Hospital care in Department define as Covid-free: A proposal for a safe hospitalization protecting helathcare professionals and patients not affect by Covid-19
Hospital care in Department define as Covid-free: A proposal for a safe hospitalization protecting helathcare professionals and patients not affect by Covid-19
A review of the covid 19 pandemic and the role of medical laboratory scientis...ArchanDomReyes
The health system of many countries has been overwhelmed by the pandemic, with many losing a significant number of their health professionals in the fight against the virus. While doctors and nurses are so visible at the front lines and are being applauded for the gallant role they are playing in the recovery of hundreds of thousands of COVID-19 patients, the world knows little about those behind their successes, the
Medical Laboratory Scientists (MLS). Medical laboratory science is the bedrock of diagnostic
medicine and the role of the MLS in containing any pandemic cannot be overemphasized.
A review of the covid 19 pandemic and the role of medical laboratory scientis...ArchanDomReyes
The health system of many countries has been overwhelmed by the pandemic, with many losing a significant number of their health professionals in the fight against the virus. While doctors and nurses are so visible at the front lines and are being applauded for the gallant role they are playing in the recovery of hundreds of thousands of COVID-19 patients, the world knows little about those behind their successes, the
Medical Laboratory Scientists (MLS). Medical laboratory science is the bedrock of diagnostic
medicine and the role of the MLS in containing any pandemic cannot be overemphasized.
The 68-page Handbook of Covid-19 Prevention and Treatment provides guidelines and practices by China’s top experts for coping with the disease. It is prepared by the First Affiliated Hospital of Zhejiang University’s School of Medicine which has treated 104 confirmed patients over the past 50 days with no medical staff infected, according to the handbook. Zhejiang, home of Alibaba, had a cumulative 1,215 confirmed Covid-19 cases, out of a population of 57 million people
, with one death from the pandemic.
Clinical course and risk factors for mortality of adult inpatients with covid...BARRY STANLEY 2 fasd
Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help
clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale
for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
The 68-page Handbook of Covid-19 Prevention and Treatment provides guidelines and practices by China’s top experts for coping with the disease. It is prepared by the First Affiliated Hospital of Zhejiang University’s School of Medicine which has treated 104 confirmed patients over the past 50 days with no medical staff infected, according to the handbook. Zhejiang, home of Alibaba, had a cumulative 1,215 confirmed Covid-19 cases, out of a population of 57 million people
, with one death from the pandemic.
Clinical course and risk factors for mortality of adult inpatients with covid...BARRY STANLEY 2 fasd
Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help
clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale
for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Similar to Hospital care in Department define as Covid-free: A proposal for a safe hospitalization protecting helathcare professionals and patients not affect by Covid-19
The world is witnessing an invasion from a new corona virus, which resulted in more than one million of deaths. Most of the sectors such industrial, economy, and tourism are facing a crisis, hence the workers in the field of medicine, considered to be the barrier to fight this invasion. This new virus seems to have two main transmission routes: direct and contact, which it will open a high chance of infection among professional health providers, especially, surgeons and dentists. Maxillofacial and dental surgeons, considered to be essential professional health experts that perform, multiple surgeries and dental procedures every day, consequently, these professions will exhibit a high risk of getting infected by Covid19, due to that, this review article aimed to discuss the possible ways that it may help in optimizing the level of infection control.
Prevention of infection in dental clinic in COVID-19Prachi Jha
PREVENTION OF INFECTION IN DENTAL CLINIC DURING COVID 19 PANDEMIC IN ACCORDANCE WITH GUIDELINES ISSUED BY MOHFW, CDC, IDA, DCI AND IT'S APPLICATION WITH AN ENDODNOTISTS'S POINT OF VIEW
Webinar Series on COVID-19: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH
Speaker: Prof Dr Sasheela A/p Sri La Sri Ponnampalavanar, Consultant Infectious Disease Physician at the University Malaya Medical Centre (UMMC) Malaysia.
More info about the speaker and this webinar available here:
https://clinupcovid.mailerpage.com/resources/u6i5w2-infection-prevention-and-control
Corna virus detail And corona virus in pakistanEmaan Uppal
The 2019–20 coronavirus pandemic is a pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in Wuhan, Hubei, China in December 2019Avoiding close contact with sick individuals; frequently washing hands with soap and water; not touching the eyes, nose, or mouth with unwashed hands; and practicing good respiratory hygiene.
Prevention of Surgical Site Infection- SSI [compatibility mode]drnahla
Infection Control Guidelines for Prevention of Surgical Site Infection- SSI
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Anesthesiologist’s Prospective on Self-protection, Therapy, and Managements i...asclepiuspdfs
During the beginnings of 2020, a virus has spread from China and caused a huge surge in severe acute respiratory cases globally. Due to the high contagiousness and anomalous course of severe acute respiratory syndrome coronavirus 2, caused by coronavirus disease, abbreviated as COVID-19, the World Health Organization (W.H.O) announced it as a pandemic and strict measurements were implemented to try and protect the vulnerable populations and those fighting on the frontline of this wave.[1] Scientific personnel all over the world began reviewing hundreds of articles published by scientific authors about the preexisting coronaviruses to assess the strain and pathogenesis of COVID-19 and explore possible effective therapies. At the beginning of the pandemic, the goal was clear: Support the immune system by using preexisting drugs such as antibiotics and antivirals to prevent superinfections and alleviate possible foreseen complications, in addition to the use of prophylactic vaccines in high-risk groups. Another therapy option was the use of convalescent sera, which is a passive antibody therapy used as prophylaxis.[2] In this review, we conclude the importance of adhering to the precautionary guidelines set by the W.H.O recommended for health care workers and the general population, as the most important factor for protection against further transmission of the virus. The extra respiratory manifestations of the virus will also be highlighted along with the therapy modalities that are already being used and the upcoming vaccines that will counteract the virus.
Dr.Hatem EL-Bitar
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د حاتم البيطار
محاضر طبي تحت الطلب
بدرس في اكتر من اكاديمية
دبلومة ادارة مستشفيات
دبلومة مكافحة عدوي
كورسات الاسعافات الاولية
ومساعد طبيب الاسنان
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دعم صفحتي بلايك وانشرها لتدعيم ثقافة الاسعافات الاولية
Similar to Hospital care in Department define as Covid-free: A proposal for a safe hospitalization protecting helathcare professionals and patients not affect by Covid-19 (20)
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Hospital care in Department define as Covid-free: A proposal for a safe hospitalization protecting helathcare professionals and patients not affect by Covid-19
1. 1Archivio Italiano di Urologia e Andrologia 2020; 92, 2
ORIGINAL PAPER
Hospital care in Departments defined as Covid-free:
A proposal for a safe hospitalization protecting healthcare
professionals and patients not affected by Covid 19
Rosario Leonardi 1, Piera Bellinzoni 2, Luigi Broglia 2, Renzo Colombo 3, Davide De Marchi 2,
Lorenzo Falcone 1, Guido Giusti 2, Vincenzo Grasso 1, Guglielmo Mantica 4, Giovanni Passaretti 2,
Silvia Proietti 2, Antonio Russo 2, Giuseppe Saitta 2, Salvatore Smelzo 2, Nazareno Suardi 4,
Franco Gaboardi 2, UrOP Executive Committee *
1 Musumeci GECAS Clinic, Gravina di Catania, Catania, Italy;
2 Department of Urology, San Raffaele Turro Hospital, Milan, Italy;
3 Department of Urology, San Raffaele Hospital, Milan, Italy;
4 Department of Urology, IRCCS Policlinico San Martino Hospital, University of Genova, Genova, Italy;
The Covid-19 pandemic influenced the nor-
mal course of clinical practice leading to
significant delays in the delivery of healthcare services for
patients non affected by Covid 19. In the near future, it will be
crucial to identify facilities capable of providing health care in
compliance with the safety of healthcare professionals, admin-
istrative staff and patients. All the staff involved in the project
of a Covid-free hospital should be subjected to a diagnostic
swab for Covid-19 before the beginning of healthcare activity
and then periodically in order to avoid the risk of contamina-
tion of patients during the process of care. The modifications of
various activities involved in the process of care are described:
outpatient care, reception of inpatients, inpatient ward and
operating room. For outpatient care, modality of appointment
procedure, characteristics of waiting room and personal pro-
tective equipment (PPE) for healthcare professionals and
administrative staff are presented. Reception of inpatients shall
be conditional on a negative swab for Covid 19 obtained with
a drive-in procedure. The management of the operating room
represents the most crucial step of the patient's care process.
The surgical team should be restricted and monitored with
periodic swabs; surgical procedures should be performed by
experienced surgeons according to standard procedures; surgi-
cal training experimental treatments and research protocols
should be suspended. Adequate personal protective equipment
and measures to reduce aerosolization in the operating room
(closed circuits, continuous cycle insufflators, fume extraction)
should be adopted. Prevention of possible transmission of the
virus during procedures in open, laparoscopic and endoscopic
surgery is to use a multi-tactic approach, which includes cor-
rect filtration and ventilation of the operating room, the use of
appropriate PPE (FFP3 plus surgical mask and protective visor
for all the staff working in the operating room) and smoke
evacuation devices with a suction and filter system.
KEY WORDS: Covid 19; Pandemy; Surgery; Endoscopy; Filtration.
Submitted 20 April 2020; Accepted 21 April 2020
Summary
No conflict of interest declared.
DOI: 10.4081/aiua.2020.2.
INTRODUCTION
This document was based on the review of information
materials from AGENAS (Agenzia Nazionale per i Servizi
Sanitari), SIU (Italian Society of Urology), SAGES (American
Society of Gastroenterology Endoscopic Surgery), EAES
(European Society of Endoscopic Surgery) and Italian Society
of Endoscopic Surgery. Prevention measures, personal pro-
tective equipment (PPE) and protocols for healthcare
professional, administrative staff and patients have been
included trying to implement the best prevention meas-
ures against Covid 19 infection in public or private health-
care facilities.
The Covid-19 pandemic influenced the normal course
of clinical practice through multiple mechanisms lead-
ing to significant delays in the delivery of healthcare
services. The possibility of meeting the demand for
healthcare in the near future will depend on the duration
of the epidemic, its economic and social consequences,
and also on changes of the population caused by the
infection itself. In consideration of the awareness that for
many months we will still have to live with the presence
of the virus among the population, it becomes mandato-
ry an immediate rationalization of resources in order to
ensure continuity of healthcare for patients not affected
by Covid 19. It is crucial to identify facilities capable of
providing health care in compliance with the safety
of healthcare professionals, administrative staff and
patients who need medical treatment. The triage of med-
ical and surgical procedures must take into account the
heterogeneity of the pathologies to be treated, the vari-
ability of the timing useful for effective treatment, the
different surgical approaches and non-surgical alterna-
tives. It should not be forgotten that the epidemic has
heterogeneous loco-regional outbreaks with differentiat-
ed measures from local government authorities.
Although there is no official data, it has been reported
that a new health migration is underway, with a flow of
patients moving from high endemic areas to areas where
they can obtain adequate care (AGENAS-SIU).
This document aims to provide indications in the triage of
patients and in the optimization of the resources available
in this difficult moment. As a precondition, all the staff
involved in the project of a Covid-free hospital should be
subjected to a diagnostic swab for Covid-19 before the
2. Archivio Italiano di Urologia e Andrologia 2020; 92, 2
R. Leonardi, P. Bellinzoni, L. Broglia, et al.
2
beginning of healthcare activity. The swab should be
repeated every two weeks in order to avoid the risk of con-
tamination of patients during the process of care. If reliable
tests will be validated, able to replace the swab in the diag-
nosis of COVID 19, these tests could be considered as
faster and less expensive screening procedure to monitor
the absence of infection in the medical staff and hospital
nursing.
We divided the text into several chapters concerning the
various activities involved in the process of care:
– Outpatient care
– Reception of inpatients
– Inpatient ward
– Operating room.
Outpatient visits
Appointment procedure
The outpatient visit should be booked through a tele-
phone triage.
Exclusion criteria:
– Coming from high endemic areas (red areas)
– Referred flu symptoms (sore throat, cough, rhinorrhea)
– Temperature
– State of quarantine or cohabitation with subjects in
compulsory quarantine.
Patients must be informed that they must access to the
office equipped with a surgical mask.
The patient can be accompanied by a person who how-
ever will not enter in the office at the time of the visit. If
it is necessary to provide information to the companion,
this will be convened separately so that the criteria for
social distancing are respected within the office.
Upon entering in the facility it would be useful to per-
form a body temperature measurement.
Waiting room
In relation to the size of the waiting room, one or more
patients can be accepted.
It is mandatory to maintain a distance between the
patients and their companions of at least two meters.
Healthcare professionals
Healthcare professionals must be equipped with Personal
Protective Equipment (PPE) including FFP3 mask and
protective goggles or visors.
Administrative staff (payment of outpatient service)
Must be equipped with PPE (FFP2 mask).
Note: It is important that the area of the consultations
must be separated from the area of hospitalization.
Hospitalization of the patient for surgery
Indispensable condition for taking care of the patient
(swab testing)
An indispensable condition for the patient to be candi-
date for surgical treatment is that of being subjected to a
swab for Covid-19 before entering the facility.
How and how long before admission, it depends on the
structural and organizational characteristics of the hospi-
tal and the time needed to obtain the result of the swab.
Our suggested option is the drive-in swab. A protected
area (parking) must be identified where the car with the
patient on board can stop for the time necessary to per-
form the swab. The staff responsible for the procedure
must be provided with the maximum individual protec-
tion (suit, FFP3 mask, protective visor and gloves).
In the case that the Hospital could arrange a special area for
pre-hospitalization the patient could be accepted after the
swab in this area of the hospital to wait for the response.
General criteria
Protect the patient from potential Covid infections in the
hospital setting.
Protect staff and other patients from contamination,
including mutual.
The surgical team should be restricted and monitored
with periodic swabs; surgical procedures should be per-
formed by experienced surgeons according to standard
procedures; surgical training experimental treatments
and research protocols should be suspended.
Admission of the patient to the hospital for elective surgery
The call of patients for elective surgery must take place
through a telephone interview to rule out a possible con-
tagion from Coronavirus SARS-CoV-2:
– clinical criteria: cough, rhinorrhea, body temperature
rise, pharyngodynia, abdominal pain, conjunctivitis
– epidemiological criteria: direct contact with positive
COVID-19 patient (cohabitation/interview for more
than 15 minutes in the same environment, attendance
at hospital facilities); origin from high endemic geo-
graphic areas identified by current epidemiological data
The patient must be informed that the following steps will
be followed on the day of the call to enter the hospital:
– arrival at the facility will take place starting at 7.30
with a staggering between one patient and the other of
about 15 min.
– arrival by car and parking in the drive-in swab area.
– return to his/her home where the patient must respect
strict self-isolation until he/she receives the call from the
triage staff who communicates the outcome of the swab
– as an alternative (especially for patients domiciled far
away from the hospital), the hospital could offer hos-
pitality in a separate area with hotel service in indi-
vidual rooms with private bathroom (nursing and
service staff of this area must wear suitable personal
protective equipment including gloves, FFP2 mask,
plus surgical masks, if the former are equipped with
an exhalation valve, waterproof gown for contacts,
and protective visor)
– any kind of personal contact of the patient with the
other patients has to be avoided
– in the case of a delayed result of the swab, food must
be delivered out of the room in disposable tray with a
sealable bag where the patient should pour food waste
including the tray
– food waste must be handled as special hazardous waste
– room must undergo sanitization at the end of the stay
– in the event of a negative outcome of the swab, the
patient can be admitted to the ward, staying fasting, to
3. start the acceptance and hospitalization procedure
– in the event of a positive outcome, the patient is invit-
ed to inform the competent health authorities to
arrange for self-isolation at home or hospitalization in
the Covid ward.
The patient can be accompanied by a family member or
friend who will be able to assist him/her in the swab pro-
cedure and in the subsequent phase of hospitalization
but who will not be admitted to the wards.
Both the patient and the companion, in the various
stages of the swab procedure and hospitalization must be
equipped with a mask.
Entry of the patient to the facility
Waiting room
Waiting room must be organized taking into account
social distancing.
Administrative staff appointed to accept the patient
Front-office administrative staff must carry out their
activity protected by a transparent glass barrier and
equipped with PPE (FFP2 mask).
Medical and nursing staff appointed to accept the patient
Collection of clinical history, compilation of the clinical
records and administration of the informed consent must
be done with compliance of the distancing measures.
Discussion of consent to surgery should include an illus-
tration of the risk of Covid-19 exposure and its potential
consequences on clinical outcomes.
Personnel dedicated to blood sampling for blood chem-
istry and to cardiological and anesthesiological evalua-
tion must be equipped with PPE (FFP2 masks with or
without surgical mask based on the presence or absence
of an exhalation valve, protective visor, gloves and water-
proof gown). Everything can take place in a dedicated
area where the rules of social distancing are respected or
directly in the hospital room.
Note: The attending physician and/or the patient's refer-
ence specialist should be invited to inform the head of the
anesthesia department or his/her delegate, before the hos-
pitalization phase, if there are, in his/her opinion, patholo-
gies that may contraindicate the intervention or that could
request diagnostic investigations before hospitalization.
In this case, the patient should be booked for an anesthe-
siological outpatient visit in a reasonable time before
admission.
Entry of the patient into the ward
After the acceptance phase and the first phase of evalua-
tion in preparation for the surgical procedure, the patient
is sent to the hospital ward and housed in a single room
with personal bathroom. The medical and nursing staff,
in this phase, must always wear suitable personal protec-
tive equipment (gloves, FFP2 mask, plus surgical masks,
if the former are equipped with an exhalation valve,
waterproof gown for contacts, protective visor).
Management of the operating room
General considerations
Management of the operating room represents the most
crucial step of the patient's care process. Even if the
patient underwent a swab the day before with a negative
result, this is not sufficient to safely exclude a positiviza-
tion in the following day.
In the operating room for a whole series of conditions
related to intubation and to the use of endoscopic and
laparoscopic surgical instruments, the risk of transmis-
sion is maximum. For this reason, the most effective PPE
systems must be adopted and it is necessary to imple-
ment well-coded behaviors that can be summarized as
follows:
– the surgical team should be restricted, monitored with
periodic swabs and subjected to restrictive measures
to limit the risk of infection
– there should be no change of staff in the room
– surgical procedures should be performed by experi-
enced surgeons to reduce operating times and the risk
of complications (therefore, the suspension of surgical
training is recommended
– the standard approach should be maintained, in order
not to compromise the outcome and standardize the
operating room times
– surgical staff should not stay in the operating room
during intubation maneuvers, waiting a few minutes
from their conclusion before entering, leaving any
infected droplets to settle
– it would be desirable for intubation and extubation to
take place inside a negative pressure room
(https://www.asahq.org/in-the-spotlight/coronavirus-covid-
19-information) (1, 2).
– all measures should be put in place to reduce the risk
of contagion among healthcare professionals by
adopting adequate personal protective equipment. All
members of the operating room staff must use PPE
(FFP3 mask). Appropriate clothing and face shields
must be used. These measures should be used during
all pandemic surgical procedures, regardless of
known or suspected Covid status. The positioning
and removal of PPE must be performed according to
the World Health Organization (WHO) and Centre
for Disease Control and Prevention (CDC) guidelines
(https://www.cdc.gov)
– measures to reduce aerosolization in the operating
room should be considered (closed circuits, insuffla-
tors continuous cycle, fume extraction).
Note: Remember that the virus has been isolated very
frequently in respiratory secretions, saliva and feces,
rarely in the blood, exceptionally in the urine.
Specific technical considerations
There is very little evidence regarding the risks of virus
spread related to the use of the laparoscopic surgical tech-
nique compared to the open approach (3). Emerging evi-
dence and regular updates are provided by the website
https://siceitalia.com/covid19/
It is recommended, however, to seriously consider the
possibility of viral contamination of operating room per-
sonnel during surgery, be it open, laparoscopic or robotic.
It is advisable to actively monitor strict application of pro-
tective measures for the safety of the operating room staff.
Although previous research has shown that the laparo-
scopic technique can favor the aerosolization of pathogens
3Archivio Italiano di Urologia e Andrologia 2020; 92, 2
Hospitalization during Covid emergency
4. Archivio Italiano di Urologia e Andrologia 2020; 92, 2
R. Leonardi, P. Bellinzoni, L. Broglia, et al.
4
present in the blood (Corynebacteria, Papillomavirus and
HIV) (4-6), there is no evidence to indicate that this effect
is also possible for the coronavirus, nor that the risk can
be confined exclusively to minimally invasive surgical pro-
cedures. However, as a precaution, coronavirus should
potentially be considered capable of aerosolizing. For this
reason, the use of devices to filter CO2 should be strong-
ly considered.
For further information https://eaes.eu/eaesand-sages-rec-
ommendations-regarding-surgical-response-to-covid-19-crisis/
The proven benefits of minimally invasive treatment in
terms of reduced duration of hospitalization and reduction
of complications, as well as the potential advantages in
terms of ultrafiltration of most or all aerosol particles, must
be strongly considered. In fact, the filtration of aerosolized
particles can be more difficult during open surgery.
There may be an increased risk of virus exposure for endo-
scopists during upper gastrointestinal tract and airway
procedures. When these procedures are necessary, the rig-
orous use of PPE of greater protection is recommended.
The complete mask with FFP 3 should be considered for
the whole team, following the guidelines of CDC
(https://www.cdc.gov) or WHO (https://www. who.int) (5-6).
Filtration
The smaller droplets, in contact with the ambient air
(aerosol) can transmit the infection from one individual
to another via the respiratory tract (within a certain dis-
tance). Currently, the "droplet" diameter classification
system (from 5 to 10 μm) represents the unit of meas-
urement used to evaluate the transmission mode of an
infectious disease. Filtration can be an effective means of
protection from virus release during minimally invasive
surgery and endoscopy. Masks such as N95 respirators
are designed to filter 95% of 0.3 micron and larger par-
ticles. Respiratory masks of protection class FFP3 offer
the maximum possible protection from the pollution of
breathing air with a protection of at least 99% from par-
ticles up to 0.6 μm in size. Purified air respirators (PAPR)
can be useful for intubation, extubation, bronchoscopy,
endoscopy and tracheostomy. Intraoperatively, filters are
used to remove smoke and particles including viruses.
Air particulate filters (HEPA) have a minimum efficiency
index of 99.97% for the removal of particles with a diam-
eter greater than or equal to 0.3 microns (6).
ULPA (Ultra-Low Particulate Air) filters can remove
99.999% of airborne particles with a minimum particle
penetration size of 0.05 microns.
The Association of periOperative Registered Nurses
(AORN) guidelines define ULPA as filters capable of
removing particles of 0.1 microns (7). Filtration is also
essential on a large scale in positive pressure operating
rooms. HEPA filters positioned in the ceiling provide
terminal cleaning.
Currently, the best practice to reduce the possible trans-
mission of the virus during procedures in open, laparo-
scopic and endoscopic surgery is to use a multi-tactic
approach, which includes correct filtration and ventila-
tion of the operating room, the use of appropriate PPE
(FFP3 plus surgical mask, plus protective visor for all
staff working in the operating room) and smoke evacua-
tion devices with a suction and filter system (8).
Practical filtration measures during laparoscopic surgery
1. The pneumoperitoneum must always be safely evacu-
ated from the trocar connected to the filtration device
before removing the trocars, extracting the operating
piece or converting by laparotomy.
2. Once the trocars are positioned, their valves should not
be opened during surgery, if possible. If it is necessary to
change the insufflation site on another trocar, the valve
must be closed before disconnecting the tubing and the
valve of the new trocar must remain closed until the insuf-
flation tubing has been connected. The insufflator must be
activated before the new insufflation valve is open. This is
to prevent the backflow of gas into the insufflator itself.
3. During the desufflation phase, all gas and exhaust
fumes must pass through an ultra-filtration system, pos-
sibly activating the desufflation mode on the insufflator,
if this mode is available.
4. If the insufflator in use does not have a desufflation
function, it must be ensured that the valve that is used
for insufflation has been closed before the CO2 flow is
deactivated (even if there is a filter in line with the tube).
Without taking this precaution, contaminated intra-
abdominal CO2 can be pushed into the insufflator when
the intra-abdominal pressure is higher than the pressure
inside the insufflator.
5. The patient must be on the level at the time of desuf-
flation.
6. The workpiece(s) must be extracted once all the CO2
gas and smoke have been evacuated.
7. Drainage pipes should only be used if absolutely nec-
essary.
8. The methods of closing the accesses of the trocars with
the use of sutures that allow the escape of gas and resid-
ual fumes must be avoided. The fascial plane must be
closed after complete desufflation.
9. Laparoscopic hand-assisted techniques can lead to sig-
nificant CO2 and smoke losses and should therefore be
avoided. A protection system can be positioned after
complete desufflation to remove more voluminous oper-
ating pieces and protect the wound. The piece can then
be removed and closed.
Systems for the evacuation of smoke and gas
Below is a list of commercially available products that
could potentially be used to filter CO2 gas or smoke
evacuated during surgical procedures (Table 1).
The list was provided by SAGES and EAES that stated
they do not promote any of the following products.
SAGES and EAES specify that they have sought informa-
tion by contacting the known manufacturers, but the
possibility is recognized that there are many other com-
panies that may have similar products on sale.
Surgeons should be aware of the characteristics of the
products used in their facility and contact the product rep-
resentative or refer to the product instructions for their use.
For a consultation of the smoke and gas evacuation sys-
tems currently on the market, refer to the links:
https://www.sages.org/resources-smoke-gas-evacuation-dur-
ing-open-laparoscopic-endoscopicprocedures/
https://www.sages.org/wp-content/uploads/2020/03/
Summary-of-Commercially-AvailablePneumoperitoneum-
Smoke-Evacuation-Systems.pdf
5. In addition to the smoke evacuation products, the
Ultravision system can minimize aerosolized particles
inside the pneumoperitoneum
(https://www.sages.org/wpcontent/uploads/2020/03/Ultravis
ion-as-an-adjunct. pdf).
Electrosurgical and laser units
The electrosurgical units and lasers must be pro-
grammed to the lowest possible settings for the desired
effect and for the correct execution of the surgery.
The use of monopolar electrosurgery, ultrasound dissec-
tors and advanced bipolar devices and lasers can lead to
aerosolization of the particles. If available, the use of
monopolar electrosurgical units with integrated smoke
aspirator is recommended (9-15). During their use, the
rules of maximum protection of the medical nursing staff
apply as required for all procedures in the operating room.
Measures to be put into practice during laparoscopic surgery
1. The skin incisions should be as small as possible to
allow trocars to pass and at the same time prevent
CO2 losses around the trocars.
2. The CO2 insufflation pressure should be kept to a
minimum and, if available, ultra-filtration (smoke
evacuation or filtration system) should be used
(https://www.sages.org/resources-smoke-gas-evacuation-
during-open-laparoscopic-endoscopicprocedures/).
3. All pneumoperitoneum must be safely evacuated
through a filtration system before removal of the tro-
cars, extraction of the surgical piece, or conversion by
open surgical procedure.
Measures to be put into practice during digestive
endoscopy procedures
(https://www.asge.org/home/joint-gi-society-message-covid-
19) (16, 17).
1. In the absence of the ability to control the aerosolized
virus during endoscopic procedures, all members of
the endoscopy room or operating room must wear
appropriate PPE (FFP3 mask, appropriate clothing and
face shields). The positioning and removal of PPE
must be carried out according to the CDC guidelines
(https://www.cdc.gov).
2. Since patients can present with gastrointestinal mani-
festations of Covid-19, all endoscopic procedures in
an emergency regime should be considered high risk.
3. Since the virus has been found in multiple cells of the
gastrointestinal tract and in all fluids (saliva, enteric
content, feces and blood) surgical energy must be
minimized.
4. Endoscopic procedures that require additional insuf-
flation of CO2 or ambient air should be avoided until
we have a better understanding of the aerosolization
properties of the virus. This includes many of the
endoscopic mucosal resection procedures and endo-
luminal procedures.
5. Removing the caps on the endoscopes could release
fluid and/or air and should be avoided.
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Hospitalization during Covid emergency
Table 1.
Commercially available systems for the evacuation of smoke and gas.
Company ConMed Cooper Ethicon Medtronic Olympus Stryker 5 Northgate
Commercial brand AirSeal® (lap) SeeClear® Plume-Away Megadyne ValleyLab RapidVac™ UHI-4 Pneumoclear™ Nebulae™ I
PlumePen® (open) Mega Vac PLUS3 PureView™
Buffalo Filter® Smoke MegaVac™
Management Mini Vac™
Open Yes No Yes Yes No No No
6. Archivio Italiano di Urologia e Andrologia 2020; 92, 2
R. Leonardi, P. Bellinzoni, L. Broglia, et al.
6
DNA in CO2 laser-generated plume of smoke and its consequences
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immunodeficiency virus DNA in laser smoke. Lasers Surg Med.
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Correspondence
Rosario Leonardi, MD (Corresponding Author)
leonardi.r@tiscali.it
Lorenzo Falcone, MD
Vincenzo Grasso, MD
Department of Urology and Andrological Surgery Musumeci GECAS Clinic
Gravina of Catania, Catania (Italy)
Piera Bellinzoni, MD
Luigi Broglia, MD
Davide De Marchi, MD
Guido Giusti, MD
Giovanni Passaretti, MD
Silvia Proietti, MD
Antonio Russo, MD
Giuseppe Saitta, MD
Salvatore Smelzo, MD
Franco Gaboardi, MD
Department of Urology, San Raffaele Turro Hospital, Milan (Italy)
Renzo Colombo, MD
Department of Urology, San Raffaele Hospital, Milan (Italy)
Guglielmo Mantica, MD
guglielmo.mantica@gmail.com
Nazareno Suardi, MD
Department of Urology, IRCCS Policlinico San Martino Hospital,
University of Genova, Genova (Italy)
* UrOP Executive Committee
Giuseppe Ludovico 1, Angelo Cafarelli 2, Ottavio De Cobelli 3, Ferdinando De Marco 4,
Giovanni Ferrari 5, Stefano Pecoraro 6, Angelo Porreca 7, Domenico Tuzzolo 8
1 Department of Urology, “F. Miulli” Hospital, Acquaviva delle Fonti (BA), Italy;
2 Department of Urology, Villa Igea Clinic, Ancona, Italy;
3 Department of Urology, European Institute of Oncology, IRCCS - Department of Oncology and Hemato-0ncology,
University of Milan, Milan, Italy;
4 Department of Urology, “INI” Italian Neurotraumatological Institute, Grottaferrata (Roma), Italy;
5 Department of Urology, CURE, Modena, Italy;
6 Department of Urology, Malzoni Clinic Neuromed, Avellino, Italy;
7 Department of Urology, Policlinico Abano Terme, Abano Terme (PD), Italy;
8 Department of Urology, “Casa del Sole” Clinic, Formia (LT), Italy.