Introduction COVID-19 emerged as a global pandemic in 2020 and has affected millions of lives. Surgical training has also been significantly affected by this pandemic, but the exact effect remains unknown. We sought to perform a national survey of general surgery residents in the United States to assess the effect of COVID-19 on surgical resident training, education, and burnout. Methods An anonymous online survey was created and distributed to general surgery residents across the United States. The survey aimed to assess changes to surgical residents’ clinical schedules, operative volume, and educational curricula as a result of the COVID-19 pandemic. Additionally, we sought to assess the impact of COVID-19 on resident burnout. Results One thousand one hundred and two general surgery residents completed the survey. Residents reported a significant decline in the number of cases performed during the pandemic. Educational curricula were largely shifted toward online didactics. The majority of residents reported spending more time on educational didactics than before the pandemic. The majority of residents feared contracting COVID-19 or transmitting it to their family during the pandemic. Conclusions COVID-19 has had significant impact on surgical training and education. One positive consequence of the pandemic is increased educational didactics. Online didactics should continue to be a part of surgical education in the post-COVID-19 era. Steps need to be taken to ensure that graduating surgical residents are adequately prepared for fellowship and independent practice despite the significantly decreased case volumes during this pandemic. Surgery training programs should focus on providing nontechnical clinical training and professional development during this time.
Childhood malignant tumors and their treatment are not well described in the natural history of methylmalonic aciduria (MMA). Here we present a case of hepatoblastoma occurring in the native liver of a 19-month-old male with MMA. His tumor was unresectable at diagnosis and he received neoadjuvant chemotherapy with cisplatin, 5-fluorouracil and vincristine. He developed metabolic acidosis and hyperglycemia during chemotherapy. In addition, he developed anemia, thrombocytopenia and febrile neutropenia. He underwent a combined liver-kidney transplant for local control of his tumor and to treat MMA. He remains in remission more than five years after his transplant. In addition, his transplant has cured his MMA and he is able to tolerate a regular diet without developing metabolic crises.
FIGURE 2. Total case number before and after the initiation of an outpatient COVID-19 management protocol in solid organ transplant recipients. A, Hospitalization and deaths were significantly reduced in both the KG and LG after the protocol was implemented (P = 0.01 for both). B, mAb therapy reduced hospitalization and eliminated deaths (P = 0.045, and P = 0.04) when compared to patients who met the criteria for administration but did not receive the therapy. COVID-19, coronavirus disease 2019; KG, kidney transplant recipient group; LG, liver transplant recipient group; mAb, monoclonal antibody.
Background As the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a viral pandemic, data on the clinical characteristics and outcomes of patients with SARS-CoV-2 infection undergoing solid organ transplant is emerging. The objective of this systematic review is to assess currently published literature relating to the management, clinical course and outcomes of SARS-Cov-2 infection in liver, kidney and heart SOT recipients. Methods We conducted a systematic review to assess currently published literature relating to the management, clinical course and outcomes of SARS-CoV-2 infection in liver, kidney and heart solid organ transplant recipients. Articles published as of June 2020 were searched in the MEDLINE, ClinicalTrials.gov and PubMed databases. We identified 49 eligible studies with a total of 403 solid organ transplant recipients. Results Older age, male sex and pre-existing comorbidity including hypertension and/or diabetes were the most common prevailing characteristics amongst the solid organ transplant recipients. Clinical presentation ranged from mild to severe disease including multi-organ failure and death. We reported an overall mortality of 21%. Conclusions Our analysis suggests no increase in overall mortality or worse outcome in solid organ transplant recipients on immunosuppressive therapy compared with mortality in the general surgical population with SARS-CoV-2. Our findings suggest that transplant surgery and its immunosuppression effects should not be a deterrence to proper surgical care for patients in the SARS-CoV-2 era.
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