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   Table of Contents - Current issue
January-March 2021
Volume 4 | Issue 1
Page Nos. 1-26

Online since Wednesday, March 17, 2021

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Telemedicine and multichronic comorbidities in the days of COVID.19: Preliminary results from Calabria Project p. 1
Maurizio Cipolla, Maria Teresa Savo, Ilaria Cipolla, Lina Giuseppina Gentile, Antonio Vittorino Gaddi
CONTEXT: The COVID-19 pandemic is probably the most challenging health crisis of the modern era as international health systems were not prepared to fight a virus whose capacity of spread is still being debated. The following are the two main challenges: the management of patients with acute infection of SARS-CoV-2, which needs more attention to have results in brief time, and the prevention of resultant neglect of patients who are not infected but need constant care for their chronic diseases. AIMS: To prevent the deaths from the “indirect effect” of the virus, the main aim was, with the help of telemedicine, to follow-up patients with high risk of poor outcome and to develop a protective system to reduce emergency department and hospitalizations access. The secondary aim was to develop an efficient telehealth model to be applied also after the COVID-19 pandemic. SETTINGS AND DESIGN: The study was voluntary and observational on patients enrolled between March and May 2020, during the first wave of the Italian pandemic. The project involved primary care and specialist physicians, nurses, informatics, and administrative services in the complex unity of primary care in Catanzaro Lido, Calabria Region. MATERIALS AND METHODS: Data such as blood pressure, heart rate, blood oxygenation, and glycemia were recorded using sphygmomanometer, oximeter, and glucometer and were communicated with a smartphone or a Bluetooth directly to a control room. The alerts were stratified according to the common emergency code: green for low risk, yellow for intermediate risk, red for high risk, and critic red for very high risk. RESULTS: Regarding patients with glycemic alerts, totally, 2135 were alert, 25% of them were at high risk, but only in 1 single case (0.04%), the intervention of 118 was necessary. The rest was resolved by telemedicine system with the help, when necessary, of first-level medical intervention. In 6.1% of cases, a specialist advice was required. Moreover, cardiovascular alerts were all resolved by the telemedicine system. CONCLUSIONS: The results obtained are preliminary but satisfying, a clear sign of how telemedicine could improve the management of disease chronicity but also of infectious disease.
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Psychological effects of COVID-19 on hospital staff: A national cross-sectional survey in mainland China p. 6
Jianming Guo, Lianming Liao, Baoguo Wang, Xiaoqiang Li, Lianrui Guo, Zhu Tong, Qinghua Guan, Mingyue Zhou, Yingfeng Wu, Jian Zhang, Alan Dardik, Yongquan Gu
OBJECTIVE: This study examined the psychological impact of the coronavirus disease 2019 (COVID-2019) outbreak on medical staff in China. MATERIALS AND METHODS: In February 2020, an online survey was carried out by using an online survey tool (WeChat) to evaluate the effects of the outbreak on the mental health of medical staff in China. RESULTS: A total of 11,118 medical staff responded to the survey. About 4.98% of the respondents reported middle and high levels of anxiety, while 13.47% of the respondents reported middle and high levels of depression since the COVID-19 outbreak. Nurses, frontline medical staff, and younger medical staff were more likely to have anxiety and depression than physicians, nonfrontline medical staff, and older medical staff. CONCLUSIONS: Although the serious psychological impact of COVID-19 is not so common in medical staff in China, programs are needed to protect them against the negative impacts of COVID-19.
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Mid-term results of one-stop endovascular aortic repair/percutaneous coronary intervention hybrid procedure for patients with aortic and coronary artery diseases p. 12
Mingyao Luo, Kun Fang, Shaodong Ye, Min Yang, Bowen Fan, Yunfei Xue, Jiawei Zhao, Zujun Chen, Haitao Zhang, Bin Lv, Yida Tang, Chang Shu
BACKGROUND: This study aimed to report our experience of endovascular aortic repair (EVAR) combined with percutaneous coronary intervention (PCI) for “one-stop” treatment of aortic and coronary artery diseases. SUBJECTS AND METHODS: From January 2016 to December 2017, 17 patients (average age: 69.0, range: 44–86) with abdominal aortic aneurysms (n = 9), penetrating aortic ulcers (n = 6), and type B aortic dissection (n = 2), also combined with severe coronary artery disease, underwent “one-stop” EVAR/PCI hybrid procedure in Fuwai Hospital and were analyzed retrospectively. RESULTS: The technical success rate was 100%. 11 cases received abdominal EVARs, 5 cases underwent thoracic EVARs, and 1 case had just aortic angiography. For the coronary lesions, 10 cases received coronary stent implantations, with an average stent number of 1.8 (1–3); one case underwent only balloon dilatation, and 6 cases merely had coronary angiography. There was no in-hospital death. Postoperative complications included subcutaneous ecchymosis in 4 cases; One suffered from pseudo-aneurysm at the puncture point of the left brachial artery, which was repaired surgically. Two had mild type II endoleak after abdominal EVAR. One patient was lost 12 months later and 16 patients were followed up for 28.6 (12–39) months. 3 deaths, with the cause of cancer in 2 and unknown in 1, and 2 readmissions were recorded. All other patients reported disappearance or significant reduction of previous symptoms. Both type II endoleak disappeared in 12 months. CONCLUSIONS: The “one-stop” EVAR/PCI hybrid procedure is a safe and feasible option for the treatment of aortic and coronary artery disease.
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Surgical treatment of traumatic arteriovenous fistula after failed endovascular treatment p. 19
Hao Cai, Kailong Li, Ziqiang Sun, Song Jin
Endovascular interventional therapy is the first choice for the treatment of the traumatic arteriovenous fistula (AVF) because of its small trauma, fast recovery, exact effect, and low incidence of complications. However, surgery is still an important option for patients with contraindications to endovascular treatment or failure of endovascular treatment. We present the case of a 64-year-old male who was carried out with traumatic AVF and given endovascular treatment in other hospital 10 years ago. However, AVF did not disappear after surgery, and symptoms of venous hypertension such as lower limb swelling and ulcers appeared. We removed the stent and repaired the AVF with opening surgery. AVF did not recur after 1-year follow-up.
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Endovascular treatment of the superficial femoral artery aneurysm infected by typhoid Salmonella p. 22
Ziqiang Sun, Xiaoqin Li, Liyong Tang, Song Jin
Salmonella aortitis accounts for approximately 40% of all infectious aortitis. Superficial femoral artery aneurysm infected by Salmonella typhi has rarely been reported. The study reported a 71-year-old Chinese woman with a previous history of nephrotic syndrome and long-term oral hormone therapy, who was admitted to the hospital with a gradually increasing pulsatile mass in the right thigh and pain. After admission, computed tomography angiography revealed rupture and bleeding of an aneurysm in the middle and lower segment of the right superficial femoral artery (SFA). The aneurysm of the SFA was satisfactorily isolated by the covered stent. The bacterial culture of the secretion from the punctured mass showed the S. typhi infection. Based on the results of the drug sensitivity test, the patient received anti-infective treatment for 4 weeks. The patient recovered well after 1-year follow-up.
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Acute subdural hematoma after spinal surgery p. 25
Varun Aggarwal, Amit Narang, Chandani Maheshwari, Paramdeep Singh
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