bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance Comparison of Multiplexed Fluorescent Resonance Emission Transfer Hybridization Probes Across Roche LightCycler® Real-Time PCR Systems for the Detection of Bartonella species
Authors: Berent T , Rothstein T , Buckwalter S , Patel R
Published: October 2021

Introduction/Objective

Molecular assays for Bartonella species are important in diagnosing infection and expediting patient treatment. Real time polymerase chain reaction (RT-PCR) using fluorescent resonance energy transfer (FRET) hybridization probes can be used to detect Bartonella species in blood and fresh/fixed tissue biopsies in RT-PCR instruments. Over time, new technologies and reagents are introduced and existing PCR primers and FRET probes must be re-validated on new platforms. This study aimed to compare the performance of a Bartonella RT-PCR assay using the sunsetting Roche LightCycler® 2.0 (Roche Diagnostics, Indianapolis, IN) and newer LightCycler® 480 RT- PCR instruments.

Methods/Case Report

DNA was extracted from 132 historically positive, whole organism spiked, and historically negative whole blood and formalin fixed paraffin embedded (FFPE) samples. Samples were run on the LightCycler® 2.0 using instrument specific LightCycler® FastStart DNA Master HybProbe enzyme and compared to results generated using the LightCycler® 480 and its instrument specific LightCycler® 480 Genotyping Master enzyme.

During optimization, MgCl2 concentrations and thermocycling profiles were adjusted. Accuracy, specificity, inclusivity, and limit of detection studies were performed. Crossing point (Cp), melting temperature (Tm), fluorescent peak and fluorescent background values were compared between the two instruments.

Results (if a Case Study enter NA)

The agreement in accuracy between the LightCycler® 2.0 and the LightCycler® 480 was 100% for whole blood samples. For historically positive FFPE samples, LightCycler® 2.0 sensitivity and LightCycler® 480 sensitivity were 86% and 100%, respectively. Specificity and inclusivity of the assay were identical between the two instruments. The limit of detection in whole blood was 5-fold lower on the LightCycler® 480 (50 copies/µL) compared to the LightCycler® 2.0 (250 copies/µL). Mean Cp and fluorescent peak intensity values increased by 5.1% and 65-fold, respectively.

Conclusion

The study demonstrates similar performance and improved limit of detection for the Bartonella FRET hybridization probe RT-PCR assay on the LightCycler® 480 compared to the LightCycler® 2.0.
Fatal, Rapidly Progressive EBV-Associated Warm Autoantibody Hemolytic Anemia (WAIHA): A Rare Case Study
Authors: Kanakis C E , Gvozdjan K , Sereseanu L , Rodheim D , DeChristopher P J
Published: October 2021

Introduction/Objective

Separately WAIHA and Epstein-Barr Virus-infectious mononucleosis (EBV-IM) are well- studied clinical entities. EBV-IM cases are commonly linked with cold autoagglutinins (IgMs with anti-i specificity), but uncommonly associated with WAIHA. More rarely, EBV-IM can be associated with rapidly fatal AIHA. Prompt and appropriate diagnostic Blood Bank testing for WAIHA in EBV-infected patients should include work-ups to prevent missing the possibility of treating complicating WAIHA.

Methods/Case Report

A 24-year-old woman presented to the ED with a month of cough/cold symptoms, night sweats, cervical lymphadenopathy, and imaging showing diffuse thoracic lymphadenopathy. DNA/PCR testing was positive for active EBV infection and a lymph node biopsy was diagnostic for EBV lymphadenitis. Increasing respiratory distress developed, coupled with renal and liver insufficiency, hypotension, and possible DIC, and (suspected septic) shock. On hospital day (HD) 5, altered mental status worsened, cardiac arrest occurred requiring resuscitation and vasopressors, and acidosis trended rapidly higher. The patient rapidly decompensated and she was compassionately extubated, expiring on HD 6.

There were significant laboratory interval changes in the final 20 hours of life. New positive DATs (with anti-IgG and - C3b/d), a pan-reactive warm autoantibody of broad specificity (in plasma & eluate), onset of acute hemolysis (nadir Hgb to 4.6 g/dL with net drop of 4.7 g/dL & LDH 23, 582 U/L), coagulopathy (peak PT 96.6 sec) and evidnece of organ failure. Blood Bank testing, received on HD 5 at 21:45, was resulted in the EMR on HD 6 at 00:30 and the patient expired at 05:15--further illustrating the rapid clinical course presented in this case.

Results (if a Case Study enter NA)

N/A

Conclusion

This patient died of complications directly associated with acute, immune-mediated intravascular hemolysis leading to high-output cardiac failure and resulting in multi-organ failure. With a relative paucity of published EBV-IM WAIHA associations, the rapidly evolving unexpected hematologic sequelae observed complicated the clinical recognition and treatment of severe WAIHA during the course of treatment for clinically suspected DIC. The rapid progression of this patients’ symptoms and laboratory values did not allow for adequate recognition of WAIHA-related pathogenesis and appropriate interventions.
Development of a COVID-19 Convalescent Plasma Curriculum Amongst Students: An Initial Pilot Study
Authors: Jhala A , Petersen J M
Published: October 2021

Introduction/Objective

Since December 2019, the World Health Organization has documented over 145 million COVID-19 infections with more than 3 million deaths worldwide. Considering this unprecedented pandemic, potential treatments including COVID-19 Convalescent Plasma (CP) received an emergency use authorization (EUA) for hospitalized patients from the Food and Drug Administration (FDA) in August 2020. CP is a form of passive immunization in which antibody-rich blood taken from recovered COVID-19 patients is used for transfusion into other patients. CP therapy is a temporary treatment that is meant to help hospitalized COVID-19 patients recover. Although there has been significant interest in CP, the peer-reviewed English literature is sparse on education initiatives on CP and appears absent regarding undergraduates and other students outside the laboratory or blood bank. Therefore, we present a first presentation of a pilot education initiative on CP for students.

Methods/Case Report

Information for the educational presentation was obtained from AABB guidelines, meta- analyses, and published clinical studies. Presented was a broad overview algorithm of when CP may be considered starting with symptomatic patients hospitalized with moderate to severe disease who have been diagnosed with COVID-19, including a brief review of the gold standard for COVID-19 diagnosis by reverse transcriptase polymerase chain reaction. As part of this pilot study, this presentation was given to a group of high school students.

Results (if a Case Study enter NA)

In this study, 22 high school students were briefly taught about convalescent plasma, including its use as a therapeutic agent to treat COVID-19. Before the presentation, 0 of the 22 students knew how CP was involved in COVID-19 or even what CP was. After the presentation, a survey was taken in order to learn about knowledge retention and after, all were understood CP’s general use in COVID-19. Therefore, this presentation improved knowledge on CP and was well accepted.

Conclusion

Educational initiatives on information related to CP have critical potential to improve the knowledge base of students. This presentation represents a pilot study for additional educational initiatives to improve the knowledge of CP amongst students.
The Impact of Social Media Engagement from a Pathology Department During COVID
Authors: Crowe C
Published: October 2021

Introduction/Objective

The events of the past year brought into stark relief the importance and impact of social media and digital communications for pathology departments as managed by an intra-departmental team of communications professionals. The University of Alabama at Birmingham Department of Pathology is home to nearly 100 faculty, more than 200 staff members and close to 40 trainees. The department’s internal communications team consists of a director of communications and content coordinator, both full time employees. Prior to the COVID pandemic, the team hosted departmental Twitter and Facebook accounts. During the course of the year, we added Instagram and LinkedIn accounts, as well as a YouTube channel. These vehicles provided multiple platforms for communicating our messages, relating to COVID and promoting regular news and updates broadly, to both internal and external audiences.

Methods/Case Report

We created LinkedIn and Instagram accounts in July 2020, to round out our social media platforms. We use Sprout Social to manage our various accounts.

Results (if a Case Study enter NA)

For the timeframe of March 2020–2021 our @UABPathology Twitter account had a total of 933 published posts, and 1,022,785 total impressions, for 3,889 followers. Total engagements with the posts were 48,420, with 2,301 post link clicks. For the same timeframe, our nascent @UABPathology Instagram account earned 56,662 impressions, and 3,329 total engagements, for a 5.9% engagement rate. Most experts agree that a good engagement rate is between 1 and 5%.

Conclusion

Our departmental social media accounts generated high impact engagements with an audience primarily in the demographic of our target for trainee and young faculty recruits, ages 25-34, in addition to broadly disseminating our department’s ongoing news and updates during the COVID pandemic. The impact of effectively communicating through social media channels is measurable, and will continue to grow the reputation of the department as a top-tier clinical, research and educational program in the field.
Analysis of the molecular evolution of histone variant H2A.Z using a linker-mediated complex strategy and yeast genetic complementation
Authors: Kitagawa Saho , Kusakabe Masayuki , Takahashi Daisuke , Narimiya Takumi , Nakabayashi Yu , Seki Masayuki , Horigome Chihiro , Harata Masahiko
Published: October 2021

The histone variant H2A.Z is deposited into chromatin by specific machinery and is required for genome functions. Using a linker-mediated complex strategy combined with yeast genetic complementation, we demonstrate evolutionary conservation of H2A.Z together with its chromatin incorporation and functions. This approach is applicable to the evolutionary analyses of proteins that form complexes with interactors.
Effects of the donor factors and freezing protocols on the bovine embryonic lipid profile
Authors: Janati Idrissi Sarah , Le Bourhis Daniel , Lefevre Antoine , Emond Patrick , Le Berre Laurene , Desnoës Olivier , Joly Thierry , Buff Samuel , Freret Sandrine , Schibler Laurent , Salvetti Pascal , Elis Sébastien
Published: October 2021

Embryo lipid profile is affected by in vitro culture conditions that lead to an increase in lipids. Efforts have been made to optimize embryo lipid composition as it is associated with their quality. The objective of this study was to evaluate whether the diet supplementation of donor cows (n-3 or n-6 polyunsaturated fatty acids), or the slow freezing protocols (ethylene glycol sucrose vs. glycerol-trehalose), or the physiological stage of the donor (nulliparous heifers vs. primiparous lactating cows) may impact the bovine embryo lipid profile. Lipid extracts of 97 embryos were individually analyzed by liquid chromatography-high resolution mass spectrometry, highlighting 246 lipids, including 85% being overabundant in cow embryos compared to heifer embryos. Among 105 differential lipids, 72 were overabundant after ethylene glycol sucrose protocol, including a single glycerophosphate PA(32:1) representing 27.3% of the significantly modulated lipids, suggesting that it is degraded when glycerol-trehalose protocol is used. No lipids were different according to the n-3 or n-6 supplementation of the donor cows. In conclusion, the embryonic lipid profile was mainly affected by the physiological stage of the donors and the slow freezing protocols. The overabundance of lipids in lactating cow embryos and the resulting lower quality of these embryos are consistent with the lower pregnancy rate observed in cows compared to heifers. Unlike glycerol-trehalose protocol, ethylene glycol sucrose freezing allowed to preserve glycerophospholipids, potentially improving the slow freezing of in vitro-produced embryos. Further studies are required to modulate embryo quality and freezability by modulating the lipidome and by integrating all stages of embryonic production.
EP.WE.20At a glance: the impact of COVID-19 on Emergency General Surgery
Authors: Aboul-Enein Mohamed , Ishak Peter , Bhambra Maninder , Ricart Pol , Ishak Lisa , Perry Anthony
Published: October 2021

Aim

This study investigated the impact of COVID-19 on emergency general surgery practice, in a district general hospital in the United Kingdom, particularly on referrals, diagnosis, investigations, management pathways, outcomes, patient behaviour and consultant practice.

Methods

Retrospective data collection from two cohorts: 112 patients admitted over one week in pre-COVID period and 90 patients admitted over one week during the COVID period. We used patient questionnaire and a consultant questionnaire to collect data on patient behaviour and consultant practice.

Results

Almost four times and seven times increase in performed X-rays (CXRs)and CT-thorax-abdomen-pelvis (TAPs) respectively. The COVID period saw 6.5% increase in conservative and 6.2% reduction in surgical management, and about 50% decline in length of stay (LoS) in conservatively managed patients. 71% of patients’ decisions to attend hospital were not affected and 78.6% of consultant surgeons preferred to manage patients conservatively during the COVID period.

Conclusion

Overall, there were delayed patients’ presentations to hospital at almost twice, increase in paediatric referrals, a surge in performed scans, and a reduction in hospital stay in patients who were managed conservatively. Patient behaviour to attend hospital was not heavily influenced by COVID, but consultant practice certainly changed towards more conservative choices. Future studies should explore the impact on paediatric referrals and long-term effects on surgical training.

This study's manuscript has been accepted for publication in the Surgical Practice Journal.
EP.WE.31A snapshot audit on the current practice of minimal access surgery in the UK during COVID-19 pandemic
Authors: Barrow Hannah , Patel Rikesh , Selvasekar Chelliah
Published: October 2021

Aims

COVID-19 is an ongoing global pandemic that poses potential increase in the risk of post-operative complications. Early guidelines placed an embargo on minimal access surgery, aiming to minimise risk to patients and the surgical team through aerolisation of the virus. We aimed to assess the practice of minimal access surgery during the peak of the pandemic and associated surgical outcomes.

Methods

An email link to an online questionnaire was distributed to a variety of surgical specialties via the Royal College of Surgeons COVID group and ALSGBI members. Data collection was carried out over a 4-month period. Data assessed included screening methods, case volume, surgical approach and patient outcomes.

Results

A total of 118 responses from a variety of surgical specialties were collected over 59 units, ranging in grade from Consultant to SHO/Core Trainee.

The volume of minimal access procedures decreased during the pandemic from 94.9% of units to 39.0% (P < 0.001), with a greater percentage opting for an open approach (54.2% vs 39.0%, P < 0.001).

Combining screening methods was a favoured approach, and it was frequently used alongside a designated ‘Clean’ theatre.

A small proportion of patients suffered from post-operative COVID-19 complications (15.3%), but COVID-19 mortality was low.

Conclusions

Whilst the risk of COVID-19 infection was not completely abolished perioperatively throughout the pandemic, it appears to be minimised by use of adequate screening with designated clean areas. It would therefore support guidelines advocating continued use of minimal access surgery during peaks of COVID-19 if prudent peri-operative measures are taken.
EP.WE.84Palliative Care Interventions for Peripheral Vascular Disease: A Systematic Review
Authors: Davies Henry , Waduud Mohammed , Laloo Ryan , Bennett Michael I , Scott Julian
Published: October 2021

Objective

Identify and evaluate palliative care interventions used in peripheral vascular disease (PVD).

Background

PVD encompasses conditions with poor outcome and severe suffering, both mentally and physically, yet utilisation and research into palliative care interventions remain sparse.

Methods

A systematic review of all study designs published between January 1991 and January 2020 in which people with PVD received palliative care interventions and at least one patient reported outcome was recorded.

Results

A total of eight studies involving 87037 unique patients met inclusion criteria (four cohort studies and four cross sectional studies). There were no randomised controlled studies; The small number of studies and study heterogeneity precluded meta-analysis. Only two papers recorded patient reported outcomes. Five papers found an association between palliative care and reduction in health care utilisation. Most of the studies reported that palliative care was likely underused. Only two of the studies included non-hospital patients. The methodological quality of the papers ranged from low to moderate.

Conclusions

Despite high mortality and morbidity associated with PVD, evidence of the effectiveness of palliative care in this group of patients is lacking. There are only a handful of papers on palliative care in vascular surgery and the majority are small, methodologically flawed and lack patient reported outcomes. Randomised controlled trials of palliative care interventions in patients with PVD are needed to determine optimal treatment outcomes.
EP.WE.93An Overview of the Effect of COVID-19 on the General Surgical Take: Before, During and After the First UK National Lockdown
Authors: Heard Rachel , Kopczynska Maja , Woyton Michal , Allen Elizabeth , Garcia Madeline , Pearce Lyndsay
Published: October 2021

Aims

Emergency general surgical (EGS) services have faced new challenges during the coronavirus pandemic. This study compared all EGS presentations before, during and after the first UK national lockdown between March and May 2020.

Methods

All EGS patients presenting to our centre in four separate weeks were included. These weeks represented ‘pre-lockdown’, ‘early lockdown’, ‘established lockdown’ and ‘post lockdown’ groups. Demographic data, treatment, admission and outcomes were collected for all patients and compared between groups.

Results

178 patients accounted for 214 EGS attendances over four weeks. Attendances decreased from 74 pre-lockdown, to 43 in early lockdown, 32 in late lockdown and rose to 65 in the post lockdown group. Significantly more patients received repeat outpatient reviews in the lockdown groups (p = 0.002). Length of stay was significantly reduced in established lockdown (0.5 days vs. 2 days pre-lockdown, p = 0.042). There was a trend towards conservative management of surgical pathology in the lockdown groups (65% vs 47% pre and post-lockdown, p = 0.10). No very elderly or frail EGS patients presented during the lockdown study period. There was no evidence of delay to presentation.

Conclusions

The COVID-19 pandemic and UK Coronavirus lockdown resulted in a large decrease in EGS admissions and alteration in characteristics of these admissions. New national guidance during the pandemic advocated ambulatory and conservative management of surgical conditions where possible and is reflected in our cohort. These changes reverted almost back to pre-lockdown state the week following the easing of the first UK national lockdown.
EP.WE.118Evaluating outcomes of a WhatsApp teaching platform for doctors: Implications for adopting innovative strategies in medical education during the COVID-19 pandemic[H1] [H1]Should this be a shorter, more targeted title?
Authors: Oyewole Bankole , Animasahun Victor , Chapman Helena
Published: October 2021

Aim

The coronavirus disease 2019 (COVID-19) pandemic has affected an estimated 1.6 billion learners around the world (UN, 2020) and has led to the rapid restructuring of the global education sector due to lockdown restrictions to curb community transmission.

The objective of this study is to examine the effectiveness and sustainability of WhatsApp as a platform to deliver medical education and its implication for the implementation of social media for medical education during the COVID-19 pandemic.

Methods

This was a cross-sectional study conducted with a sample of 358 participants of the WhatsApp study platform known as PLAB[H1] network. Inclusion criterion included participants who completed[H2] the PLAB 1 exam on one of three dates (March 14, 2019; November 7, 2019; March 12, 2020).

Results

A total of 358 respondents, comprising of 60.6% males and 39.4% females, age ranged from 18 to 47 years with a mean age of 30.3±4.4 years.

90.8% passed the PLAB exam, 83.5% scored above the GMC average. 76.3% reported the PLAB network helped them prepare adequately. 90% reported increased their motivation to learn, and 85.2% reported that it encouraged collaborative learning and participation. 78.8% felt the sessions were organised and easy to follow. An estimated 71.5% stated that they preferred learning via the PLAB network.

Conclusion

WhatsApp can be used to deliver sustainable medical education during the COVID-19 pandemic and beyond

Please spell out for first use

Who took and passed – or just took?
EP.WE.126Survey on surgeons’ experience of wearing full PPE in theatres
Authors: Liyanage Aloka Suwanna Danwaththa , Ngo Vivien , Gokul Krishnan , Ainsworth Paul
Published: October 2021

Aims

With the invasion of surgical work space by SARS-CoV-2 virus in 2020, the surgical safety concerns have been escalated to a new height. COVID-19 risk has questioned the adequacy of traditional Personal Protective Equipment (PPE) that has been in practice until now. Full PPE including respirator masks and visors in day today practice by all theatre staff across all surgical disciplines being implemented during and post pandemic time. However this implementation is not without its drawbacks as much as its positive merits. We conducted a survey among surgeons to ascertain their personal experience of wearing full PPE in theatres in day today practice.

Methods

Survey Monkey questionnaire was sent to surgeons at various levels in their carrier in different disciplines in the region.

Results

47 surgeons responded to the questionnaire. 65% of the respondents were from General surgery and 38% of them were consultants. 85% of surgeons considered full PPE uncomfortable. Communication and visibility were main issues. Majority (52%) thinks that full PPE can affect their performance. The length of the procedure makes the negative effects of full PPE worse. More than 50% of respondents were not sure of the beneficial effects of full PPE in theatres.

Conclusions

Full PPE can have impact on the performance of surgeons. Communication being one of the main issues in wearing full PPE, an alternative strategy needs to be developed to improve communication between individuals in theatres.
EP.WE.238Implications of COVID-19 on Laparoscopic General Surgery: a single site experience
Authors: Lawrence Eloise , Stathakis Panos , Goldsmith Paul , Smith Stella , Macutkiewicz Christian , Chan Anthony
Published: October 2021

Introduction and Aims

The COVID-19 pandemic has had an unprecedented impact on service provision in Emergency General Surgery. Due to the unknown risk of COVID-19 transmission, the use of laparoscopic surgery was cautioned against in favour of open surgery or conservative management. This study looks at the impact of service reconfiguration on rates of laparoscopic surgery.

Methods

The management and outcomes were audited of all patients admitted to our unit during the UK COVID-19 lockdown period and compared against the same period last year.

Results

In total, 645 patients (223 COVID-19 period, 422 non-COVID) were included. Less surgery was performed during the pandemic (32.3% vs 39.3%), with only 2 cases of laparoscopic surgery (0.9% vs 16.1%). Despite a change to conservative management, we report no differences in complication rates or length of stay and 30-day mortality (excluding deaths from COVID-19 pneumonitis). Re-admission rates were higher following conservative management (10.6% vs 4.7%).

Conclusion

There is a significant reduction in surgery (particularly laparoscopic surgery) during the COVID-19 pandemic. There are no differences in outcomes, but we show higher re-admission rates for patients treated conservatively. Together with emerging evidence on the safety of laparoscopic surgery, these findings help inform service re-configuration for future pandemic responses.
EP.WE.324Variation Between Observed and Perceived Volume of Antireflux Operations Completed by Upper-Gastrointestinal Surgeons at a University Teaching Hospital
Authors: Ashmore Christopher , Hunter David , Boddy Alex
Published: October 2021

Aims

Increased institutional volume and surgeon experience with antireflux surgery has been shown to improve patient outcomes. We have sought to illustrate the discrepancy between the perceived (self-reported) and observed annual volume of anti-reflux operations completed by each surgeon.

Method

A retrospective questionnaire was delivered to all upper-gastrointestinal (UGI) surgeons performing antireflux surgeries (ARS) at a University Teaching Hospital. Surgeons were asked to estimate the quantity of NHS antireflux cases completed annually. Objective, anonymised data was retrieved from the Surgical Workload Outcomes Audit Database (SWORD) from 2017 to 2020 for comparison.

Results

127 ARS were completed by 6 UGI consultants between January 2018 and December 2020. The median number of ARS completed per surgeon was 5 (2-10) in 2018, 9 (4-11) in 2019 and 10 (1-11) in 2020. Conversely, the median number of self-reported annual procedures per surgeon was 20 (12-35). On average, participants overestimated the number of NHS ARS completed by 14.5 (4-27) cases or a factor of 2.08. No surgeon correctly or underestimated the number of ARS performed.

Conclusion

We conclude that self-reported operation volume should not be relied upon for the purposes of assessment or audit. Estimations of annual ARS procedures could be up to triple that suggested by objective data. Our data supports the importance of local or national data sets like SWORD to give an accurate reflection of practice and to allow individuals to compare their performance against their peers.
EP.WE.338Ambulatory Ultrasound Scans Reduce Inpatient Admissions During COVID-19: A Need for the Expansion of Ambulatory Services
Authors: Cornett L , Davidson S , McElvanna K
Published: October 2021

Aim

With the increased need to manage patients out of hospital during COVID-19, it was anticipated that need for ambulatory imaging would increase. This study aimed to assess the demand for ambulatory ultrasounds (US) during the COVID-19 pandemic and the impact on inpatient admissions.

Methods

A retrospective review of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required an US as first line imaging. Electronic Care Records were used to collect data regarding type of US i.e., inpatient, or ambulatory, time taken for ambulatory US and outcome after imaging. The same period in 2019 was assessed for comparison.

Results

In 2020, 100 patients required an US compared to 88 in 2019. 37% (37/100) of which were discharged for an ambulatory US, compared to 14.8% (13/88) in 2019 (p = 0.006). The average waiting time for an ambulatory US in 2019 was 2 days, this increased to 7 days in 2020. Following ambulatory US in 2020 43.2% (16/37) required further outpatient imaging or assessment; similar outcomes were seen in 2019 with 46.2% (6/13). Overall, there was a 150% increase in the use of ambulatory US, with a 26% decrease in admissions in 2020 vs. 2019.

Conclusions

There was a significant increase in the number of patients discharged from ED to undergo an ambulatory US resulting in reduced inpatient admissions. This increase in demand is reflected by the prolonged waiting time highlighting the requirement for expansion of ambulatory services to meet this clinical need.
EP.WE.410Appendicectomy during the COVID-19 pandemic: an assessment of the change in practice within the West of Scotland
Authors: Al-Azzawi Yassir , Gall Lewis , Miller Gillian , Lowrie Joanna , Thomas Rachel , Macdonald Andrew
Published: October 2021

Aims

The Covid-19 pandemic has significantly impacted emergency and elective surgical activities. Multiple surgical professional bodies initially recommended appendicitis be managed conservatively or with judicious open surgery to mitigate potential risks with Covid-19 transmission. This study compares the investigation, operative findings and outcomes of patients who underwent appendicectomy before and after the National lockdown.

Methods

A multicentre retrospective cohort study of patients who had emergency appendicectomy in four West of Scotland hospitals between September 2019 and November 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK National lockdown of 23rd March 2020 compared to those presenting post-lockdown.

Results

A total of 559 appendicectomies were performed (280 pre-lockdown and 279 post-lockdown) in four hospitals and included in the analyses. More males than females had appendicectomy in the post-lockdown period (60.6% vs 52.1%, p 0.044). Pre-operative CT scanning was performed more often post-lockdown (71.7% vs 56.8%, p < 0.001) and an open approach was adopted more frequently post-lockdown (19.0% vs 3.6%, p < 0.001). The proportion of operations for complicated appendicitis increased post-lockdown (31.9% vs 22.1%, p = 0.009). Median hospital stay was equal in both groups (3 vs 3 days, p = 0.787). Post-operative complication rates were similar in both groups apart from a higher 30-day re-admission rate post-lockdown (7.9% vs 3.6%, p = 0.028).

Conclusion

Covid-19 has resulted in significant modifications to the pre-operative work-up and surgical approach to patients undergoing emergency appendicectomy. Whilst the proportion of patients with complicated appendicitis has increased post-lockdown, overall clinical outcomes remain similar.
EP.WE.577Chest air-leak complications in critically ill COVID-19 Patients: a retrospective single-centre cohort study
Authors: Fong Michelle , Shepherd Sophie , Gandre Priti , Gahir Jasdeep
Published: October 2021

Introduction

COVID-19 has caused a global pandemic with a proportion of patients admitted to intensive care with viral pneumonia and respiratory failure. Spontaneous air leaks have been reported in patients with COVID-19. We report on a phenomenon of significant chest air-leak manifestations on a cohort of critically unwell intubated COVID-19 patients in our single centre.

Methods

All patients admitted to our single-centre intensive care unit during the initial outbreak of COVID-19 in the UK were identified. Individual electronic notes and imaging were screened to look for complications of: surgical emphysema, pneumomediastinum and/or pneumothorax.

Results

158 patients were admitted to our intensive care and eleven (7.0%) of patients were found to have suffered air leak complications unrelated to line insertion. Five suffered surgical emphysema only, one surgical emphysema with pneumomediastinum and two with the full triad of surgical emphysema, pneumomediastinum & pneumothorax. Two patients had unilateral pneumothoraces and one patient experienced a tension pneumothorax. Four patients were managed conservatively and seven had chest drains inserted. Overall outcomes were: one patient was discharged home, one discharged to ward, two transferred to an outside hospital and seven died.

Conclusion

Air-leak complications in COVID-19 patients, both spontaneous and ventilation associated are an under-recognised phenomenon. In the critically ill population literature suggests there is a > 5% incidence and risk reduction strategies should be considered. We advocate for early diagnosis and decompressive therapy with chest drains to avoid tamponade in intubated patients. Virus spread from air-leak should also be considered and health-care professionals adequately protected.
EP.WE.604Communicating with relatives during covid: creating a vision
Authors: Olaleye Oladapo , Joseph Jinto , Smith Stella
Published: October 2021

Aim

The unique situation created by the global pandemic has led us to re-evaluate how we disseminate information about service provision to patients and their relatives. The aim of this project is to create a patient centred video, explaining the Major Trauma (MT) service.

Methodology

Participants who accessed the MT service. from May 2020- July 2020 were approached to evaluate their thoughts on the service through open questions. The raw data was analysed using thematic analysis. The themes generated were the incentivizing force behind the creation of the video.

Results

13 patients participated in the telephone consultation. The main themes identified were ‘knowledge of service,’ ‘communication with family,’ and ‘encouraging holistic inpatient care’. The themes identified a lack of knowledge about the MT service by both patients and their relatives. This led to poor understanding on the utility of the service by participants, and ineffective engagement of the service by relatives.

Conclusion

The video was created in response to our survey and aims to inform and educate its audience about what services the M.T. service provides. The authors foresee a patient centred video series that guides our service users as they engage with the multidisciplinary team through their inpatient stay. The current video will be made available to service users via tablets on the ward and the MT service web page. This can be accessed remotely by relatives. This video represents the expansion of the Major Trauma Services’ digital footprint and a move towards more user-friendly formats.
EP.WE.628The Challenges of Consent and COVID-19: Analysis of Documentation of Risk of Hospital Acquired COVID-19 Infection in a District General Hospital
Authors: Mishra Shashwat , Davis Heather , Tan Wei Jian , Cooke Joanne
Published: October 2021

Aims

The COVID-19 pandemic poses a new material risk to hospital admissions and we must modify consenting practice accordingly. This study assessed documentation of the risk of COVID-19 infection and associated morbidity in consenting practice for patients undergoing general surgical procedures under general anaesthesia at a district general hospital.

Methods

This is was a two-cycle study design. An initial retrospective case-note analysis of 41 inpatient consent forms and operation notes during April 2020 was performed. Data were gathered on points from the Royal College of Surgeons (RCS) guidance, including documentation of risk of COVID-19 infection. Recommendations were then offered including a teaching session from the departmental lead into the importance of documenting risk of COVID-19 infection. A prospective case-note analysis of 45 inpatient consent forms and operation notes during November to December 2020 was then performed.

Results

In cycle one, of 41 cases, 39% (16) had risk of chest infection documented. Of these, 16 (63%) specified COVID-19 in risk documentation. Morbidity related to COVID-19 was documented in 4 (25%) of these 16 cases. Following interventions, of 45 cases, 93% had risk of COVID-19 infection and associated morbidity documented (χ2 = 89.3646, p < 0.00001 significant at p < 0.05).

Conclusion

We initially identified a deviation from RCS consent guidance. The second cycle results show a significant improvement in consenting practice for the risk of contracting COVID-19 for inpatient surgical procedures. We aim to further refine our recommendations to ensure that this material risk is communicated to patients during the initial consent process.
EP.WE.709A local experience of non-operative management for an appendicitis cohort during COVID-19
Authors: Mai Dinh Van Chi , Sagar Alex , Menon Nainika Suresh , Claydon Oliver , Down Billy , Keeler Barrie David
Published: October 2021

Background

During the first United Kingdom COVID-19 wave, the Royal Colleges of Surgeons initially recommended conservative management with antibiotics instead of surgery for appendicitis. This study compared local outcomes of appendicitis during this period with a pre-COVID-19 cohort.

Methods

An observational study was conducted in a district general hospital. All episodes of appendicitis were prospectively studied from 25th March 2020 until 26th May 2020 and compared with a retrospective pre-COVID cohort from 27th November 2019 until 29th January 2020. Primary outcome was 30-day treatment failure of simple appendicitis for conservatively managed cases during COVID-19 compared to surgically managed cases pre-pandemic. Treatment failure was defined as any unplanned radiological or surgical intervention.

Results

Over nine weeks, there were 39 cases of appendicitis during COVID-19 and 50 cases pre-COVID-19. Twenty-six and 50 cases underwent appendicectomy during and pre-COVID-19 respectively. There was no difference in 30-day postoperative complication rates and nor were there any peri-operative COVID-19 infections.

Twelve cases of simple appendicitis underwent conservative management during COVID-19 and were compared with 23 operatively managed simple cases pre-pandemic. There was a higher failure rate in the conservative versus operative group (33.3 vs 0% OR = 24.88, 95% CI 1.21 to 512.9, p = 0.0095). Length of stay was similar (1.5 vs 2.0 p = 0.576).

Discussion

Locally, conservative management was more likely to fail than initial appendicectomy. We suggest that surgery should remain first line for appendicitis, with conservative management reserved for those with suspected or proven COVID-19 infection.
EP.WE.782Retrospective analysis of acute surgical admissions during COVID-19 pandemic
Authors: Rajamanikam Shenbaga , Argyropoulos Suzzana , Zadeh Reza Arsalani
Published: October 2021

Background

COVID-19 pandemic has affected the number of surgical admissions and the number of emergency general surgical operations performed. COVID-19 pandemic has also led to changes in how some of the acute surgical patients were managed. Aim of the study was to compare acute surgical admissions and number of emergency general surgical procedures in this period.

Material and Method

We retrospectively analyzed acute surgical admissions during the pandemic from 20/3/20 to 19/4/20 and compared it with acute surgical admissions during pre-COVID-19 period from 1/11/2019 to 30/11/2019.

Results

During the COVID-19 pandemic 97 patients were assessed and admitted by the General surgical team, during the pre COVID-19 period 205 patients were assessed and admitted by the General surgical team. The number of acute surgical admissions during COVID-19 pandemic dropped by 53%. There were 46% less emergency surgeries performed during COVID 19 pandemic period. Length of stay during and before the COVID-19pandemic were 4.1 vs 4.4 days.

Conclusion

During the COVID-19 pandemic number of acute surgical admissions and the number of emergency surgeries were fewer than during pre COVID-19 pandemic. Length of hospital stay was less during COVID-19 pandemic.
EP.WE.802Are we over-zealous in our management of acute diverticulitis?
Authors: Lafaurie Guillaume , Butterworth James , Engledow Alec
Published: October 2021

Aims

Of the 25% of people with diverticula who develop symptomatic diverticular disease, approximately 75% will have at least one episode of diverticulitis. However according to the latest NICE guidance those with diverticulitis who are not systemically unwell may not require either admission or antibiotics. In the financially austere environment facing the NHS within the COVID 19 pandemic, prudence in such resource allocation is of vital importance. We aim to review management of patients with acute diverticulitis over a 6-month period in a district general hospital against the 2019 NICE guidelines.

Methods

29 patients presenting with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed. Biochemical markers, lactate and vital signs were used to assess if attending patients were systemically unwell.

Results

23 patients were admitted and 6 managed as outpatients via the surgical ambulatory unit. Of the 29 patient cohort, 9 (31%) were systemically unwell. All 9 unwell patients received antibiotics. Of the 20 patients not considered systemically unwell, 11 (55%) received antibiotics. 16 (80%) that were admitted did not require admission on retrospective review.

Conclusion

Prompt administration of intravenous antibiotics for septic patients with diverticulitis reduces associated morbidity and mortality and the observed adherence to this principle is encouraging. For systemically well patients, increased clinical discernment is required to consider managing patients in the surgical ambulatory setting, avoiding unnecessary admissions. Similar caution must be used in appropriate use of antimicrobials to avoid unnecessary adverse consequences.
EP.WE.824Effect of bariatric surgery on gut permeability in humans: a systematic review
Authors: O'Brien James , Robertson Denise , Griffin Bruce , Rockall Timothy , Pring Chris
Published: October 2021

Aims

Altered intestinal permeability (“leaky gut”) is associated with obesity. Several mechanisms have been suggested to explain the harmful sequalae that follow permeability change such as inflammation, alteration to the microbiome and onset of insulin resistance. Studies describe bariatric surgery as having varying effects on intestinal permeability. We aim to summarise and review the literature.

Methods

A systematic review was performed using MEDLINE, EMBASE, and Scopus to identify studies in humans that investigated permeability change after bariatric surgery.

Results

5 studies were identified, all cohort. Heterogeneity precluded meta-analysis. All calculated permeability change following oral intake of different sugar solutions. Two studies described a reduction in gastroduodenal permeability post sleeve gastrectomy (SG), one from an increased baseline compared to lean controls. Two described an increase in small intestinal permeability after “malabsorptive” operations (biliopancreatic diversion and duodenal switch). Two found decreased small intestinal permeability at one month post Roux-en-Y gastric bypass and six months post SG. One including only SG had opposite findings of increased small intestinal permeability at 6 months. The only colonic change reported was increased permeability also 6 months post SG.

Conclusion

Research found both increased and decreased permeability of the small intestine. Two studies found reduced gastroduodenal permeability post operatively. Evidence regarding the effect of bariatric surgery on the permeability of the gastrointestinal tract and specifically the colon is limited and follow up, operation type and small numbers limit meaningful comparison. Further study into this crucial aspect of obesity both before and after surgery is needed.
EP.WE.844Two-week bowel cancer referrals during the COVID pandemic
Authors: Antakia Ramez , Popa-Nimigean Vladimir , Athisayaraj Thomas
Published: October 2021

Aims

The aims were to assess the impact of the COVID-19 pandemic on the waiting times for patients referred via the two-week pathway for suspected colorectal cancer. We also examined the use of Faecal Immunochemical Test (FIT) alongside the presenting complaints in triaging/prioritising patients for further imaging and/or endoscopic investigations appropriately.

Methods

A list of all patients referred via the two-week pathway to the West Suffolk Hospital for suspected colorectal cancers from 30/01/2020 to 19/07/2020 was compiled. The main four red flag symptoms were change in bowel habit (CIBH), anorectal bleeding, anaemia and weight loss. A subset of 235 patients were closely examined regarding their presenting complaints, FIT, imaging and endoscopy results with analysis of outcomes.

Results

127 male versus 108 female patients were included. 59.61% of patients who were eligible for the FIT test received one. Mean waiting time for FIT positive patients was 42.39 (95% CI) versus 61.10 (95% CI) for FIT negative patients. Patients with one or two red flags symptoms had a mean waiting time of 44.81 days (95% CI 35.79-53.82) and 47.91 days (95% CI 38.07-57.75) respectively. Patients with three red flag symptoms had a mean waiting time of 28.2 days (95% CI 17.94-38.39). There was a statistically significant difference in mean waiting time between patients having 1-2 symptoms and patients with three symptoms (p < 0.005).

Conclusions

Despite delays during the COVID pandemic particularly for endoscopy, high risk and FIT positive patients were prioritised. Waiting times were still higher than advised national guidelines.
EP.WE.858Risk of Post-Operative COVID-19 Infection Following Breast Surgery
Authors: Akosile Catherine , Ravichandran Duraisamy , Knight Alexandra , James Ruth , Kirkpatrick Katharine
Published: October 2021

Aims

To study the risk of post-operative COVID-19 infection in patients undergoing breast surgery during the height of the pandemic in 2020.

Methods

We continued to perform surgery for breast cancers and other urgent breast conditions during the pandemic in a dedicated “Green” operating theatre in a COVID-19-free hospital. NHS guidance regarding staff and patient COVID-19 screening and patient self-isolation period changed frequently during the study period, and recommended guidance was followed. PPE was worn by theatre team. Patient records were subsequently reviewed for a positive COVID-19 swab or a COVID-19-related hospital admission within 8 weeks of surgery.

Results

96 consecutive operations were performed by 4 consultants between April and August 2020. All but 14 were for breast carcinoma. Median age 56 (21-89). Median ASA grade 2 (1-3). 64 patients had negative preoperative COVID-19 swabs, others in the early stages were screened with chest X-ray or CT. 83% (n = 80) were done as day cases. Among breast cancer operations there were 17 mastectomies, bilateral in 2 cases. There was no cases of COVID-19 positivity or COVID-19-related hospital admission post-operatively.

Conclusions

Breast surgery, done mainly as day case, did not predispose patients to COVID-19 infection in the postoperative period when guidelines were followed. Concern about postoperative COVID-19 infection should not be a cause of surgical delay in any future waves, which can be potentially harmful to breast cancer patients.