic had been withdrawn. The Glasgow Composite Measure Pain Scale was used to analyse the effect of therapy. Analysis of variance (ANOVA) followed by the Tukey test was used to evaluate the test data. Statistical differences were deemed significant when p ≤0.05. Results The Arnica montana 30cH group maintained analgesia on average for 17.8 ± 3.6 hours, whilst the hydroalcoholic solution group did so for 5.1 ± 1.2 hours and the saline solution group for 4.1 ± 0.9 hours (p ≤0.05). Conclusion These data demonstrate that Arnica montana 30cH presented a more significant analgesic effect than the control groups, thus indicating its potential for postoperative analgesia in dogs undergoing OH.

Thyromental Height - As a Predictor of Difficult Laryngoscopy

The fundamental responsibility of the anaesthesiologist and one of the most important steps in anaesthesia practice is the intubation and maintenance of the airway. The integral part of pre-anaesthetic evaluation to recognize a potentially difficult airway is the airway assessment. There are multitude of bedside screening tests which are helpful to predict a difficult airway but the accuracy is doubtful. Thus, pointing out a single reliable predictor of difficult intubation is important. Accordingly, this study aims to evaluate the practicality of thyromental height test alone as a sole predictor of difficult laryngoscopy in our present population. Ethical clearance was obtained and after taking an informed consent, a randomised prospective observational study was conducted on 315 adult patients who were posted for elective surgical procedures under general anaesthesia with endotracheal intubation. On the day before the surgery, airway was assessed and Thyromental height (TMHT) was measured. Laryngoscopy was performed intra-operatively and Cormack Lehane’s grading was noted. The evaluation of the accuracy of thyromental height in predicting difficult laryngoscopy was done by comparing the preoperative assessment data and laryngoscopy findings. In our study, the mean thyromental height observed was 5.4cm. Thyromental height at cut off of 50mm had a high negative predictive value of 94.1% and high sensitivity of 72.5%, but with low specificity of 64.2% (P value 0.000). When the cut off was emended to 48mm, sensitivity of the test decreased to 56.2% and specificity increased to 79.8% (P value 0.002).The conducted study demonstrates the usefulness of thyromental height. It substantiates the good sensitivity of thyromental height for predicting difficult intubation. But, the validation will require further studies in more diverse patient population.

Surgical Site Infection in a Tertiary Care Teaching Hospital

Introduction: Surgical site infections [SSIs] are the Third most common nosocomial infections, According to the National Nosocomial Infections Surveillance, patients who are hospitalized account for 15 to 18 percent of all nosocomial infections .increased mortality and morbidity rates associated with Surgery. Surgical wounds are divided into four categories: clean, clean-contaminated, contaminated and dirty wounds. Materials and Methods: This was a retrospective study, done throughout for two years period, from June 2018 to May 2020 .785 patients underwent surgery in the Dept. of General Surgery in Saveetha Medical College and Hospital, Thandalam. Were taken as part of this study. Elective surgical procedures were performed on 495 patients. And 290 were taken to the hospital for emergency treatment. An in-depth examination of these cases was conducted, taking into account the date of admission, clinical features, history, types of surgery [emergency or elective], pre-operative preparation, drain used, and its type and postoperative findings. Results: Surgical Site Infections were found in 58 cases out of 785 surgeries. In elective clean and contaminated patients, the overall postoperative SSI rate is 4.34 percent of all cases, whereas emergency cases account for 12.41 percent. According to the research, that the most prevalent type of surgical site infection is superficial surgical site infection accounting for 72.1 percent of all SSIs in elective cases and 61.11 percent in emergency cases, and deep surgical site infection accounting for 23.25 percent of elective cases and 30.55 percent of emergency cases. Conclusion: The most common bacteria found in elective surgical wounds are E. coli. Proteus mirabilis is the most prevalent organism isolated from emergency surgical wounds. A shift in the pre-operative period antibiotics may even diminish the occurrence. Pre-existing medical conditions like diabetes mellitus wound type, operation time, emergency procedures, and wound contamination all had a significant impact on the development of surgical site infection.

P157 EFFECTS OF COVID-19 PANDEMIC ON THE SCIENTIFIC PUBLICATIONS IN HERNIA FIELD

Aim The increase in the number of publications in the hernia field has been higher than the most of our areas of surgery. COVID-19 pandemics has affected many elective surgical procedures like hernia repairs. We assumed that the declines in case volumes might cause some falls in related publications, and searched the literature in order to find the number of herniology publications before and during the pandemic. Material and Methods A systematic PUBMED search was done for three consecutive decades “1991-2000”, “2001-2010” and “2011-2020” by using the key words “inguinal and hernia”, “umbilical and hernia”, “incisional and hernia”, “mesh and hernia”, “laparoscopic and hernia”, “robotic and hernia”, and “experimental and hernia”. Later, a comparison of years 2019 and 202o was done. Results Although increases were detected for all searches with the key words, the largest rise was seen in publications related to “robotic and hernia”. Some undulations were recorded during the years, but the number of publications showed obvious increases decade by decade. A very small decrease was found in the number of publications for “experimental and hernia” only, however all other searches presented increases during the first year of the pandemic, 2020 in comparison with 2019. Conclusions The increases in the number of publications in hernia field continued during the last decade. COVID-19 pandemic did not cause a decrease in these publications the first year. We assume that year 2021 can be a more correct criteria in order to observe the potentially negative effect of the pandemic.

424. The Impact of COVID-19 Response on Infection Prevention Programs and Practices in Southeastern United States

Background Early assessments of COVID19 preparedness reported resource shortages, use of crisis capacity strategies, variations in testing, personal protective equipment (PPE), and policies in US hospitals. One year later, we performed a follow-up survey to assess changes in infection prevention practice and policies in our diverse network of community and academic hospitals. Methods This was a cross-sectional electronic survey of infection preventionists in 58 hospitals within the Duke Infection Control Outreach Network (community) and Duke/UNC Health systems (academic) in April-May 2021 to follow-up our initial survey from April 2020. The follow-up survey included 26 questions related to resource availability, crisis capacity strategies, procedures, changes to PPE and testing, and staffing challenges. Results We received 54 responses (response rate, 93%). Facilities reported significantly fewer PPE and resource shortages in the follow-up survey compared to our initial survey (Figure 1, P&lt; 0.05). Only 32% of respondents were still reprocessing N95 respirators (compared to 73% in initial survey, P&lt; 0.05). All hospitals performed universal masking, universal symptom screening on entry, and 30% required eye protection. In 2020, most hospitals suspended elective surgical procedures in March-April, and restarted in May-June. Approximately 92% reported in-house testing for SARS-COV-2 by April 2020, at least a third of which had a weekly capacity of &gt;100 tests. Almost 80% performed universal pre-operative testing, while 61% performed universal preadmission testing for SARS-COV-2. Almost all hospitals switched from test-based to time-based strategy for discontinuing isolation precautions, majority in August-September 2020. Twenty-five percent hospitals reported infection prevention furloughs, staffing cuts, and or reassignments, while 81% reported increased use of agency nursing during the pandemic. Conclusion Our follow-up survey reveals improvement in resource availability, evolution of PPE guidance, increase in testing capacity, and burdensome staffing changes. Our serial surveys suggest increasing uniformity in infection prevention policies, but also highlight the increase in staff turnover and infection prevention staffing shortages. Disclosures Sonali D. Advani, MBBS, MPH, Nothing to disclose David J. Weber, MD, MPH, PDI (Consultant)