Présomption et Prévention

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Présomption et Prévention

49  articles in this collection
Written by Mathias Castonguay, Laurie-Anne Duquette, Camille Blouin, Noémie Desgagnés, 

Metastatic Prostate Cancer: Management Suggestions

Telemedicine should always be prioritized as well as laboratory monitoring rather than in-clinic visit to avoid exposures.1 Encourage patient to have enough supply of oral medications.1 Imaging may be differed if PSA is declining and in the absence of new symptom until deemed safe.1   Regarding RT (radiation therapy): RT for oligo-metastatic disease may be […]

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04/12/2020

Gynecological Ultrasound Management

Indications for immediate assessment : Acute persistent pelvic pain, to rule out ovarian torsion, ruptured ovarian cyst, PID and tubo-ovarian abscess; Suspicion for postoperative complications or hyperstimulation syndrome; Abdominopelvic mass provoking systemic symptoms; AUB causing hemodynamic instability or severe anemia.   Indications to delay scan for 2-4 weeks : Risk for malignancy : family history […]

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04/10/2020

Localized Prostate Cancer: Management Suggestions

In most cases, minimal harm is expected with delays of 3-6 months, especially when estimating the risk: benefit ratio within mind the mortality related to COVID-19. Telemedicine should always be prioritized as well as laboratory monitoring rather than in-clinic visit to avoid exposures.  About staging, surveillance and timing of treatment: For low risk cancer (very […]

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04/10/2020

Cancer Surgery in the Time of Pandemic

Cancer surgery patients should be considered “essential” and they should be among the last group of to be delayed.  In case a hospital cannot carry out non-emergency surgeries, a jurisdictional coordination should facilitate transfer care of cancer patients to less overwhelmed institutions, rather than delaying surgery.  In spite of that, triage of cancer surgery cases […]

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04/10/2020

Should We Manage Obstetric Ultrasounds Differently?

General considerations : The number of visits needs to be minimal and the patient should come alone. Triage based on risk factors and temperature at arrival should be performed before the patient enters the ultrasound unit. Non-urgent appointments should be postponed for 14 days. Monochorionic twin pregnancy should be managed as usual. Some high-risk pregnancy […]

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04/09/2020

The Attack on Hemoglobin: a Distraction or a Virulence?

This study suggests that structural and transcribed proteins of the virus may attack the β1-chain of hemoglobin leading it to release its porphyrin (just like the heme oxidase)1, 2. It also suggests that the virus can capture the free porphyrin and use it to enter the human cells, rather than only using the ACE2 and […]

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04/07/2020

Advanced Lung Cancer: Management Suggestions

Patients with lung cancer are more at risk of pulmonary complications from COVID-19 disease and the risk: benefit ratio of systemic anticancer treatment has to be considered.1,2 Practical suggestions to treat patients are proposed (see table 1 below).2 Regarding Potential Surgery: Stage IIIA should be considered urgent and surgery should be done within one month […]

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04/07/2020

Effective Measures to Prevent Transmission in the Oncology Department?

Mandatory measures have been carried out at the National Cancer Center in China: Multiple on-site temperature tests were be performed (entrances of hospital, outpatient clinic, wards); Online appointments were offered. If not doable, essential personal protective measures were implemented (wearing mask, bringing disinfectant); For patients preparing to be admitted, symptoms that are potentially associated with […]

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04/07/2020

What About Abortion?

Some evidence show that at-home medical abortion is preferable to other methods for pregnancy <9 weeks. Safety and efficiency of different methods are comparable. When surgical abortion is necessary, local anesthesia should be preferred to OR and general anesthesia. Phone call and video conference should be prioritised for necessary appointments.  If in-hospital abortion necessary, probable […]

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04/06/2020

Rationale Behind Coronaviruses’ Vaccines

What we know about SARS-CoV: Caused an outbreak in 2002; Immune responses are mediated by both humoral and cellular immunity; S protein is responsible for 3 important mechanisms:  attachment of the virus by binding to the ACE2; entry in the host cells and membrane fusion; allowing release of the viral RNA. This makes S protein the […]

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04/06/2020

Epidemiology and Transmission in Pregnancy

Epidemiology : Epidemiological and transmission tendencies are like those seen in non-pregnant adults.  Consistent with findings in non-pregnant adults, the cases were predominantly classified as mild or common in terms of severity. Lag time between onset of symptoms and diagnosis was directly related to the severity of the infection.   Transmission via the reproductive system […]

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04/05/2020

Urology Practice during the Outbreak

Urgent procedures that can be performed under local anesthesia are preferable considering the limited availability of anesthesiologists.  Gross hematuria should be treated to limit the use of blood derivatives. Non-deferrable oncological procedures should be planned while taking in consideration the patient comorbidity profile and the availability of intensive care beds. All procedures for benign diseases […]

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04/05/2020

Theoretical Dangers in Using Immune Checkpoint Inhibitors

ICI (immune checkpoint inhibitors) and immunocompetence. Hematological irAEs (immune related adverse event) are uncommon, as ICI secondary autoimmune thrombocytopenia and neutropenia, antibody-mediated hemolytic anemia and thrombotic thrombocytopenic purpura are rare. Their impact may actually be beneficial in countering the tumoral immunosuppressive microenvironment. Considering the potential anti-PD1/PD-L1 pneumological toxicity. As already known, the presence of an […]

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04/05/2020

Dilemmas Regarding Oncology Care System

Delaying Treatment or Accepting Harm of Exposure? Many solid tumors (such as lung or pancreatic cancer) and some hematologic cancer (such as acute leukemia or aggressive lymphomas) require immediate diagnosis and treatment, opposed to other common early-stage cancers (breast, prostate, cervical, nonmelanoma skin…) that may not need immediate action and therefore prevent unnecessary exposition. For […]

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04/04/2020

Psychological Consequences of Quarantine

Quarantine triggers a wide range of psychological symptoms and disorders, such as anxiety, irritability, anger, confusion, post-traumatic stress and depressive symptoms. The impact of quarantine on mental health may have long lasting consequences. A longer quarantine duration, fears of infection, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma were reported as stress factors. […]

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04/04/2020

Viral Load in Upper Respiratory Tracts

Viral loads seems to be higher soon after the symptom onset, with higher viral loads detected in the nose than in the throat. The results suggest a potential transmission potential by asymptomatic or minimally symptomatic patients, as the viral load in the asymptomatic patient was similar to the symptomatic ones.   These data come from […]

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04/03/2020

Perioperative Management of Infected Patient

Management of the dedicated operating room(OR):  The OR should be adequately ventilated, ideally with negative pressure.  The same OR and the same anesthesia machine should be used for COVID-19 positive patients.  The anesthetic drug trolley should be kept in the induction room and all the drugs and equipment required for the procedure should be placed […]

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04/03/2020

Guidelines: Tracheotomy

Canadian Society of Otolaryngology-Head and Neck Surgery strongly advise against performing a tracheotomy in still infectious COVID-19 patients. In positive patients, requests for tracheotomy should generally not be considered regardless of duration of endotracheal intubation.  In emergency tracheotomy with unknown COVID-19 status:  Manage patient as if COVID-19 positive.  Intubation rather than tracheotomy is highly preferable. […]

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04/03/2020

Should We Discontinue ACE-I and ARB?

Despite some evidence of up-regulation of ACE2 by RAAS inhibition, with its theoretically associated higher susceptibility to COVID-19 infection and increased viral load, there is currently no data suggesting a causal relationship between ACE2 activity and COVID-19 associated mortality; therefore, based on currently available data, the assumption of a causal relationship between ACE-I or ARB […]

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04/03/2020

Origin of SARS-CoV-2

The evidence strongly suggests that SARS-CoV-2 is not a laboratory creation nor an intentionally manipulated virus. The RBD (receptor-binding domain) sequence of the SARS-CoV-2 spike protein appears to bind with high affinity to human ACE2, but this sequence is different than those predicted to be optimal for receptor binding based on previous computational analyses on […]

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04/02/2020

Stratifying the Risk Among Cancer Patients

Prior anti-tumor treatment within 14 days before COVID-19 diagnosis is a major risk factor for developing severe events.1 Patchy consolidation on the first CT on admission is a major risk factor for developing severe events.1 Patients with blood cancer and metastatic cancer seem to have a higher risk of severe events compared to patients without […]

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03/29/2020

Neuroinvasive Potential of COVID-19

Previous studies have shown that CoVs, like SARS-CoV, have a tropism for the central nervous system. Due to its high similarity with SARS-CoV,  SARS-CoV-2 may also possess a similar neuroinvasive potential, which may partially explain the acute respiratory failure of COVID-19 patients. Review of past studies on coronaviruses’s propensity for neuroinvasion.   Source:  Li YC, […]

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03/28/2020

Risk of Severe Events in Cancer Patients

Patients with cancer have a higher risk of severe events and death compared with patients without cancer.1,2 Patients who underwent chemotherapy or surgery in the past month had higher risk.1 In Italy, it was found that 20% of patient who died from COVID-19 had an active cancer. 2   Wenhua L and al. conducted a […]

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03/28/2020

Postpartum Care and Breastfeeding

Delayed umbilical cord clamping does not seem to increase pathogens transmission. Leaving vernix caseosa in place 24h after birth can be considered due to the presence of antimicrobial peptides. The majority of neonatal infections are caused by the environment and droplet transmission from the mother and other relatives.  Physical separation at birth can be considered […]

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03/28/2020