Why are more otorhinolaryngology surgeons dying from Covid-19 than any other surgical specialty?
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Abstract:
Covid-19 infection is caused by the coronavirus SARS-CoV-2.This has resulted in the present pandemic from which thousands of people have died including many front-line health care workers.Of the surgeons who have died from covid-19 it would appear that otorhinolaryngology surgeons have made the largest sacri ice (Figure 1) [1].The potential explanations for this are discussed.Keywords:
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2019-20 coronavirus outbreak
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2019-20 coronavirus outbreak
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Although SARS-CoV-2 may primarily enter the cells of the lungs, the small bowel may also be an important entry or interaction site, as the enterocytes are rich in angiotensin converting enzyme (ACE)-2 receptors. The initial gastrointestinal symptoms that appear early during the course of Covid-19 support this hypothesis. Furthermore, SARS-CoV virions are preferentially released apically and not at the basement of the airway cells. Thus, in the setting of a productive infection of conducting airway epithelia, the apically released SARS-CoV may be removed by mucociliary clearance and gain access to the GI tract via a luminal exposure. In addition, post-mortem studies of mice infected by SARS-CoV have demonstrated diffuse damage to the GI tract, with the small bowel showing signs of enterocyte desquamation, edema, small vessel dilation and lymphocyte infiltration, as well as mesenteric nodes with severe hemorrhage and necrosis. Finally, the small bowel is rich in furin, a serine protease which can separate the S-spike of the coronavirus into two "pinchers" (S1 and 2). The separation of the S-spike into S1 and S2 is essential for the attachment of the virion to both the ACE receptor and the cell membrane. In this special review, we describe the interaction of SARS-CoV-2 with the cell and enterocyte and its potential clinical implications.
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ResumenSe presenta un caso clínico de eventración infraumbilical complicada estrangulada con obstrucción intestinal que acude durante la pandemia de la COVID-19, causada por el virus SARS-CoV-2, al Hospital Municipal de la provincia de Buenos Aires (Argentina), con múltiples factores de riesgo y comorbilidades que potencialmente podían afectar a la evolución posoperatoria de la paciente.Se analiza, además de la técnica de plástica de pared abdominal, las medidas sanitarias implementadas para prevenir la infección del personal quirúrgico y del paciente.
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2019-20 coronavirus outbreak
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2019-20 coronavirus outbreak
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