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      Nuclear medicine practices during the COVID-19 pandemic—review of some recently published protocols

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          Abstract

          Background

          With the global surge in COVID-19 pandemic, it has become inevitable for everyone, inclusive of nuclear medicine personnel, to play their role in combating and containing its transmission. During fall 2019, China encountered a novel coronavirus in Wuhan city which was later on termed as COVID-19. The pneumonia caused by COVID-19 is characterized by dry cough, fever, fatigue, and shortness of breathing (dyspnea). Until now, this virus has spread worldwide and continues to cause exponential causalities.

          Main body

          This global catastrophic scenario calls for stringent measures to control COVID-19 infection. Thus herein, the respective authors have endeavored to review precautionary measures for nuclear medicine department, encompassing its personnel as well as the patients so that intradepartmental transmission can be prevented. This requires development and execution of a robust and dynamic plan elaborating the healthcare guidelines. Hence, our review paper covers the arena of nuclear medicine services in particular.

          Conclusion

          Nuclear medicine can play its role in mitigating COVID-19 transmission to personnel and patients if provided with ample PPEs and guidelines are strictly followed. With implementing SOPs (standard operating procedures) based on these guidelines, nuclear medicine facilities will be better prepared for impromptu actions in case of any future outbreak while retaining the smooth flow of obligatory healthcare services.

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          Emerging coronaviruses: Genome structure, replication, and pathogenesis

          Yu Chen, Qianyun Liu, Deyin Guo (2020)
          Abstract The recent emergence of a novel coronavirus (2019‐nCoV), which is causing an outbreak of unusual viral pneumonia in patients in Wuhan, a central city in China, is another warning of the risk of CoVs posed to public health. In this minireview, we provide a brief introduction of the general features of CoVs and describe diseases caused by different CoVs in humans and animals. This review will help understand the biology and potential risk of CoVs that exist in richness in wildlife such as bats.
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            Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2

            Xi Xu, Chengcheng Yu, Jing Qu … (2020)
            Background The pneumonia caused by the 2019 novel coronavirus (SARS-CoV-2, also called 2019-nCoV) recently break out in Wuhan, China, and was named as COVID-19. With the spread of the disease, similar cases have also been confirmed in other regions of China. We aimed to report the imaging and clinical characteristics of these patients infected with SARS-CoV-2 in Guangzhou, China. Methods All patients with laboratory-identified SARS-CoV-2 infection by real-time polymerase chain reaction (PCR) were collected between January 23, 2020, and February 4, 2020, in a designated hospital (Guangzhou Eighth People’s Hospital). This analysis included 90 patients (39 men and 51 women; median age, 50 years (age range, 18–86 years). All the included SARS-CoV-2-infected patients underwent non-contrast enhanced chest computed tomography (CT). We analyzed the clinical characteristics of the patients, as well as the distribution characteristics, pattern, morphology, and accompanying manifestations of lung lesions. In addition, after 1–6 days (mean 3.5 days), follow-up chest CT images were evaluated to assess radiological evolution. Findings The majority of infected patients had a history of exposure in Wuhan or to infected patients and mostly presented with fever and cough. More than half of the patients presented bilateral, multifocal lung lesions, with peripheral distribution, and 53 (59%) patients had more than two lobes involved. Of all included patients, COVID-19 pneumonia presented with ground glass opacities in 65 (72%), consolidation in 12 (13%), crazy paving pattern in 11 (12%), interlobular thickening in 33 (37%), adjacent pleura thickening in 50 (56%), and linear opacities combined in 55 (61%). Pleural effusion, pericardial effusion, and lymphadenopathy were uncommon findings. In addition, baseline chest CT did not show any abnormalities in 21 patients (23%), but 3 patients presented bilateral ground glass opacities on the second CT after 3–4 days. Conclusion SARS-CoV-2 infection can be confirmed based on the patient’s history, clinical manifestations, imaging characteristics, and laboratory tests. Chest CT examination plays an important role in the initial diagnosis of the novel coronavirus pneumonia. Multiple patchy ground glass opacities in bilateral multiple lobular with periphery distribution are typical chest CT imaging features of the COVID-19 pneumonia.
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              Issues relevant to mental health promotion in frontline health care providers managing quarantined/isolated COVID19 patients

              Ritin Mohindra, Ravaki R, Vikas Suri … (2020)
              COVID-19 is caused by the SARS-CoV-2 virus and is now pandemic (“WHO/Europe| Coronavirus disease (COVID-19) outbreak - WHO announces COVID-19 outbreak a pandemic”, n.d.). In such a scenario and given the experiences of various countries hit by the disease, it is expected that frontline health care providers (HP) would suffer from mental health consequences (Lai et al., 2020). The impact of COVID-19 among the general population is also considerable as is evident across the world. In such a scenario, the role of a psychiatrist is likely to be important both in short and long-term (Banerjee, 2020). The unprecedented situation has raised questions regarding the nature and determinants of mental health promotion at a population and an institutional level (Yao et al., 2020; Zandifar and Badrfam, 2020). This work was conducted with a view to find out the perceived motivations influencing morale amongst HP in a multi-specialty tertiary hospital. This work was conducted in a tertiary hospital in North India that is involved in the care of patients with COVID-19/suspected COVID-19. As per the prevailing norms issued by the Government of India, patients with suspected infection due to direct contact/foreign travel are quarantined at home or a facility specially created for this purpose. Patients with confirmed infection are mandatorily admitted to isolation wards in the hospital specially created for this purpose. Owing to the danger of infection and paucity of protective gear, direct access to patients is limited but for the frontline HP who are trained to provide medical care for the infection. One of the authors conducted interviews with HP involved in care of these patients in this hospital and at other places in North India. The following themes were identified on the basis of these interviews. These are presented below with a view to disseminate so that hospitals facing or preparing for COVID-19 can factor in these issues. Positive Motivational factors (that need to be strengthened): Intellectual 1 Knowledge and acceptance of possible inevitability of infection/resolution in the absence of herd immunity, and constant exposure to millions of microorganisms. Emotional : 1 Supportive and proud family and colleagues 2 Positive Role models in senior colleagues and peers 3 Validation and appreciation by peers, also among those who are not at the frontline at present 4 Being in close contact with patient, positive care taking experience: managing fears, anxiety, day to day issues 5 Appreciation and gratitude of patients 6 A sense of validation of existence, the culmination of what you were trained to do 7 Being part of something bigger than all of us Negatives, frustrations associated with patient care (and suggestions): 1 Patients in isolation have many needs beyond medical management. This includes psychological, social, rehabilitative. All these cannot be looked after by the treating doctor alone. The treating doctor becomes a one-stop shop. This can be draining and exhausting. Social and financial needs (safety and welfare of the family of the patient that may be quarantined) is a major issue that needs addressing. Treating doctors do not have solutions to these problems but patients have no one else to turn to. Possible solution: a background multi-disciplinary team can help. Development of tools/ Screening questionnaires to rapidly identify problem areas, getting on board local administration etc. can be possible solutions. 2 Stigma is an unexplored area. Patient stigma has been found to be a major cause of suppression of travel history and jumping quarantine. In all likelihood, discharged patients are also likely to face stigma and face difficulty in reintegration with their families and communities. Currently HP is not equipped to handle this issue. This needs to be addressed. 3 Perceived need for a clear chain of command in the management and execution of plans. Personal fears and annoyances experienced by doctors 1 Not only is the patient, even the doctors and nurses are isolated and worried about going back home and possibly be sources of infection to their families. Possible solution: more manpower, acknowledgment of work beyond call of duty, respite, projection as role models to be emulated. 2 Fear of getting infected and being isolated, fear of coming in contact and having to be quarantined 3 Putting family members and other staff at risk of quarantine 4 The fear of missing out and worry of how others will perform in your stead 5 The problems that households are facing due to lockdown will get accentuated if the doctor requires isolation/quarantine (social services, institute and administration should reassure doctors that families needs will be taken care of on priority) 6 Mandatory insurance for all frontline HP. 7 The fear of not using PPE properly because of lack of adequate practice (more availability to become comfortable with the same as prevailing norms). 8 People in the community stigmatise and worry that HP themselves may transmit infection. Solution: colleagues need to be better informed and be conscious of not saying anything or behaving in a way that may be construed as stigmatising. Proper diet, respite, adequate rest, and meditative practice/relaxation are very important to keep demoralisation at bay. These must be taken into account when hospitals plan for COVID-19. 1 Financial disclosures None. Declaration of Competing Interest None of the authors report any conflict of interest.
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                Author and article information

                Contributors
                Muhammad Iqbal:
                ORCID: http://orcid.org/0000-0001-7202-6670
                iqbalpinum@gmail.com
                Muhammad Shahbaz: m_shahbaz2000@hotmail.com
                Owais Bin Qadeer: drowaisgill@gmail.com
                Kanwal Nazir: Kanwal.nazir23@gmail.com
                Muhammad Naeem: muhammadnaeemdr@yahoo.com
                Muhammad Shahzad Afzal: msamirza@yahoo.com
                Muhammad Babar Imran: muhammadbabarimran@yahoo.com
                Journal
                Journal ID (iso-abbrev): Egypt J Radiol Nucl Med
                Title: The Egyptian Journal of Radiology and Nuclear Medicine
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0378-603X
                ISSN (Electronic): 2090-4762
                Publication date (Electronic): 16 November 2020
                Publication date PMC-release: 16 November 2020
                Publication date (Print): 2020
                Volume: 51
                Issue: 1
                Electronic Location Identifier: 230
                Affiliations
                Department of Nuclear Medicine, PINUM Cancer Hospital, Jail road Faisalabad, Faisalabad, Pakistan
                Author information
                http://orcid.org/0000-0001-7202-6670
                Article
                Publisher ID: 349
                DOI: 10.1186/s43055-020-00349-1
                PMC ID: 7667283
                SO-VID: fc507a45-b23b-4b54-bd63-816f6fbd215a
                Copyright © © The Author(s) 2020
                License:

                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
                Date received : 19 August 2020
                Date accepted : 2 November 2020
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                Keywords: covid-19,coronavirus,nuclear medicine,pandemic,scanning
                Data availability:
                Keywords: covid-19, coronavirus, nuclear medicine, pandemic, scanning

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