AbstractAs the world continues to study and understand coronavirus disease (COVID-19), existing investigations and tests have been used to try and detect the virus to slow viral transmission and its global spread. A ‘gold-standard’ investigation has not yet been identified for detection and monitoring. Initially, computed tomography (CT) was the mainstay investigation as it shows the disease severity and recovery, and its images change at different stages of the disease. However, CT has been found to have limited sensitivity and negative predictive value in the early stages of the disease, and the value of its use has come under debate due to whether its images change the treatment plan, the risk of radiation, as well as its practicality with infection control. Therefore, there has been a shift to the use of other imaging modalities and tests, such as chest X-rays and ultrasound. Furthermore, the use of nucleic acid-based testing such as reverse-transcriptase polymerase chain reaction (RT-PCR) have proven useful with direct confirmation of COVID-19 infection. In this study, we aim to review and analyse current literature to compare RT-PCR, immunological biomarkers, chest radiographs, ultrasound and chest CT scanning as methods of diagnosing COVID-19.
There remains a significant paucity of information evaluating the effect of
glycated HbA1c levels and its theorized effect on mortality and morbidity rates
following cardiac surgery. Diabetes is a very common comorbidity in patients
undergoing open heart surgery, as there is a shift in patient characteristics
and greater risk. Currently, there is no clear consensus that an increase in
HbA1c level is associated with increased perioperative mortality rate. However,
the reported literature is more commonly able to demonstrate that elevated HbA1c
levels is associated with increased rates of wound infection, cardiovascular
events and renal failure, and thus, higher post-operative morbidities. This
review aims to examine and synthesis the evidence behind each of the morbidities
and mortalities associated with open heart surgery and the impact of high HbA1c
on the reported outcomes.
Objectives
The use of extracorporeal membrane oxygenation (ECMO) in cardiac surgery has been established in cases of postcardiotomy cardiogenic shock, which is refractory to conventional therapy with inotropes and intra‐aortic balloon pulsation support. We sought to examine the literature in a systematic review manner on the outcomes of using ECMO postcardiac surgery.
Methods
A comprehensive electronic literature search was done to identify all the articles that have discussed the use of ECMO postcardiac surgery. The keywords and medical subject headings terms were used to identify the relevant articles. Studies have been screened according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.
Results
The identified studies have been summarized in each relevant section of this study. Cardiogenic shock postcardiac surgery can benefit from ECMO to varying degrees and the survival for this; otherwise, fatal condition has been shown to be improving through the use of ECMO. However, the decision and timing to initiate ECMO therapy remains selective and is dependent on a range of factors such as patient factor, clinician's judgment, meaning there is no consistent and solid ground regarding the timing of ECMO initiation.
Conclusion
Current evidence suggests that the circulatory support provided by ECMO improves survival rates for postcardiac surgery cardiogenic shock patients who are refractory to inotropic management, without such ECMO support patient mortality rates would be much greater.
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