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1

Novel approaches in the post-tracheostomy care of the COVID-19 patient.

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Rai A., Chang A. P., Soo S., Thomas J., Ackerman J., Mitzman B., Bender M. T.

Critical Care Innovations

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2020

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vol. 3

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issue 3

13-19

EN

INTRODUCTION: SARS-CoV-2 is a novel strain of coronavirus that has caused illness in over 6 million people worldwide as of June 2020. Patients with severe illness are treated with invasive mechanical ventilation, as such, tracheostomy has become a topic of interest. Traditional schema employed during independent breathing trials in patients with tracheostomies employ the use of a collar mask attached to flexible corrugated tubing with humidified oxygen from a wall source. One drawback of this arrangement is the creation of an open circuit with the potential for viral aerosolization. MATERIAL AND METHODS: We adapted high flow oxygen (HFO) therapy to patient’s tracheostomy tube and devised a rapid decannulation protocol for patients recovering from Covid-19. Corrugated flexible tubing with a heating element is attached to the HFO meter-blender/heated humidifier apparatus and then connected directly to one end of a Y-adapter. An in-line suction kit specified for tracheostomy patients is also placed. Humidified air is delivered to the patient using the heating element of the HFO system obviating the need for a heat moisture exchanger. A second corrugated tube is attached to the free end of the Y-adapter and a non-conductive viral particle filter is attached to its free end to limit viral aerosolization. RESULTS: The mean time to tracheostomy placement is 18 days from initiation of mechanical ventilation (5-39 days). To date 20/52 (38%) patients have undergone tracheostomy tube removal, and of those 13 have been discharged. The mean time to decannulation is 15 days (8-32 days). Three patients failed decannulation requiring repeat endotracheal intubation (5.7%). SARS-CoV-2 was not detected in 22/24 patients undergoing repeat polymerase chain reaction testing on day 45 after initial positive test. CONCLUSIONS: Utilizing HFO to tracheostomy scheme creates a closed circuit theoretically reducing the risk of COVID-19 exposure, while also helping patients breathe independently. This schema coupled with a rapid decannulation protocol is a reasonable alternative in select patients recovering from severe COVID-19.

PL

WSTĘP: SARS-CoV-2 to nowy szczep koronawirusa, który wywołał zakażenia u ponad 6 milionów ludzi na całym świecie od czerwca 2020 r. Pacjenci z ciężkimi chorobami są leczeni za pomocą inwazyjnej wentylacji mechanicznej, której przedmiotem zainteresowania stała się tracheostomia. W tradycyjnym schemacie stosowanym podczas niezależnych prób oddechowych u pacjentów z tracheostomią należy stosować maskę z kołnierzem przymocowaną do elastycznej rurki falistej z nawilżeniem tlenu ze źródła ściennego. Wadą tego układu jest utworzenie obwodu otwartego z potencjałem na aerozol wirusowy. MATERIAŁ I METODY: Dostosowano terapię tlenem o wysokim przepływie (HFO) do rurki tracheostomijnej pacjenta i opracowano protokół szybkiej dekaniulacji dla pacjentów wracających do zdrowia po Covid-19. Rura elastyczna karbowana z elementem grzejnym jest przymocowana do miernika-mieszalnika / podgrzewanego nawilżacza HFO, a następnie podłączona bezpośrednio do jednego końca adaptera Y. Umieszczany jest również zestaw do odsysania liniowego przeznaczony dla pacjentów z tracheostomią. Nawilżone powietrze jest dostarczane do pacjenta korzystając z elementu grzejnego systemu HFO, co eliminuje potrzebę stosowania wymiennika ciepła i wilgoci. Rura karbowana jest przymocowana do wolnego końca trójnika, a nieprzewodzący filtr cząstek wirusowych jest przymocowany do jego wolnego końca, aby ograniczyć aerozolację wirusów. WYNIKI: Średni czas do założenia tracheostomii to 18 dni od rozpoczęcia wentylacji mechanicznej (5-39 dni). Do tej pory usunięto rurkę tracheostomijną u 20/52 (38%) pacjentów, z czego 13 zostało wypisanych do domu. Średni czas do dekaniulacji to 15 dni (8-32 dni). U trzech pacjentów dekaniulacja nie powiodła się, wymagając powtórzenia intubacji dotchawiczej (5,7%). SARS-CoV-2 nie został wykryty u 22/24 pacjentów poddawanych powtórnemu łańcuchowi polimerazy badania reakcji w 45 dniu po wstępnym pozytywnym teście. WNIOSKI: Wykorzystanie HFO do schematu tracheostomii tworzy zamknięty obwód teoretycznie zmniejszając ryzyko ekspozycji na COVID-19, a jednocześnie pomaga pacjentom w samodzielnym oddychaniu. Ten schemat w połączeniu z szybkim protokołem dekaniulacji jest rozsądną alternatywą u wybranych pacjentów po powrocie z ciężkiego COVID-19.

2

Coronavirus: The Hidden Truth

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Adesola R. O., Waheed S. A., Abodunrin L.

World News of Natural Sciences

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2022

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vol. 43

38-59

EN

Coronavirus is one of the most dangerous and contagious illnesses that arise from the introduction of host organisms into the biological system. As of March 2022, this sickness had caused more harm than good, with 479 million cases and 6.12 million deaths worldwide. These illnesses are unpredictable sources of social, financial, and economic distress. The rising incidence of infections is the most concerning aspect. Human coronaviruses were discovered in the 1960s using two distinct ways in the United Kingdom and the United States, while the first reports of coronavirus infection in animals occurred in the late 1920s when an acute respiratory infection of farmed hens developed in North America. Although some estimates place the common ancestor as far back as 55 million years or more, reflecting long-term co-evolution with bat and bird species, the most recent common ancestor (MRCA) of all coronaviruses is thought to have lived as recently as 8000 BCE. Coronaviruses have a single-stranded, positive-sense RNA genome that ranges in size from 26.4 to 31.7 kilobases. When the viral spike protein binds to its matching host cell receptor, infection occurs. There is no specific, effective, or 100 percent cure for coronavirus as of 2021, but supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support, and prone positioning as needed, as well as medications or devices to support other affected vital organs, is the cornerstone of COVID-19 management.

3

Amputation sequelae of both forefoot and its consequences after embolism syndrome in the course of Covid 19. Case report

89%

Napiontek M.

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vol. 87

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issue 2

83-85

PL

Opisano przypadek 52-letniego chorego z cukrzycą, po amputacji stóp w przebiegu Covid 19 na poziomie stawu Lisfranca po stronie prawej i stawu Choparta po stronie lewej. Niewielkie szpotawe ustawienie prawej stopy wraz ze skróceniem mięśnia brzuchatego łydki wymagało korekcji zniekształcenia w celu zniesienia dolegliwości, przeciążenia zewnętrznego brzegu stopy oraz prewencji powstania owrzodzenia troficznego.

EN

The case described in the article refers to a 52-year-old diabetic male after foot amputation in the course of Covid 19 at the level of the Lisfranc joint on the right and the Chopart joint on the left. A slight varus position of the right foot with shortening of the gastrocnemius muscle required correction of the deformity to relieve pain and overload of the anterolateral edge of the foot and prevent trophic ulcer formation.

4

Adventure travel and the Covid-19 pandemic - recommendation of the Medical Commission of the Union Internationale des Associations d’Alpinisme (UIAA)

89%

Szawarski P., Hillebrandt D.

Health Promotion & Physical Activity

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2021

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vol. 16

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issue 3

32-39

EN

Lots of information is available by news, internet, social media, press and medical papers. However there is a lack of specific information on how to manage the COVID risk while mountaineering. The paper should assist mountaineers and agencies to fulfill safety procedures en route.

5

Eight-Week Zumba Training for Women in the New Normal Period

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Utamayasa I. G. D., Hanafi M., Rosmi Y. F., Mardhika R., - S.

Central European Journal of Sport Sciences and Medicine

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2023

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vol. 43

45-51

EN

Zumba shares similarities with other aerobic exercises such as dancing and cycling, as it enhances cardiovascular health and facilitates calorie burning. However, what distinguishes Zumba is its emphasis on enjoyment and the incorporation of dance movements from various music genres. This form of aerobic exercise involves sustained moderate to high-intensity activity without excessive fatigue. It strengthens the heart muscle and promotes efficient blood circulation. Furthermore, aerobics can effectively reduce blood pressure in individuals with hypertension. This positive effect is attributed to the improvement of blood vessel function, facilitating better blood flow and alleviating strain on the heart. Regular aerobic exercise also contributes to weight loss, which further aids in lowering blood pressure. Nevertheless, the impact of Zumba on VO2 max ability remains to be explored. In this study, a pre-experimental design was employed, involving one-hour Zumba sessions conducted over eight weeks, comprising approximately 12 tracks prepared by the instructor. The study sample consisted of 30 participants engaged in Zumba classes. Prior to Zumba, the Jackson non-exercise test formula was employed to assess VO2 max fitness. Post-Zumba, the 1-mile jog test formula was utilized to measure VO2 max fitness. The study findings indicate a significant increase in the mean VO2max value after treatment, compared to the lower mean value observed before treatment. Specifically, the mean value of VO2max increased from 38.46 ml/kg/minute before treatment to 47.83 ml/kg/minute after treatment. These results suggest that Zumba exercise enhances aerobic fitness by positively impacting cardiovascular biological mechanisms in young women during the transition to the new normal period.

6

Abdominal wall fungal co-infection mucormycosis associated with COVID-19: a case report.

88%

Saseedharan S., Patil S., Kadam V., Mehendale V.

Critical Care Innovations

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2021

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vol. 4

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issue 4

45-52

EN

The Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed a public health system challenge across the globe. A retrospective analysis of COVID-19 globally surmises that the fungal co-infections associated with COVID-19 might be missed or misdiagnosed. However, data regarding all the signs and symptoms of COVID-19 are insufficient. The available few publications conclude that patients with COVID-19 have a higher susceptibility to fungal coinfections. Mucormycosis is a rare and often lifethreatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. Based on the available data it seems COVID-19 patients, especially severely ill or immunocompromised, have a higher susceptibility to invasive mycoses. Therefore, it is important to assess the risk factors, the types of invasive mycosis, the strengths and limitations of diagnostic methods, clinical settings, and the need for standard or individualized treatment in COVID-19 patients. A 33 years old female operated case of laparoscopic ectopic removal with salpingectomy and tubectomy, at post-operative Day 5 had redness and pus discharge from the operative site and was diagnosed with abdominal wall cellulitis. She underwent local exploration and wound wash. At post operative day 5, the patient came to our emergency room with mild disorientation, cellulitis, and pain at the port insertion site. On examination, we highlight BP 90/50 mmg and blood test analysis with HB-8.3, leucocyte count 29.91×109/L, CRP 333mg/L. CT scan revealed necrotizing fasciitis. She then underwent wide local excision and debridement. Post debridement the next day during dressing, the wound showed a cotton fluffy appearance at the edges and part of the base with black necrotic areas. Wound swab was sent for fungal culture, KOH mount, blood culture, pus culture, and tissue for histopathology. In the meantime, she was started on empirical antifungal amphotericin B, meropenem and minocycline antibiotics. Covid antibodies test was done which were reactive: 1.96. Tissue histopathology revealed mucormycosis. A high degree of suspicion and promptness in starting antifungal prevented fatal outcome.

PL

Choroba COVID-19 wywołana przez koronawirusa zespołu ostrej ostrej niewydolności oddechowej (SARS-CoV-2) stanowi wyzwanie dla systemu zdrowia publicznego na całym świecie. Retrospektywna analiza COVID-19 globalnie przypuszcza, że koinfekcje grzybicze związane z COVID-19 mogą zostać przeoczone lub błędnie zdiagnozowane. Jednakże, dane dotyczące wszystkich oznak i objawów COVID-19 są niewystarczające. Z nielicznych dostępnych publikacji wynika, że: pacjenci z COVID-19 mają większą podatność na koinfekcje grzybicze. Mukormykoza jest rzadką i często zagrażającą życiu chorobą grzybiczą charakteryzującą się inwazją strzępek naczyniowych, prowadzącą do zakrzepicy i martwicy. Na podstawie dostępnych danych wydaje się, że pacjenci z COVID-19, szczególnie ciężko chorzy lub z obniżoną odpornością, mają wyższą podatność na inwazyjne grzybice. Dlatego ważna jest ocena czynników ryzyka, rodzajów grzybicy inwazyjnej, mocnych i ograniczonych metod diagnostycznych, warunków klinicznych oraz potrzeby standardowych lub zindywidualizowanych form leczenia u pacjentów z COVID-19. 33-letnia kobieta operowana laparoskopowo z salpingektomią i tubektomią, w w 5. dniu pooperacyjnym zgłosiła zaczerwienienie i wydzielinę ropna z pola operacyjnego i zdiagnozowano u niej zapalenie tkanki łącznej ściany jamy brzusznej. Przeszła lokalną eksplorację i obmycie rany. W piątej dobie pooperacyjnej pacjentka zgłosiła się do naszego oddziału ratunkowego z łagodną dezorientacją, zapaleniem tkanki łącznej i bólem w miejscu wprowadzenia portu. Podczas badania określono BP 90/50 mmg i wykonano badanie krwi z HB-8,3, liczbą leukocytów 29,91×109/L, CRP 333mg/L. Tomografia komputerowa ujawniła martwicze zapalenie powięzi. Następnie została poddana szeroko zakrojonemu miejscowemu wycięciu i oczyszczeniu rany. Po oczyszczeniu następnego dnia podczas zmiany opatrunku, rana wykazywała bawełniany puszysty wygląd na brzegach i części podstawy z czarnymi obszarami martwiczymi. Wymaz z rany został wysłany do hodowli grzybów, osadu KOH, hodowli krwi, hodowli ropy i tkaneki do oceny histopatologicznej. W międzyczasie rozpoczęto leczenie przeciwgrzybicze amfoterycyną B, meropenem i antybiotykami minocyklinowymi. Wykonano test na przeciwciała Covid które były reaktywne: 1,96. Histopatologia tkankowa wykazała mukormykozę. Wysoki stopień podejrzliwości i terminowości w rozpoczęciu leczenia przeciwgrzybiczego zapobiegł zgonowi.

7

COVID-19 – current clinical data and review of recommendations for otolaryngologists and dentists

75%

Niemczyk K., Jasińska A., Krawczyk P., Bilińska M.

Polski Przegląd Otorynolaryngologiczny

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2020

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vol. 9(1)

19-27

EN

Despite multidirectional activities in the sphere of politics, health care and limiting direct interpersonal contacts to a minimum, the Covid-19 pandemic has covered the whole world and the number of new cases is rising exponentially. This demonstrates the considerable severity of the situation. The doctors and other health professionals are and will be at the forefront of the fight against the pandemic, being at the same time the group most at risk of infection. SARS-CoV-2 virus infection applies to patients of all ages, with a median age of 49–59 years. The most common complaints in patients with Covid-19 include fever, caught, dyspnea, general malaise and muscle aches. In the course of Covid-19 may occur pneumonia, which in about 20% of cases is moderately to severe and associated with respiratory distress. Important for otorhinolaryngologists are reports of smell and taste disorders. Post-infective loss of smell can make up about 30% of all patients with Covid-19. The confirmation of SARS-CoV-2 infection in patients with symptomatic or epidemiological suspicion of Covid-19 are genetic tests RT-PCR. Biological material is usually taken from the nose or nasopharynx. The management of Covid-19 is symptomatic because there is currently no specific cure drug. There is a particularly high risk of transmitting infection from a patient to the physicians, who are treating diseases of the respiratory tract or perform any interventions on the upper and lower respiratory tract. Low-symptomatic first stages of the disease with high viral load mean that during a pandemic, scheduled examinations and procedures should be limited. During the examination of patients or their treatment, adequate full PPE protection is indicated, reducing the risk of accidental infection of the treatment team. For the treatment of patients with confirmed SARS-CoV-2 infection or requiring immediate treatment without the possibility of determining epidemiological factors Covid-19, full protection in PPE is obligatory.

8

Changes in running habits during the COVID-19 confinement in amateur distance runners

71%

Mayer K., Lukács A.

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EN

Introduction: In this study, we examined the impact of government measures being imposed to slow down the spread of COVID-19 pandemic on long-distance runners’ sports habits and well-being. Material and methods: Data from a total of 323 runners (mean age 41.72 (8.78), 41.8% male) were analysed using quantitative and qualitative methods. Results: 46.9% of runners changed their running habits during the pandemic, 20.4% partly changed it. The poorest psychological well-being was found in a group that changed previous habits. Only 9 individuals reported no running activity at all, and 10 trained on a treadmill instead of a field. Overall, our respondents ran significantly more during the quarantine than before, which is partly explained by changed working conditions, reduced working hours, or lost jobs. The explanatory variables of excess running were previous mileage and distress. Conclusions: Running is suitable for relieving distress and restoring the feeling of freedom. All of these were confirmed by our subjects in the survey interview.

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