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      Urgent surgery for COVID-19–positive pediatric patient

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          Abstract

          Background

          We present a case of COVID-19–positive pediatric patient for urgent urological surgery by spinal anesthesia to avoid aerosolizing procedure.

          Case presentation

          A 12-year-old, COVID-19–positive boy presented for urgent wound incision and drainage at the circumcision site. Our anesthetic plan consisted of spinal anesthesia with sedation. He was transported from the COVID-19 isolation floor to the negative pressure operating room. He was placed in lateral decubitus position and oxygen was delivered through facemask. Under sedation, spinal anesthesia was achieved at first attempt. The patient maintained spontaneous ventilation without airway intervention. Patient was recovered in the operation room then transported back to the floor.

          Conclusion

          Spinal anesthesia is a safe alternative to general endotracheal anesthesia for many pediatric urology procedures. Effective team communication and preparation are keys when caring COVID-19–positive patient in perioperative setting to avoid minimize the risk to healthcare providers.

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          Most cited references15

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          Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

          Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. Methods We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. Findings Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; p interaction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; p interaction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. Interpretation The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. Funding World Health Organization.
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            Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review

            The current rapid worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection justifies the global effort to identify effective preventive strategies and optimal medical management. While data are available for adult patients with coronavirus disease 2019 (COVID-19), limited reports have analyzed pediatric patients infected with SARS-CoV-2.
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              Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam

              To the Editor: The emergence and spread of a novel coronavirus (2019-nCoV) from Wuhan, China, has become a global health concern. 1 Since the detection of the coronavirus in late December 2019, several countries have reported sporadic imported cases among travelers returning from China. 2 We report one family cluster of 2019-nCoV originating from a Chinese man. On January 22, 2020, a 65-year-old man with a history of hypertension, type 2 diabetes, coronary heart disease for which a stent had been implanted, and lung cancer was admitted to the emergency department of Cho Ray Hospital, the referral hospital in Ho Chi Minh City, for low-grade fever and fatigue. He had become ill with fever on January 17, a total of 4 days after he and his wife had flown to Hanoi from the Wuchang district in Wuhan, where outbreaks of 2019-nCoV were occurring. He reported that he had not been exposed to a “wet market” (a market where dead and live animals are sold) in Wuhan. Throat swabs obtained from the patient tested positive for 2019-nCoV on real-time reverse-transcription–polymerase-chain-reaction (RT-PCR) assays. 3 On admission to the hospital, the man was isolated and treated empirically with antiviral agents, broad-spectrum antibiotics, and supportive therapies. Chest radiographs obtained on admission showed an infiltrate in the upper lobe of the left lung (Figure 1A). On January 25, he received supplemental oxygen through a nasal cannula at a rate of 5 liters per minute because of increasing dyspnea with hypoxemia. The partial pressure of oxygen was 57.2 mm Hg while he was breathing ambient air, and a progressive infiltrate and consolidation were observed on chest radiographs (Figure 1B through 1D). His fever disappeared on January 25, and his clinical condition has improved since January 26. His wife had no symptoms of illness while they were traveling. She was healthy as of January 28. The couple’s healthy 27-year-old son had lived in Long An, a province 40 km southwest of Ho Chi Minh City, since October 2019. He had not traveled to a region where 2019-nCoV was spreading, and he had not had any known contact with any person returning from such a region. On January 17, he met his father in Nha Trang in central Vietnam and shared a bedroom with his parents for 3 days in a hotel room that had an air conditioner. On January 20, a dry cough and fever developed in the son. He also reported having had vomiting and loose stools one time before the admission. This suggests that the incubation period for 2019-nCoV may have been 3 days or less in this case. When the son presented at Cho Ray Hospital with his father on January 22, his illness, characterized by a fever (39°C), was recognized and he was immediately isolated. Chest radiographs and other laboratory examinations in this patient showed no abnormalities except for an increased level of C-reactive protein (13.9 mg per liter). Real-time RT-PCR assays for influenza A and B viruses and nonstructural protein 1 antigen rapid tests for dengue viruses were negative in both the father and son. A throat swab in the son was positive for 2019-nCoV. His father was thought to be the source of infection. However, sequencing of strains from the two patients to ascertain the transmission of 2019-nCoV from the father to son has not been performed. The son’s condition was stable after January 23. This family had traveled to four cities across Vietnam using various forms of transportation, including planes, trains, and taxis. A total of 28 close contacts have been identified, and symptoms of an upper respiratory infection have not developed in any of them. This family cluster of 2019-nCoV infection that occurred outside China 4 arouses concern regarding human-to-human transmission.
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                Author and article information

                Contributors
                mnagoshi@chla.usc.edu
                Journal
                JA Clin Rep
                JA Clin Rep
                JA Clinical Reports
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2363-9024
                22 July 2021
                22 July 2021
                December 2021
                : 7
                : 57
                Affiliations
                GRID grid.42505.36, ISNI 0000 0001 2156 6853, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, , University of Southern California, ; 4650 Sunset Blvd, Los Angeles, CA 90027 USA
                Author information
                http://orcid.org/0000-0002-8430-2203
                Article
                461
                10.1186/s40981-021-00461-9
                8297428
                34292420
                62a7a85f-f4d5-4924-becf-96e51f6e455c
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 6 February 2021
                : 11 July 2021
                : 12 July 2021
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2021

                covid-19,pediatric anesthesia,spinal anesthesia,airway management,perioperative management

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