Hospital care in Department define as Covid-free: A proposal for a safe hospi...Valentina Corona
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 hospi...Valentina Corona
Hospital care in Department define as Covid-free: A proposal for a safe hospitalization protecting helathcare professionals and patients not affect by Covid-19
www.cebm.netoxford-covid-19 1 What is the.docxodiliagilby
www.cebm.net/oxford-covid-19/
1
What is the efficacy of standard face masks compared to respirator
masks in preventing COVID-type respiratory illnesses in primary
care staff?
Trish Greenhalgh and Xin Hui Chan, University of Oxford
Kamlesh Khunti, University of Leicester
Quentin Durand-Moreau and Sebastian Straube, University of Alberta, Canada
Declan Devane and Elaine Toomey, Evidence Synthesis Ireland and Cochrane Ireland
Anil Adisesh, University of Toronto, and St. Michael’s Hospital, Toronto, Canada
On behalf of the Oxford COVID-19 Evidence Service Team
Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences,
University of Oxford
23rd March 2020
Correspondence to [email protected]
Most real-world research comparing standard face masks with respirator masks has
been in the context of influenza or other relatively benign respiratory conditions and
based in hospitals. There are no published head-to-head trials of these interventions
in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection,
COVID-19, and no trials in primary or community care settings. Current guidance is
therefore based partly on indirect evidence – notably, from past influenza, SARS and
MERS outbreaks – as well as expert opinion and custom and practice.
Policy guidance from various bodies (e.g. Public Health England, WHO) emphasises
the need to assess the contagion risk of an encounter and use the recommended
combination of equipment for that situation. A respirator mask and other highly
effective PPE (eye protection, gloves, long-sleeved gown, used with good
donning/doffing technique) are needed to protect against small airborne particles in
aerosol-generating procedures (AGPs) such as intubation. For non-AGPs, there is
no evidence that respirator masks add value over standard masks when both are
used with recommended wider PPE measures.
A recent meta-analysis of standard v respirator (N95 or FFP) masks by the Chinese
Cochrane Centre included six RCTs with a total of 9171 participants with influenza-
like illnesses (including pandemic strains, seasonal influenza A or B viruses and
zoonotic viruses such as avian or swine influenza). There were no statistically
significant differences in their efficacy in preventing laboratory-confirmed influenza,
laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory
infection and influenza-like illness, but respirators appeared to protect against
bacterial colonization.
http://www.cebm.net/oxford-covid-19/
mailto:[email protected]
https://www.cebm.net/oxford-covid-19/
www.cebm.net/oxford-covid-19/
2
CONTEXT
Concerns have been raised about the limited personal protective equipment (PPE)
provided for UK primary and community care staff with some GP surgeries,
pharmacies and care homes having very limited provision. We were asked to find out
whether and in what circumstances standard m ...
www.cebm.net/oxford-covid-19/
1
What is the efficacy of standard face masks compared to respirator
masks in preventing COVID-type respiratory illnesses in primary
care staff?
Trish Greenhalgh and Xin Hui Chan, University of Oxford
Kamlesh Khunti, University of Leicester
Quentin Durand-Moreau and Sebastian Straube, University of Alberta, Canada
Declan Devane and Elaine Toomey, Evidence Synthesis Ireland and Cochrane Ireland
Anil Adisesh, University of Toronto, and St. Michael’s Hospital, Toronto, Canada
On behalf of the Oxford COVID-19 Evidence Service Team
Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences,
University of Oxford
23rd March 2020
Correspondence to [email protected]
Most real-world research comparing standard face masks with respirator masks has
been in the context of influenza or other relatively benign respiratory conditions and
based in hospitals. There are no published head-to-head trials of these interventions
in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection,
COVID-19, and no trials in primary or community care settings. Current guidance is
therefore based partly on indirect evidence – notably, from past influenza, SARS and
MERS outbreaks – as well as expert opinion and custom and practice.
Policy guidance from various bodies (e.g. Public Health England, WHO) emphasises
the need to assess the contagion risk of an encounter and use the recommended
combination of equipment for that situation. A respirator mask and other highly
effective PPE (eye protection, gloves, long-sleeved gown, used with good
donning/doffing technique) are needed to protect against small airborne particles in
aerosol-generating procedures (AGPs) such as intubation. For non-AGPs, there is
no evidence that respirator masks add value over standard masks when both are
used with recommended wider PPE measures.
A recent meta-analysis of standard v respirator (N95 or FFP) masks by the Chinese
Cochrane Centre included six RCTs with a total of 9171 participants with influenza-
like illnesses (including pandemic strains, seasonal influenza A or B viruses and
zoonotic viruses such as avian or swine influenza). There were no statistically
significant differences in their efficacy in preventing laboratory-confirmed influenza,
laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory
infection and influenza-like illness, but respirators appeared to protect against
bacterial colonization.
http://www.cebm.net/oxford-covid-19/
mailto:[email protected]
https://www.cebm.net/oxford-covid-19/
www.cebm.net/oxford-covid-19/
2
CONTEXT
Concerns have been raised about the limited personal protective equipment (PPE)
provided for UK primary and community care staff with some GP surgeries,
pharmacies and care homes having very limited provision. We were asked to find out
whether and in what circumstances standard m ...
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
White paper 2020: G-CON's Transmissible Disease Defense UnitsBrittany Berryman
This white paper discusses the use of flexible, mobile biocontainment and test units to prevent the spread of transmissible diseases. Transmissible diseases are no longer scarce and geographically limited to a location, but are becoming a more frequent occurrence, spreading rapidly due to rising populations and modern travel capability. Additionally, infectious diseases are now thriving in regions previously unsuitable for spread due to unfavorable climate and environmental conditions. Both types of diseases, therefore, have become a real threat for the entire global population.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- 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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
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.
How to Give Better Lectures: Some Tips for Doctors
Minimally invasive surgery and the novel coronavirus outbreak lessons learned in china and italy.pdf.pdf.pdf.pdf.pdf
1. 2020 Wolters Kluwer Health, Inc. All rights reserved.
Minimally invasive surgery and the novel coronavirus outbreak: lessons learned in China and Italy
Min Hua Zheng1
MD, Luigi Boni2
MD FACS, Abe Fingerhut1,3
MD FACS
1 Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
Minimally Invasive Surgery Center, Shanghai 200025, P. R. China
2 Department of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, University of
Milan, Milan, Italy
3 Surgical Research, Department of Surgery, Medical University of Graz, Austria
“So all a man could win in the conflict between plague and life was knowledge and memories.”
Albert Camus French writer and philosopher in “The Plague” 1947
As elective operations are being cancelled, and surgeons are called upon to perform only emergency or
carcinological surgery, the precautions to take when operating on patients who are potentially or proven
COVID-19 positive are of utmost importance.
The novel coronavirus (2019-nCoV) outbreak hit China in the beginning of December 2019, and ignited the
headlines a few days later. Unexpected, unprecedented, and radical modifications have profoundly shaken the
world since then. The economic shutdown in China cleared the map of China viewed from the sky, the halt in
travel, counseled first within the country, then internationally, was too late to stop the diffusion outside of
China, and meanwhile has destroyed enterprises such as Flybe, while changing the economy of airlines and
airports the world over. Hospitals and medical structures, in China, then Korea, and now Italy and France,
abound with people either infected, or afraid of being so. The stock of respiratory machines has never been
used so prominently, while facial masks, visors of all sorts and handkerchiefs, wipes and tissues have never
been expended more often, and are even depleted in certain regions.
First in China, then in Europe, and in particular, in Italy, the sudden and rapidly exponential afflux of patients in
need of management, simple or intensive care, or simply advice to stay where they were, became the
omnipresent and urgent preoccupation of health care workers, essentially those based in hospitals. In China,
make-shift neo-hospitals were built in unparalleled record-braking time spans, and in Europe, external triage
tents, internal reshuffling of beds and usage radically modified the architecture of existing health facilities.
2. 2020 Wolters Kluwer Health, Inc. All rights reserved.
Surgery has also evolved and changed radically, but over a 30- year span. How has the novel coronavirus (2019-
nCoV) outbreak affected surgery in China and Italy and will affect the future of surgery tomorrow is the
question of today.
The Centers for Disease Control and Prevention recently published recommendations that were upgraded by
the American College of Surgeons (1). Both recommended to stop elective surgery and to take general
precautions, but there was little on the pragmatic aspects of surgery.
In laparoscopic surgery, an essential part of the technique is the establishment and maintenance of an
artificial pneumoperitoneum; with this comes the risk of aerosol exposure for the operation team.
Ultrasonic scalpels or electrical equipment commonly used in laparoscopic surgery can easily produce
large amounts of surgical smoke, and in particular, the low-temperature aerosol from ultrasonic scalpels
cannot effectively deactivate the cellular components of virus in patients. In previous studies, activated
corynebacterium, papillomavirus and H.I.V. have been detected in surgical smoke (2-4) and several
doctors contracted a rare papillomavirus (5) suspected to be connected to surgical smoke exposure. The
risk of 2019-ncov infection aerosol should not be any exception. One study found that after using
electrical or ultrasonic equipment for 10 minutes, the particle concentration of the smoke in
laparoscopic surgery was significantly higher than that in traditional open surgery (6). The reason may
be that due to the low gas mobility in the pneumoperitoneum, the aerosol formed during the operation
tends to concentrate in the abdominal cavity. Sudden release of trocar valves, non-air-tight exchange of
instruments or even small abdominal extraction incisions can potentially expose the health care team
to the pneumoperitoneum aerosol; the risk is definitely higher in laparoscopic than in traditional open
surgery. This outbreak thus poses a great challenge to the clinical work of surgeons who practice MIS.
As the epidemic spreads and pandemics, we surgeons have the responsibility of raising the level of awareness,
prevention and control of transmission, not only for the current epidemic, but also, in general, as a principal for
all surgeries (7). Even if all elective surgery has been curtailed if not stopped in countries of the current
pandemic, the risk is present for patients who require emergency surgery or operations for malignancy, and
above all, for the surgeons and operating room staff who undertake these operations.
We would like to share the following, based on our recent experience in Shanghai and Milan.
1) General protection: all surgery patients must complete preoperative health screening, whether
they are symptomatic or not. As operating staffs might become infected, and therefore
3. 2020 Wolters Kluwer Health, Inc. All rights reserved.
reduced in number, all medical personnel have to comply with the tertiary protection
regulations (8,9).
2) Prevention and management of aerosol dispersal: During operations, whether laparoscopic or via
laparotomy, instruments should be kept clean of blood and other body fluids. Special attention should
be paid to the establishment of pneumoperitoneum, hemostasis and cleaning at trocar sites or
incisions to prevent any gush of body fluid caused by air leakage or uncontained laparotomy incisions.
Liberal use of suction devices to remove smoke and aerosol during operations, and especially, before
converting from laparoscopy to open surgery or any extra-peritoneal maneuver. Avoid using two-way
pneumoperitoneum insufflators to prevent pathogens colonization of circulating aerosol in
pneumoperitoneum circuit or the insufflator.
3) Management of artificial pneumoperitoneum: keep intraoperative pneumoperitoneum pressure and
CO2 ventilation at the lowest possible levels without compromising the surgical field exposure.
Reduce the Trendelenburg position time as much as possible. This minimizes the effect of
pneumoperitoneum on lung function and circulation, in an effort to reduce pathogen susceptibility.
4) Operation techniques: The power settings of electrocautery should be as low as possible.
Avoid long dissecting times on the same spot by electrocautery or ultrasonic scalpels to
reduce the surgical smoke. Special attention is warranted to avoid sharp injury or damage of
protective equipment, in particular gloves and body protection.
5) Postoperative operating room and equipment management: all protocols involving
postoperative cleaning and disinfection should comply with governmental and learned society
instructions (1,8,9). Devices used on infection-suspected or proven patients should undergo
separate disinfection followed by proper labeling. It is mandatory to specifically label and
dispose clinical wastes separately.
6) Ideally hospitals should be immediately divided into two main categories: dedicated hubs for positive
COVID-19 patients (with limited surgical staff and ORs, for those infected patients requiring surgery)
and other both for emergency surgery and urgent oncological procedures in negative COVID 19
patients. Health authorities should allow surgical teams to move from one hospital to another.
7) Teaching and future recommendations: Strengthen the awareness on the hazards caused by
surgical smoke and the management of intraoperative aerosol. Strict protocols must be
established for the creation and maintenance of laparoscopic pneumoperitoneum to reduce
the occupation hazard caused by aerosol exposure.
8) Operating staff protection: efforts must be made to raise awareness of the occupation
protection on operating staffs, including surgeons, anesthetists, and nurses and all possible
4. 2020 Wolters Kluwer Health, Inc. All rights reserved.
transiting persons in the OR. Correct two-way protective apparel (goggles, visor, mask, and
body protective garb) should be routine. When engaging a suspected or diagnosed patient,
tertiary dress code should be applied according to the protocols which also include
strengthening OR ventilation and installing air purification equipment.
9) Preoperative health screening: In order to effectively battle against the possibility of
prolonged 2019-nCOV outbreak, it is imperative to establish new standards of practice for
admitting patients in the future. This should range from preoperative health screening to final
differential diagnosis, including epidemiology investigation and adequate imaging.
This outbreak not only raises challenges to MIS in terms of disease control today but also should
remind surgeons that we need stronger occupational protection in the future. We must raise the level
of awareness and protection measures for the risk of occupational exposure in laparoscopic but also
traditional open surgery. There is an urgent need of a strict protocol to accurately manage the
artificial pneumoperitoneum and the hazards of aerosol diffusion for surgeons.
1) Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the
United States https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html
March 15 2020
2) Capizzi P J, Clay R P, Battey M J. Microbiologic activity in laser resurfacing plume and debris. Lasers in
Surgery & Medicine, 1998,23: 172-174
3) Hensman C. Chemical composition of smoke produced by high-frequency electrosurgery in a closed
gaseous environment. Surgical Endoscopy, 1998, 12(8): 1017-1019
4) Johnson G K, Robinson W S. Human immunodeficiency virus-1 (HIV-1) in the vapors of surgical power
instruments, 1991, 33: 47-50
5) Gloster H M, Roenigk R K. Risk of acquiring human papillomavirus from the plume produced by the
carbon dioxide laser in the treatment of warts J Am Acad Dermatol 1995; 32: 436-441
6) Li C I, Pai J Y, Chen C H. Characterization of smoke generated during the use of surgical knife in
laparotomy surgeries. J Air Waste Manag Assoc, 2020, Feb 12 [online ahead of print]. DOI:
10.1080/10962247.2020.1717675.
7) Zheng MH, Ma JJ, Wu C. Twenty year progression and future directions of minimally invasive surgery.
Chin J Pract Surg. 2020, 40: 23-26
5. 2020 Wolters Kluwer Health, Inc. All rights reserved.
8) General Office of National Health and Family Planning Commission of the People's Republic of China,
Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of novel
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