Surgery. General and Specialized

29/04/2022

Delhi reported over 1490 new cases in last 24 hours.
======================
Wear a mask,
Carry a sanitiser,
Get your booster shots,
Follow COVID Appropriate Behaviour (CAB),
Experts advise and warn that the " pandemic isn't over yet""
😷😷😷😷😷😷😷😷😷

01/04/2022

What happened to Archana Sharma is reprehensible beyond words..That it should not happen to anyone is the key issue so that we don't lose another accomplished life to such mindless act of insensitive police administration....
Exemplary punishment should be given to the police officer responsible for registering FIR and harrassment to the late doctor and her family..They should be tried under abetment to su***de clause..
There should be clear guidelines about when can an FIR be registered against Doctors...and when an FIR is registered the Doctor and his establishment should be provided all protection.
And for the profession, the time to altruism is over, donot accept critical cases unless the relatives are willing to give high risk/DoT consent.
Practice defensive Medicine to cover yourselves completely..
Have a strong fraternity relationship so that in situation of stress you may approach the peers and use the platform for collective negotiations/ defusing of an explosive situation.. Every town every where should have such mechanism..
Last but not the least just have a social group to lean on when in stress: by all means your life is precious su***de won't absolve you, your sound legal defense in the court, will!

10/01/2022

Omicron Covid symptoms, similarities and divergence from the Delta..

08/01/2022

Should you visit hospital for non Covid conditions?
Hospitals are seeing surge of Covid patients due to Omicron variant.. Since highly transmissible is this varient, the risk of acquiring Covid is very high if you come in close contact with a patient harbouring virus, with or without symptoms...And this is exactly the scenario that prevails in the hospitals, whether designated Covid or non Covid facilities.. So what should you do if you have a medical condition needing a hospital visit...?
Set up a video consultation and let your caregiver decide whether you need a hospital visit or not..
If it's a serious medical emergency, then alone you should visit Hospital..Here too with all Covid appropriate precautions..like mask, distancing with only one attender..
If you, or someone you are looking after is scheduled for an intervention or therapy, do check in with your caregiver about the course of action to undertake..
By all means avoid hospital visit for minor problems to help hospitals cater to the more needy ones..
Stay safe.. stay masked when outdoor..

06/01/2022

Omicron wave is waging strong...it is likely to peak in 2 weeks' time and subside equally rapidly...
Save yourself; go out only if essential, follow the vaccine mandate, mask properly, wash hands frequently, and isolate yourself if you have any hint of Covid to prevent spread to your contacts.
Looks like the Pandemic is in its last stages; brave some hardships here and there to reach the coast safely..

03/11/2021

Covid live: 'Bharat Biotech's Covaxin gets WHO approval'
https://timesofindia.indiatimes.com/india/coronavirus-in-india-live-updates-covid-19-vaccination/liveblog/87497013.cms?utm_campaign=andapp&utm_medium=referral&utm_source=native_share_tray
Download the TOI app now:
https://timesofindia.onelink.me/mjFd/toisupershare

The United States can now start giving children aged 5-11 the Pfizer-BioNtech Covid vaccine, US health authorities said Tuesday as they gave final ap

31/05/2021

*Covid Update-167*

🌹 *Surgery after Covid*🌹
High Risk of infection to Surgical team and High Mortality in Patient

*Suggested waiting times from the date of COVID-19 diagnosis to surgery* # :

1️⃣. *Four weeks for an asymptomatic* patient or recovery from only mild, non-respiratory symptoms.
2️⃣.Six to *seven weeks for a mild symptomatic* patient (e.g., cough, dyspnea) who did not require hospitalization.
3️⃣.Eight to *10 weeks for a moderate* symptomatic patient who is diabetic, immunocompromised, or hospitalized.
4️⃣. *Twelve weeks for a patient who was admitted to ICU* intensive care unit due to COVID-19 infection.

Note : These *timelines should not be considered definitive*; each patient’s preoperative risk assessment should be individualized, factoring in surgical intensity, co-morbidities, and the benefit/risk ratio of further delaying surgery.

‼️ *PAC in Post Covid patients*:
A thorough *preoperative evaluation*, with special attention given *to the cardiopulmonary systems*,

🌹 *Evidence in favour of guidelines*:🌹
An international, multicentre, prospective *study of 140,231 patients undergoing surgery in 116 countries* during pandemic including AIIMS. Published in _Anaesthesia_

30 day post operative mortality compared in patients with pre-operative SARS-CoV-2 infection with those without previous covid.

‼️ *30 day post surgical mortality in patients with no evidence of pre op covid was1.5%. It increased to two and half time (4%)when patients were operated within 6 wks of mild covid but remaimed at 1.5% if patients were operated at 7-8 wks after SARS-CoV-2 diagnosis*. ‼️

*Further Delay beyond 7 weeks in cases of persistent post-covid symptoms*
patients who are still symptomatic seven weeks after SARS-CoV-2 infection and undergo surgery, have an increased mortality rate.
Such patients may benefit from a further delay until their symptoms resolve.

Q *When should RTPCR be done before surgery?*
A: In non admitted patients testing is advised *within 96 hours before surgery*. After testing patient should be instructed to limit their social interactions to their own household given the as short as 2 day incubation period of COVID-19 after exposure.

Q. *Can we accept a COVID-19 test done 96 or more hours before surgery?*
A: Since the incubation period (time from exposure to symptoms) is as short as 2 days with COVID-19, the clinician should ask the family if they have limited their contact with their own household. If not, please retest.

Q: *How long is a negative test good in admitted patients?*
A Admitted patients who tested negative for COVID on admission do not need to be retested unless the patient develops new symptoms of COVID-19 or worsening conditions.

# ASA-APSF Joint Statement on Elective Surgery and Anesthesia.
drskgupta@gmail.com

28/04/2021

Courtesy Prof Ravi Kant
Director AIIMS Rishikesh
https://www.facebook.com/625918677/posts/10159532886558678/

24/04/2021

Copied from the wall of my friend Dr Sanwar Aggarwal MD
Child Specialist Raipur..
Logical and science based treatment is the need of the hour..The personal experience of a doctor receiving such treatment should reassure the people and allay anxiety...

Dear friends,
I had mild symptoms and tested positive, now completed my isolation. I m totally asymptomatic and having no problems now.
Wish to convey heartfelt thanks to each one of you, and also reiterate the need to be calm, composed and rational. I did not get any test, CT or take any irrational treatment, just 3 tablets of Crocin in initial 2 days.
Be rational and treat rational is my mantra.

20/04/2021

Copied from the wall of Dr J K Bhutani ..I totally endorse his views which are based on the best evidence...

'WHAT do not work in COVID are Azithromycin, Doxycycline, Ivermectin, Hydroxychloroquine, Vitamins, and Oseltamivir clones….
What works in some are steroids, low-molecular-weight heparin, and in very early and very few Remdesivir…
Patients with severe or moderate hypoxia, which generally occurs after a week of onset of symptoms, are treated with supplemental oxygen…

The optimal oxygen saturation (SpO2) in adults with COVID-19 is uncertain...
A target SpO2 of 92% to 96% seems logical and beneficial…
The experience in patients in observational studies of COVID-19, suggests that a SpO2 96% may be harmful….
SpO2 of 88% to 92% and SpO2 of >96% were both associated with higher mortality....
The conventional oxygen therapy or options for providing enhanced respiratory support including HFNC, NIPPV, intubation, and invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) logically should have a similar target of, SpO2 92%....

Too much oxygen, unmonitored or casually monitored oxygen therapy often is associated with reactive inflammation, growth of microbes (bacteria, and fungi) leading to superadded lung infections, induction of subsequent fibrosis, and restrictive lung disease….
Nearly nothing is even known about the effect of therapeutic administered oxygen on the expression of ACE2 and Furin in respiratory tissues and possible long-term outcomes….
Some generation of ‘oxygen radicals’ may not be bad, as phagocytic cells generate radicals to kill invading pathogens…..
But too much reactive oxygen can be toxic to cells and possibly damaging to many macromolecules, including lipids, proteins, and inhibitory mutant or autoimmune triggers…

As most of the data and published work on COVID-19. is observational, anecdotal or subjectively biased, clinical, and not based on randomized controlled trials…
An astute clinician shall facilitate the immune response of the patient, with watchful expectant expediency, while looking for more mysteries of the body, COVID, and medical science to reveal….

The majority of the patients will get well on their own with just supportive treatment and no drug, oxygen, or device intervention…

post-COVID sequelae and the genesis of these in the panic responses of the medical science to the pandemic is a worthwhile compassionate consideration…'

30/03/2021

Wonderful Analysis:

*Why many people (including Imran Khan) have become infected with Corona virus after vaccination?*

*What is Peltzman effect?*

A doctor friend of mine laments: “I treated thousands of patients with Covid 19 for the last several months. But I was not positive. But after taking the vaccination, I became positive with the virus.”

Accounts like these are not uncommon. Imran khan was vaccinated on a Thursday and became positive with the virus on Saturday. We have heard similar stories about several law makers in India too.

The known facts:

1. The immunity against Covid 19 doesn’t build immediately after the first dose or even immediately after the second. Full fledged immunity takes a few weeks after the second dose.

2. Immunity is not absolute. Even after complete vaccination, a person can get infected. His/her chance of dying or getting a severe infection requiring hospitalisation will be substantially less though.

3. Not all vaccines work to the same extent. The efficacy varies.

4. Not all vaccines are effective against all the variants. A lot of vaccines are less effective against B1.351 (the South African variant), for example.

Now what is this Peltzman effect? And why is it important to know about it?

Peltzman effect means behaviour compensating for the perceived risk. In other terms, people become more careful when they sense greater risk and less careful if they feel more protected.

This means that vaccines are giving a sense of security which leads to a increased risky behaviour.

But the problem is that while vaccines neither give immediate protection or full protection (against infection as against death), the sense of security unfortunately starts much earlier, even before the actual injection. And Peltzman effect comes into play: people wear masks with less caution, do not maintain distance as soon as they reach vaccination centres.

The Peltzman effect in fact started for most people even before they took the vaccine. Many people felt protected just looking at the vaccination numbers. The mask usage, social distancing and hand sanitisation have become progressively less. While this is attributed mainly to pandemic fatigue, the Peltzman effect cannot be ignored.

While this behaviour is dangerous for general public, this can be disastrous for health care workers who directly deal with Covid 19 patients. A lot of them can get infected in the present second wave impairing the health care services.

The Peltzman effect is also evident in the drastic decline in the usage of PPE kits by the healthcare workers.

It is important to vaccinate the majority of the people at risk. But it is also important to be aware of Peltzman effect and be more careful until the effect of vaccination takes us close to herd immunity.

Here is a definite instance where spreading awareness will save lives.

22/03/2021

*Covid Update --

*Covid Vaccination in Pregnancy*
*Pregnancy has higher risk of Severe Covid*
Although the overall risk of severe illness is low, *pregnant women are at an increased risk for severe illness* from COVID-19 when compared to non-pregnant.

*Evidence for vaccination in pregnancy so far* :
1. *Expert opinion*
Based on how these vaccines work in the body, experts believe they are unlikely to pose a specific risk for people who are pregnant

2. *Animal studies*
Studies in animals receiving a COVID-19 vaccines before or during pregnancy found no safety concerns.

3. *Continued Monitoring by Various agencies*
Various agencies like FDA are continuing to monitor pregnant ladies who have opted Covid Vaccine. Since these are new vaccines most pregnancies are ongoing, so complete information on the outcomes of these pregnancies is still not known.
One needs to _continue to follow pregnancies long-term to understand effects on pregnancy and infants_.

4. *Past experience of viral vector vaccines*
The Covishield, SputnikV, J&J/Janssen COVID-19 Vaccine is a viral vector vaccine, meaning it uses a modified version of a different virus (the vector) to deliver important instructions to our cells.

Vaccines that use the same viral vector have been given to pregnant people in all trimesters of pregnancy, including _in a large-scale Ebola vaccination trial.No adverse pregnancy-related outcomes, including adverse outcomes that affected the infant, were associated with vaccination in these trials_

5. *Case Reports*
There are case reports involving individuals to few thousand pregnant women with Covid Vaccination that show no immediate safety concerns to either fetus or mother.
6. *Laboratory Data*
Many reports have encouraging data on Antibody levels in Mother as well as fetus following Covid Vaccination.

*Lactating Mothers*
The COVID-19 vaccines authorized now are non-replicating vaccines, meaning they are able to create an immune response but do not reproduce inside host cells. Because non-replicating vaccines pose no risk for lactating people or their infants, *COVID-19 vaccines are also thought to not be a risk to the breastfeeding infant. Therefore, lactating people may choose to be vaccinated*.

*Planning Pregnancy*
to become pregnant now or want to get pregnant in the future, one may receive a COVID-19 vaccine when one is available.

There is currently *no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems*.

*CDC does not recommend routine pregnancy testing before COVID-19 vaccination*