man cells. Coronavirus fusion with the cell membrane and internalization also depends on the interaction with the cellular serine protease transmembrane protease serine 2 (TMPRSS2), the cysteine proteases cathepsin B and L, furin and furin-like proteins. 3 As previously observed for SARS-CoV in 2003, and Middle East respiratory syndrome-CoV (MERS-CoV) in 2012, 4 SARS-CoV-2 is thought to be transmitted by respiratory droplets or aerosols and direct contact. 5 Once transmitted to an individual, typical presentations of the infection, such as dry cough, headache, fever, fatigue and pneumonia, are observed. 6 However, disease transmission and, the viral target cells and organs are still under investigation. Interestingly, it has recently been debated that some patients present with gastrointestinal manifestations, including diarrhea, nausea and vomiting. Some studies have also suggested that the gastrointestinal symptoms represent the onset manifestations of the disease. 7 Furthermore, viral RNA has been detected in COVID-19 patients stool samples 8 and rectal swabs 9 even when the virus is
BACKGROUND: With the increased use of antenatal ultrasounds, urinary tract dilation (UTD) is the most common anomaly diagnosed in antenatal screens (diagnosed in 1-5% of all pregnancies at tertiary care centres). Postnatal management of prenatally detected hydronephrosis (HN) lacks consensus, prompting the release of the Urinary Tract Dilation (UTD) system to address this lack of consistency. Despite being a common finding, this diagnosis lacks standardization of practice in its postnatal management. There is inconsistent practice in ordering the initial postnatal ultrasound and whether a voiding cystourethrogram (VCUG) is also warranted.A national survey evaluating the current practices (Urology, 2014), confirmed a lack of management guidelines and called for efforts to obtain consistency in the management protocols for this common condition. The UTD (Urinary Tract Dilation) Guidelines were developed in 2014, by a multidisciplinary committee, to create consistency in antenatal and postnatal management of antenatally diagnosed urinary tract dilation. The risk stratification into UTD P1 (low risk postnatal urinary tract dilation), UTD P2 (intermediate risk postnatal urinary tract dilation), and UTD P3 (high risk postnatal urinary tract dilation) were clearly defined as per the ultrasound findings postnatally. The management of each risk category were also discussed in details.We aimed to establish 90% compliance to guidelines by utilizing the recent UTD recommendations. OBJECTIVES 1. We aim to achieve a 90% compliance rate to the newly published postnatal management of antenatal urinary tract dilation guidelines (Journal Of Pediatric Urology, December 2014), for neonates with the prenatal diagnosis of the same. 2. To reduce the number of inappropriate ultrasounds (the ultrasounds that don't adhere to the recommendations and are either too early or too late or inadequate in terms of description of all parts of urinary tract requiring repeat) to 10% 3. To reduce the number of inappropriate VCUGs to 10% DESIGN/METHODS: We piloted a quality initiative to standardize the postnatal management of hydronephrosis based on the Urinary Tract Dilation (UTD) guidelines employing convenience sampling.A retrospective review (n=28) of existing practices (2010 SFU consensus) was conducted (Jan-Dec 2014), prior to the release of the UTD guidelines.Prospectively collected feasibility data was then obtained on protocol compliance from Jan 2015-May 2016 (n= 72), divided into 3 periods: (1) briefing of involved staff and standardized data collection forms, (2) training residents and staff in grand rounds, and (3) distribution of standardized protocol flowcharts.First, we implemented the guidelines in January 2015 for 8 months (period 1). At the end of the period 1, we planned to reinforce adherence by giving a talk (period 2: 2nd Intervention) on the Division of General Pediatric Rounds, to the general Pediatricians, residents and fellows of the department. Our Pediatric Nephrologist was also present during the rounds, held 1 week befo...
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