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      Delayed presentation and sub-optimal outcomes of pediatric patients with acute appendicitis during the COVID-19 pandemic.

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          Abstract

          Early presentation and prompt diagnosis of acute appendicitis are necessary to prevent progression of disease leading to complicated appendicitis. We hypothesize that patients had a delayed presentation of acute appendicitis during the COVID-19 pandemic, which affected severity of disease on presentation and outcomes.

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          Covid-19 and Health Care’s Digital Revolution

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            Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong

            Objective: To describe the infection control preparedness measures undertaken for coronavirus disease (COVID-19) due to SARS-CoV-2 (previously known as 2019 novel coronavirus) in the first 42 days after announcement of a cluster of pneumonia in China, on December 31, 2019 (day 1) in Hong Kong. Methods: A bundled approach of active and enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers (HCWs) with unprotected exposure in the hospitals was implemented. Epidemiological characteristics of confirmed cases, environmental samples, and air samples were collected and analyzed. Results: From day 1 to day 42, 42 of 1,275 patients (3.3%) fulfilling active (n = 29) and enhanced laboratory surveillance (n = 13) were confirmed to have the SARS-CoV-2 infection. The number of locally acquired case significantly increased from 1 of 13 confirmed cases (7.7%, day 22 to day 32) to 27 of 29 confirmed cases (93.1%, day 33 to day 42; P < .001). Among them, 28 patients (66.6%) came from 8 family clusters. Of 413 HCWs caring for these confirmed cases, 11 (2.7%) had unprotected exposure requiring quarantine for 14 days. None of these was infected, and nosocomial transmission of SARS-CoV-2 was not observed. Environmental surveillance was performed in the room of a patient with viral load of 3.3 × 106 copies/mL (pooled nasopharyngeal and throat swabs) and 5.9 × 106 copies/mL (saliva), respectively. SARS-CoV-2 was identified in 1 of 13 environmental samples (7.7%) but not in 8 air samples collected at a distance of 10 cm from the patient’s chin with or without wearing a surgical mask. Conclusion: Appropriate hospital infection control measures was able to prevent nosocomial transmission of SARS-CoV-2.
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              Delayed diagnosis of paediatric appendicitis during the COVID‐19 pandemic

              Abstract Aim To present seven paediatric patients with appendicitis, all with late diagnosis resulting from different aspects of the fear from the current global COVID‐19 pandemic. Methods Cases were collected from three paediatric surgical wards. Comparison between complicated appendicitis rates in the COVID‐19 era and similar period in previous year was performed. Results All seven children presented with complicated appendicitis. Main reasons for the delayed diagnosis during the COVID‐19 era were parental concern, telemedicine use and insufficient evaluation. Higher complication rates were found during the COVID‐19 era compared to similar period in previous year (22% vs 11%, P‐value .06). Conclusion The fear from COVID‐19 pandemic may result in delayed diagnosis and higher complication rates in common paediatric medical conditions. We believe caregivers and healthcare providers should not withhold necessary medical care since delay in diagnosis and treatment in these routinely seen medical emergencies may become as big of a threat as COVID‐19 itself.
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                Author and article information

                Journal
                J Pediatr Surg
                Journal of pediatric surgery
                Elsevier BV
                1531-5037
                0022-3468
                May 2021
                : 56
                : 5
                Affiliations
                [1 ] Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032.
                [2 ] Department of Biostatistics, Columbia University Mailman School of Public Heath, 722 W 168(th) St, New York, NY 10032.
                [3 ] Division of Pediatric Surgery, Department of Surgery, Weill Cornell Medical Center / NewYork-Presbyterian Komansky Children's Hospital, 525 East 68(th) Street, New York, NY 10065.
                [4 ] Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032.
                [5 ] Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032. Electronic address: vd2312@cumc.columbia.edu.
                Article
                S0022-3468(20)30756-9
                10.1016/j.jpedsurg.2020.10.008
                7569380
                33220973
                16bd260b-4019-4686-8b3d-a1d8f7352fd3
                History

                Acute appendicitis,Appendiceal perforation,COVID-19,Intra-abdominal abscess,SARS-CoV-2

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