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LONG Covid is the term used to explain the long-term effects of Covid-19 that are being discovered as people recover from the initial impact of the virus.

According to a review by the National Institute of Health Research (NIHR), it may actually be a number of different syndromes and researchers are now examining what exactly happens after someone has contracted coronavirus.

In the NIHR review, it was suggested that people suffering from long-term effects of Covid-19 may have different syndromes such as post-intensive care syndrome, post-viral fatigue syndrome, and long term covid syndrome.

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Patients with long-term effects of Covid-19 are those with symptoms for more than 12 weeks that ‘can affect any system in the body’, according to a new definition by NICE.

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As Belgium enters a new wave of Covid-19 infections, the federal knowledge centre for health care (KCE) has just issued an extensive new report warning of a danger on the horizon: a wave of cases of post intensive care syndrome (PICS).

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For patients with severe symptomatic aortic stenosis, surgical aortic valve replacement (SAVR) is the reference treatment where surgical risk is low. For those assessed by a heart team as being at increased surgical risk transcatheter aortic valve implantation (TAVI) is an alternative procedure. SAVR can be performed using different surgical approaches (full sternotomy and more minimally invasive procedures), different kinds of valves, and different kinds of valve anchoring techniques (sutured and sutureless). TAVI involves the insertion of a prosthetic valve, which functionally replaces the damaged aortic valve, using fluoroscopic and echographically guided minimally invasive procedures. The prosthetic valve is compressed within a dedicated delivery system and, once in place within the diseased aortic valve, its deployment allows its expansion and the compression of
the native diseased valve against the wall of the aorta. Depending on the anatomy of the patient and device characteristics, the procedure can be performed by one of four different approaches. The transfemoral (TF) route is the most common, whereas the others are performed when the anatomy of the patient precludes access via the TF route. These approaches are the subclavian/ transaxillary (S/T) approach, the transapical (TA) approach, and the transaortic (TAo) approach. Evidence note | 6 Data from randomised controlled trials (RCTs) in elderly patients at who are at high surgical risk indicate that TAVI is non-inferior or superior to SAVR2. This is reflected in SHTG advice on the use of TAVI in patients who are inoperable or at high surgical risk3, 4. This evidence review examines the evidence comparing outcomes of TAVI and SAVR in patients with severe aortic stenosis who are at intermediate surgical risk.

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Background

There has been a lot of debate in the surgical literature about the best way to surgically access the infrarenal abdominal aorta during an operation to repair an abdominal aortic aneurysm (AAA; a ballooning of an artery (blood vessel) which occurs in the major artery in the abdomen (aorta)). Two approaches are commonly used: the retroperitoneal (RP) approach and the transperitoneal (TP) approach. Both approaches appear to have advantages and disadvantages. Many trials comparing RP and TP aortic surgery have been published with conflicting results. The aim of this Cochrane review is to assess the effectiveness and safety of the TP versus RP approach for planned surgical open AAA repair on mortality, complications, hospital stay and blood loss.

Key results

We included four small randomized controlled trials (RCTs) (129 participants) after we searched the literature up to May 2015). There were no differences between RP and TP for death. Our analysis seems to show a trend that RP might increase the complications such as hematoma (swelling of clotted blood), chronic wound pain and abdominal wall hernia compared with TP but there were variations between the included trials. We found that RP led to lower blood loss, and shorter hospital stay and ICU stay compared with TP but there were no differences between the two approaches for operating time and aortic cross‐clamp time (length of time a surgical instrument, used to clamp the aorta and separate the circulation from the outflow of the heart, is used).

Quality of the evidence

Three of the four included trials had methodological weaknesses, such as unclear randomisation methods, and no reporting of blinding of the people assessing the outcome which compromised the value of their results. In addition, the included trials only included a small number of people, there were few outcomes reported, there was a relatively short follow‐up and there were inconsistencies between the included trials resulting in very low to low quality of the evidence. More large‐scale RCTs of the RP approach versus the TP approach for planned surgical open AAA repair are needed.

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Authors' objectives
To compare surgical techniques for traumatic rupture of the thoracic aorta.

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Another reason to be wary of a hospital stay- a new study shows that patients who survive intensive care units in hospitals are at high risk for developing post-traumatic stress disorder (PTSD).

PTSD is in the news most often in relation to combat veterans, but researchers from the Johns Hopkins University School of Medicine found that one in three people who survived an intensive care unit (ICU) stay for acute lung injury showed PTSD symptoms that lasted up to two years.

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These are the UK coronavirus stories you need to know about today.
Moderna mRNA Vaccine 'Almost 95% Effective'.
A candidate vaccine to protect against COVID-19 is almost 95% effective, according to US company Moderna.

The results from early data, revealed in a press release, came a week after Pfizer and BioNTech announced that their vaccine could prevent more than 90% of people developing COVID-19. Both companies use the same messenger RNA (mRNA) technology.

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The overall objective of the guidelines is to provide up-to-date, evidence-based recommendations for the diagnosis and management of the full spectrum of Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and SJS–TEN overlap in adults during the acute phase of the disease. The document aims to: (i) offer an appraisal of all relevant literature up to February 2016, focusing on any key developments; (ii) address important, practical clinical questions relating to the primary guideline objective, i.e. accurate diagnosis
and identification of cases and suitable treatment; (iii) provide guideline recommendations; and (iv) discuss areas of uncertainty, potential developments and future directions SJS/TEN is rare and few healthcare professionals are confident in the recognition and management of the disorder. There is widely divergent practice among different specialities and healthcare settings, and limited information on outcomes.
These guidelines aim to provide recommendations on the diagnosis and management of SJS/TEN, to inform clinical decision-making and, when justified by evidence, to standardize practice. The breadth of this document should be sufficient to assist clinicians of all relevant specialities in the management of patients with SJS/TEN. The recommendations will also inform pathways of care to optimize healthcare delivery and highlight key areas of uncertainty for future research. In these guidelines, the term SJS/TEN encompasses the full spectrum of the disease, i.e. SJS, TEN and SJS–TEN overlap (see section 7.2 for clinical definition of the separate entities). The guideline is presented as a detailed review with highlighted recommendations for practical use (see section18.0), in addition to the development of a new patient information leaflet [available on the British Association of Dermatologists’ (BAD) website, www.bad.org.uk]. Unless otherwise specified, recommendations apply to all forms of the disease.

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The NHS is to set up more than 40 specialists clinics in England for those suffering with the long-term effects of coronavirus, Matt Hancock has confirmed.

Prompted by concerns thousands of patients are suffering with so-called long Covid, the 43 clinics will bring together doctors, nurses, therapists and other NHS staff to assess those experiencing enduring symptoms.

Long Covid, which is thought to affect more than 60,000 people in the UK, can cause continuing fatigue, brain fog, breathlessness and pain, according to the NHS.

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The two pager provide information about Delirium which included: definition, symptoms, causes. and how it can be treated

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Treating COVID-19 patients has been a call to action for medical professionals, and a year in they are still trying to understand the illness' implications, a University of Michigan doctor says.

Dr. Jake McSparron, a pulmonary and critical care physician at Michigan Medicine and a clinical associate professor at U-M in pulmonary and critical care, has seen firsthand the symptoms described by survivors in Lenawee County .