Background Coronavirus disease 2019 (COVID-19) has affected all facets of life and continues to cripple nations. COVID-19 has taken the lives of more than 2.1 million people worldwide (23), with a global mortality rate of 2.2% (23). Current COVID-19 treatment options include supportive respiratory care, parenteral corticosteroids, and Remdesivir. Although COVID-19 is associated with increased risk of morbidity and mortality in patients with comorbidities, the vulnerability, clinical course, optimal management, and prognosis of COVID-19 infection in patients with organ transplants has not been well described in the literature (9, 13). The treatment of COVID-19 differs, based on the organ(s) transplanted (6). Preliminary data suggested that liver transplant patients with COVID-19 did not have higher mortality rates than untransplanted COVID-19 patients (2). Table 1 depicts a compiled list of current published data on COVID-19 liver transplant patients. Most of these studies included both recent and old liver transplant patients. No distinction was made for early liver transplant patients who contract COVID-19 within their post-transplant hospitalization course. This potential differentiation needs to be further explored (14). Here, we report two patients who underwent liver transplantation who acquired COVID-19 during their post-transplant recovery period in the hospital. Case Descriptions Two patients who underwent liver transplant and contracted COVID-19 in the early post-transplant period. Treated with hydroxychloroquine, methylprednisolone, tocilizumab and convalescent plasma. Description of their hospital course, including treatment and recovery. Conclusions The management of post-liver transplant patients with COVID‐19 infection is complicated. Strict exposure precaution practice following organ transplantation is highly recommended. Widespread vaccination will help with prevention, but there will continue to be patients who contract COVID-19. Therefore, continued research into appropriate treatments is still relevant and critical. A temporary dose reduction of immunosuppression and continued administration of low-dose methylprednisolone, remdesivir, monoclonal antibodies, and convalescent plasma might be helpful in the management and recovery of severe COVID-19 pneumonia in post-liver transplant patients. Future studies and experiences from post-transplant patients are warranted to better delineate the clinical features and optimal management of COVID-19 infection in liver transplant recipients.

An audit of triage was conducted between June and September 2003 in a district general hospital genitourinary medicine department to evaluate the appropriateness of triage criteria to identify those who require urgent intervention. We selected gonorrhoea (B1), chlamydia (C4a), gential herpes (C10a/b) and epidemiological treatment of contacts of B1 or C4a (C4e/B4) as conditions requiring urgent intervention. Eighty-eight percent met one or more of the criteria and were offered urgent appointments and 69% who did not meet the criteria were offered routine appointments. The incidences of B1, C4a, C10a/b and C4e/B4 were 26.5%, 21.2%, 16.8% and 8% respectively in the urgent group compared with corresponding incidences of 4.4% and 16.2% respectively in the routine group. No cases of C10a/b or C4e/B4 were seen in the latter group. Although triage criteria did not identify asymptomatic infections, efficient contact tracing will improve detection of asymptomatic carriers of infections and should be encouraged. The outcome of the audit informed modifications to the criteria and reinforced the need for staff training in triage. In the United Kingdom, genitourinary medicine must be urgently prioritized and invested in, to improve access to all who need to be seen within 48 h of contacting the service.

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BACKGROUND: Older trauma patients present with poor preinjury functional status and more comorbidities. Advances in care have increased the chance of survival from previously fatal injuries with many left debilitated with chronic critical illness and severe disability. Palliative care (PC) is ideally suited to address the goals of care and symptom management in this critically ill population. A retrospective chart review was done to identify the impact of PC consults on hospital length of stay (LOS), ICU LOS, and surgical decisions. STUDY DESIGN: A Level 1 Trauma Center Registry was used to identify adult patients who were provided PC consultation in a selected 3-year time period. These PC patients were matched with non-PC trauma patients on the basis of age, sex, race, Glasgow Coma Scale, and Injury Severity Score. Chi-square tests and Student’s t-tests were used to analyze categorical and continuous variables, respectively. Any p value >0.05 was considered statistically significant. RESULTS: PC patients were less likely to receive a percutaneous endoscopic gastric tube or tracheostomy. PC patients spent less time on ventilator support, spent less time in the ICU, and had a shorter hospital stay. PC consultation was requested 16.48 days into the patient’s hospital stay. Approximately 82% of consults were to assist with goals of care. CONCLUSION: Specialist PC team involvement in the care of the trauma ICU patients may have a beneficial impact on hospital LOS, ICU LOS, and surgical care rendered. Earlier consultation during hospitalization may lead to higher rates of goal-directed care and improved patient satisfaction.