Pediatric surgery during the COVID-19 pandemic

The coronavirus disease 2019(COVID-19)pandemic has had a major impact on pediatric surgery.The infection is often asymptomatic and atypical in children,while overlapping presentations with other infectious diseases generate additional diagnostic challenges.The high probability of missed pediatric cases and the invasive nature of surgery generate great concern for widespread transmission in this setting.Current guidelines suggest that triage of cases should be made on a case-by-case basis by a multidisciplinary team of experts.Decisionmaking can be assisted by classifying cases as elective,urgent,or an emergency according to the risks of delaying their surgical management.A workflow diagram should ideally guide the management of all cases from admission to discharge.When surgery is necessary,all staff should use appropriate personal protective equipment,and high-risk practices,such as aerosol-generating tools or procedures,should be avoided if possible.Furthermore,carefully designed organizational protocols should be established to minimize transmission while ensuring the uninterrupted operation of pediatric surgery units.For example,surgical teams can be divided into small weekly rotating groups,and healthcare workers should be continuously monitored for COVID-19 symptoms.Additionally,team protocols in the operating room can optimize communication and improve adherence to personal protective equipment use.Isolated operating rooms,pediatric intensive care units,and surgical wards should be specifically designed for suspected or confirmed COVID-19 cases.Finally,transportation of patients should be minimal and follow designated short routes.All these measures can help mitigate the effects of the COVID-19 pandemic on pediatric surgery units.

Imaging in the COVID-19 era:Lessons learned during a pandemic

The first year of the coronavirus disease 2019(COVID-19)pandemic has been a year of unprecedented changes,scientific breakthroughs,and controversies.The radiology community has not been spared from the challenges imposed on global healthcare systems.Radiology has played a crucial part in tackling this pandemic,either by demonstrating the manifestations of the virus and guiding patient management,or by safely handling the patients and mitigating transmission within the hospital.Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic,including workflow alterations,volume reductions,and strict infection control strategies.Despite the ongoing challenges,considerable knowledge has been gained that will guide future innovations.The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19,and to discuss the implications of the pandemic on radiology departments globally,including infection control strategies and delays in cancer screening.Lastly,the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.

Platelet rich plasma effectiveness in bowel anastomoses:A systematic review

BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage,with detrimental effects on patient postoperative outcomes.Despite the investigation of several factors and the invention of protective materials,the ideal agent to prevent anastomotic leaks is yet to be determined.AIM To study the effect of platelet rich plasma(PRP)on the healing of bowel anastomoses.METHODS A systematic literature search was performed in PubMed,EMBASE,and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.RESULTS Eighteen studies were eligible with a total population of 712 animals including rats(14 studies),rabbits(2 studies)and pigs(2 studies).No postoperative complications were reported following PRP application.Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention,such as intraperitoneal chemotherapy or peritonitis.Similar results were reported by ten studies in terms of tissue hydroxyproline levels.One study reported significant increase in collagen deposition in PRP groups.PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy(6 studies).CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes,especially in animal models having an underlying condition affecting the normal healing process.PRP application seems to augment the normal healing process under these circumstances.However,further studies are needed to investigate the potential role of PRP on bowel anastomosis healing,especially in clinical settings.

Emergency department utilization for gastrointestinal care and patient characteristics associated with hospital admission in a national cohort

Introduction Gastrointestinal diseases and care in the USA account for a significant amount of healthcare resources and spending,recently totaling>$119 billion dollars annually[1].In addition to ambulatory sites and clinics,a substantial portion of gastrointestinal care occurs through the emergency department(ED).Though the overall rate of ED visits in the USA has remained stable over the past 10 years[2],the number of visits for gastrointestinal complaints has been increasing[1,3],contributing to rising healthcare costs.