LitCovid-sentences  

PMC:7417187 / 3425-29657 JSONTXT 12 Projects

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Id Subject Object Predicate Lexical cue
T25 0-12 Sentence denotes Introduction
T26 13-113 Sentence denotes The recent novel coronavirus disease 2019 (COVID-19) pandemic has brought the world to a standstill.
T27 114-217 Sentence denotes This outbreak not only affected the healthcare systems but the resultant economic losses were enormous.
T28 218-466 Sentence denotes COVID-19 has demanded that the health care systems globally evolve, develop new strategies, identify new models of functioning, and at times, fall back on the old conservative methods of orthopedic care to decrease the risk of disease transmission.
T29 467-568 Sentence denotes The usual incubation period of the disease is 5-14 days but with reported outliers up to 24 days [1].
T30 569-756 Sentence denotes It is not just the contagiousness of the COVID-19 but the alarming fatality as well (approximately 3.6%), which far exceeds the other severe acute respiratory syndrome (SARS) viruses [1].
T31 757-936 Sentence denotes Although the recent World Health Organization (WHO) report suggests that the asymptomatic cases are less likely to transmit the virus, this is debatable with conflicting evidence.
T32 937-1014 Sentence denotes Moreover, the presymptomatic cases are as likely to transmit the virus [2,3].
T33 1015-1152 Sentence denotes Infection among health care workers (HCWs) is further straining the already overburdened workforce due to a sudden spike in the caseload.
T34 1153-1289 Sentence denotes Although, the majority of hospitals are refraining from performing elective surgeries, emergent and urgent procedures cannot be delayed.
T35 1290-1520 Sentence denotes Various strategies have been developed at the institute level to reduce the risk of infection transmission among the theatre team from an unsuspected patient (asymptomatic and presymptomatic) during the perioperative period [2,3].
T36 1521-1820 Sentence denotes India has rapidly surged its capacity of reverse transcription-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but with its 1.3 billion population and a rapidly increasing infection rate, a selective testing approach was adopted initially.
T37 1821-1998 Sentence denotes The policy regarding testing in India formulated by the Indian council of medical research (ICMR) has been revised with evolving evidence regarding the spread of infection [4]. 
T38 1999-2439 Sentence denotes Since testing could not be performed in all patients in need of surgical intervention due to time or resource constrain, nor an initial negative test can surely rule out infection, a “consider all positive” approach was adopted by the authors' institute to manage patients requiring emergent or urgent care including the available recommendations regarding reducing the risk of exposure to the surgical team during the perioperative period,
T39 2440-2578 Sentence denotes We developed a “caution at each step” model in an effort to minimize the risk of exposure to the theatre team from an unsuspected patient.
T40 2579-2701 Sentence denotes In this study, we elaborate on this model in detail along with our experience of its use in emergency spine surgery cases.
T41 2703-2724 Sentence denotes Materials and methods
T42 2725-2910 Sentence denotes The patients participating are also part of an ongoing prospective study on spine injuries at the authors' institute for which institutional ethics committee approval has been obtained.
T43 2911-3035 Sentence denotes All patients admitted either for vertebral fracture or spinal cord compression from February 2020 to May 2020 were included.
T44 3036-3264 Sentence denotes The spine conditions included were spinal cord injury (SCI), epidural abscess, epidural hematoma, close reduction of cervical facet dislocation, cauda equine syndrome, surgical spine tumor with spinal cord compression (Table 1).
T45 3265-3299 Sentence denotes No COVID-19 patients were treated.
T46 3300-3475 Sentence denotes The neurological status was assessed using the American Spinal Injury Association (ASIA) impairment scale as it can be used for traumatic [5] as well as non-traumatic SCI [6].
T47 3476-3837 Sentence denotes Thoracolumbar injury classification and severity score (TLICS) based on the morphology of the injury, the integrity of the posterior ligamentous complex, and neurological status of the patient was performed in which points are assigned for each category and the final total points suggest the possible treatment option for thoracolumbar vertebral fractures [7].
T48 3838-3880 Sentence denotes Table 1 Inclusion and exclusion criterias
T49 3881-3939 Sentence denotes A) Inclusion Criteria (Indications for emergency  surgery)
T50 3940-3987 Sentence denotes 1) Spinal Cord injury due to verbral fracture  
T51 3988-4007 Sentence denotes 2) Epidural Abscess
T52 4008-4029 Sentence denotes 3) Epidural Haematoma
T53 4030-4121 Sentence denotes 4) Surgical Spine tumour with Spinal Cord compression with progressive neurological deficit
T54 4122-4146 Sentence denotes 5) Cauda equina syndrome
T55 4147-4235 Sentence denotes 6) Infective pathology of spine (tubercular spondylodiscitis,bacterial spondylodiscitis)
T56 4236-4290 Sentence denotes B) Exclusion Criteria (Surgeries which can be delayed)
T57 4291-4347 Sentence denotes 1) Surgical lumbar disk herniation  with radiculopathy  
T58 4348-4370 Sentence denotes 2) Spondylolisthesis  
T59 4371-4407 Sentence denotes 3) Surgical cervical radiculopathy  
T60 4408-4438 Sentence denotes 4) Cervical myelopathy Methods
T61 4439-4533 Sentence denotes The detailed description of the steps which we took is mentioned below and briefly in Table 2.
T62 4534-4583 Sentence denotes Table 2 Brief description of precautionary steps
T63 4584-4588 Sentence denotes PPE:
T64 4589-4625 Sentence denotes Personal protective equipment; TOCC:
T65 4626-4830 Sentence denotes Travel to regions with a high prevalence of COVID-19, occupation with a high risk of COVID-19 infection, contact with people known to be infected with COVID-19, or proximity with a COVID-19 positive case.
T66 4831-4832 Sentence denotes  
T67 4833-4845 Sentence denotes Do’s Dont’s
T68 4846-4870 Sentence denotes 1.Preoperative period  
T69 4871-4972 Sentence denotes A) History, examination and screening Questinnare related to COVID 19 (Table 3) A) Entry to visitors
T70 4973-5035 Sentence denotes B) TOCC information (Table 3) B)  Allow unnecessary attendant
T71 5036-5151 Sentence denotes C) Explain the hospital’s protocol for COVID-19 Infection C) Overcrowing of patients in the ward and recovery room
T72 5152-5200 Sentence denotes D) Compulsory Mask for patient and attendant.  
T73 5201-5227 Sentence denotes 2.Intraoperative period  
T74 5228-5317 Sentence denotes A) Proper donning and doffing technique of prescribed PPE A)Avoid using High power tools
T75 5318-5459 Sentence denotes B) Limiting the number of people in the operating room   B) Unnecessary Crowd in  operation room especially during intubation and extubation
T76 5460-5546 Sentence denotes C) Reducing door opening in the operating room C) Cluttering of unnecessary equipment
T77 5547-5596 Sentence denotes D) Cautious use of electrocautery with suction  
T78 5597-5664 Sentence denotes E) Thorough cleaning of the operation room and all the equipment  
T79 5665-5667 Sentence denotes 3.
T80 5668-5691 Sentence denotes Postoperative period  
T81 5692-5749 Sentence denotes A) Mask for patient A) Overcrowding in the recovery room
T82 5750-5827 Sentence denotes B) Social distancing in the recovery room B) Keeping patient for longer time
T83 5828-5920 Sentence denotes C)Cleaning of bed and it's surface after the transfer of patient C)Prolong stay in hospital
T84 5921-6056 Sentence denotes D) Immediate Postoperative round by  Senior resident, Chief surgeon should be telephonically informed D)Change in antibiotic protocols
T85 6057-6151 Sentence denotes E) Prescribed PPE by health care personnel  E) Interdepartmental  Transfer for rehabilitation
T86 6152-6249 Sentence denotes F)Wound inspection and dressing – wear an N95 mask F) A frequent follow-up visit to the hospital
T87 6250-6302 Sentence denotes G) Early rehabilitation and physiotherapy program  
T88 6303-6364 Sentence denotes H) Teleconsultation for follow up   Precautions at admission
T89 6365-6438 Sentence denotes At presentation, history was recorded and clinical examination performed.
T90 6439-6516 Sentence denotes The temperature and oxygen saturation at room air recorded for every patient.
T91 6517-6978 Sentence denotes All patients were screened with a series of questions related to COVID-19 symptoms (fever, cough, fatigue, anorexia, shortness of breath, sputum production, loss of taste and smell, sore throat, diarrhea, nasal congestion) as well as TOCC information (travel to regions with a high prevalence of COVID-19, occupation with a high risk of COVID-19 infection, contact with people known to be infected with COVID-19, or proximity with a COVID-19 positive case) [8].
T92 6979-7076 Sentence denotes Information was also obtained regarding the previous infection and test for SARS-CoV-2 (Table 3).
T93 7077-7145 Sentence denotes Table 3 Coronavirus disease 2019 (COVID-19) screening questionnaire
T94 7146-7157 Sentence denotes SARS-CoV-2:
T95 7158-7214 Sentence denotes Severe acute respiratory syndrome coronavirus 2; RT-PCR:
T96 7215-7262 Sentence denotes Reverse transcription-polymerase chain reaction
T97 7263-7276 Sentence denotes S.no      
T98 7277-7297 Sentence denotes 1 Temperature    
T99 7298-7328 Sentence denotes 2 Pulse Oximetry (Spo2)    
T100 7329-7352 Sentence denotes 3 Travel History    
T101 7353-7372 Sentence denotes 4 Occupation    
T102 7373-7418 Sentence denotes 5 Contact with COVID positive  Patient    
T103 7419-7473 Sentence denotes 6 Close proximity to COVID 19 Positive patients    
T104 7474-7533 Sentence denotes 7 Symptoms Yes/ NO If Yes, when was the onset of symptom
T105 7534-7548 Sentence denotes a Fever    
T106 7549-7563 Sentence denotes b Cough    
T107 7564-7580 Sentence denotes c Fatigue    
T108 7581-7598 Sentence denotes d Anorexia    
T109 7599-7627 Sentence denotes e Shortness of breath    
T110 7628-7654 Sentence denotes f Sputum production    
T111 7655-7687 Sentence denotes g Loss of taste and smell    
T112 7688-7708 Sentence denotes h Sore throat    
T113 7709-7726 Sentence denotes i Diarrhea    
T114 7727-7752 Sentence denotes j Nasal Congestion    
T115 7753-7802 Sentence denotes 8) Previous history of COVID -19 infection    
T116 7803-7975 Sentence denotes 9) Previous SARS- COV2 RT PCR test (Date)   Result – Positive/Negative In the case of history or examination suggestive of COVID 19, the patient was isolated and tested.
T117 7976-8057 Sentence denotes However, none of the emergency surgeries was delayed while awaiting test results.
T118 8058-8167 Sentence denotes The sample was sent and surgery was conducted by donning full prescribed personal protective equipment (PPE).
T119 8168-8192 Sentence denotes Preoperative precautions
T120 8193-8451 Sentence denotes Preoperatively, patients and attendants explained about the precautions and measures (hand hygiene, wearing a mask, social distancing, restrictions of family members, and visitors in hospital) recommended by hospital authorities because of COVID-19 pandemic.
T121 8452-8536 Sentence denotes The patients were provided with a surgical mask throughout the perioperative period.
T122 8537-8651 Sentence denotes The patient was transferred to an operation theatre only on-call from the operation theatre to avoid overcrowding.
T123 8652-8768 Sentence denotes The individual operating rooms have separate air-handling units with high-efficiency particulate air (HEPA) filters.
T124 8769-8805 Sentence denotes Precautions in the operation theatre
T125 8806-8934 Sentence denotes Intraoperatively, the anesthesia team consisted of a consultant, senior resident, junior resident, and an anesthesia technician.
T126 8935-9329 Sentence denotes All preparation for general anesthesia was performed by the anesthesia team before shifting the patient to the operation table, during intubation either the consultant or the senior resident intubated the patient donning the prescribed PPE which consisted of Association for the Advancement of Medical Instrumentation (AAMI) level III gown, hood, N95 mask, face shield, boot covers, and gloves.
T127 9330-9428 Sentence denotes The junior resident or the anesthesia technician was available to assist during the procedure [8].
T128 9429-9596 Sentence denotes During intubation and extubation, the surgical team was outside the operating room to limit the number of persons inside and minimize the risk of disease transmission.
T129 9597-9687 Sentence denotes After intubation, the patient was handed over to the surgical team after about 20 minutes.
T130 9688-9788 Sentence denotes The surgical team consisted of the chief surgeon, senior resident, junior resident, and scrub nurse.
T131 9789-9922 Sentence denotes The entire surgical team was on hydroxychloroquine (HCQ) prophylaxis as advised by the Indian council of medical research (ICMR) [9].
T132 9923-10146 Sentence denotes The entire surgical team wore the prescribed PPE - N95 mask, hood with a face shield that wraps around the face and has an extension that can be placed inside the gown, AAMI level III gown, boot cover, and gloves [8,10,11].
T133 10147-10290 Sentence denotes The surgical knife was used for dissection and electrocautery was minimally used with suction wherever required to minimize aerosol generation.
T134 10291-10425 Sentence denotes Kerrison rongeur, nibblers, and osteotomes were used in place of burr or harmonic scalpel which decreased the aerosol generation [12].
T135 10426-10517 Sentence denotes Wound closure was done over the drain with staplers and the occlusive dressing was applied.
T136 10518-10697 Sentence denotes During extubation, theatre personnel was limited to the anesthesia team and the patient was allowed to recover in the operating room to minimize the shifting to the recovery room.
T137 10698-10811 Sentence denotes In case there was any other emergency case waiting for surgery the patient was shifted to the recovery room [13].
T138 10812-11023 Sentence denotes For the cases performed under local anesthesia like a transpedicular biopsy, the team inside the operating room was limited to surgeon, scrub nurse, and radiology technician to operate a C-arm image intensifier.
T139 11024-11086 Sentence denotes After the procedure, the patient directly shifted to the ward.
T140 11087-11310 Sentence denotes As per institutional policy, following the procedure. the surfaces of all equipment in the operating room (including computers, lead gowns, case carts, operation chair, and so on) were thoroughly wiped down after each case.
T141 11311-11376 Sentence denotes The surgeon and the surgical team changed scrubs after each case.
T142 11377-11443 Sentence denotes Respirators (N95) were not discarded after each use unless soiled.
T143 11444-11482 Sentence denotes A new respirator is required each day.
T144 11483-11577 Sentence denotes As per institutional policy, the N95 masks were reused up to five times unless visibly soiled.
T145 11578-11610 Sentence denotes Precautions in the recovery room
T146 11611-11720 Sentence denotes In the recovery room, patients were separated from each other by a minimum distance of two meters (six-feet).
T147 11721-11879 Sentence denotes Personnel taking care of the patient wore an N-95 mask as the patient is under the effect of general anesthesia, might not have control over cough and sneeze.
T148 11880-11982 Sentence denotes However, the patient’s stay in the recovery area was minimized while maintaining perioperative safety.
T149 11983-12067 Sentence denotes Patients were made to wear a triple-layer surgical mask in the postoperative period.
T150 12068-12134 Sentence denotes Over-crowding and non-essential personnel traffic were restricted.
T151 12135-12164 Sentence denotes Post-operative care protocols
T152 12165-12268 Sentence denotes Postoperative rounds were done by the senior resident and informed to the chief surgeon telephonically.
T153 12269-12404 Sentence denotes The surgical wound was inspected by the resident wearing an N95 mask on the third postoperative day and the drain, if any, was removed.
T154 12405-12591 Sentence denotes The patient was usually discharged on the same day if the wound was healthy after teaching physiotherapy and other precautions to the patient and attendant to minimize the hospital-stay.
T155 12592-12697 Sentence denotes For procedures that were performed under local anesthesia, the patients were discharged the next morning.
T156 12698-12756 Sentence denotes Suture removal was advised to be done at a local hospital.
T157 12757-12925 Sentence denotes Institute telemedicine number and the resident’s contact number was provided to the patient to consult in case of any surgery-related problem and to schedule follow up.
T158 12927-12934 Sentence denotes Results
T159 12935-13059 Sentence denotes The present study included 13 patients (nine males and four females) with an average age of 35.4 years (range- 42-63 years).
T160 13060-13186 Sentence denotes Eight patients (61.5%) presented with SCI due to vertebral fracture with fall from height (87.5%) as the most common etiology.
T161 13187-13261 Sentence denotes Road traffic accidents accounted for only one patient as the cause of SCI.
T162 13262-13456 Sentence denotes Among the traumatic SCI patients, six (75%) were managed surgically with posterior decompression and instrumented fusion with pedicle screws while two patients (25%) were managed conservatively.
T163 13457-13855 Sentence denotes There were four patients (30.8%) of tuberculosis of the spine of whom two (50%) were managed with posterior decompression, debridement, and stabilization with pedicle screws, samples for culture, biopsy, and CBNAAT were collected during the procedure; for the remaining two patients (50%), the trans-pedicular biopsy was performed to confirm the diagnosis for initiation of anti-tubercular therapy.
T164 13856-13976 Sentence denotes Prolapsed intervertebral disc causing cauda equina syndrome was the reason for emergency surgery in one patient (7.7%). 
T165 13977-14194 Sentence denotes COVID-19 (SARS-CoV-2 RT-PCR) test was done in four patients (30.8%), in whom the most common symptom was fever (two patients (50%)) and all these patients were residents of high prevalence area for COVID-19 infection.
T166 14195-14345 Sentence denotes Sore throat (25%), fatigue (25%), and low oxygen saturation (25%) were present in one patient each patient which prompted us to get the COVID-19 test.
T167 14346-14395 Sentence denotes All patients were reported negative for COVID-19.
T168 14396-14535 Sentence denotes Among the traumatic SCI patients, four were operated within 48 hours of injury as they were referred from other centers after primary care.
T169 14536-14591 Sentence denotes All patients were managed within 24 hours of admission.
T170 14592-14667 Sentence denotes The average hospital stay was 2.7 days (range four to five days) (Table 4).
T171 14668-14709 Sentence denotes Table 4 Patient demographics and results
T172 14710-14714 Sentence denotes RTA:
T173 14715-14741 Sentence denotes Road traffic accident; PF:
T174 14742-14760 Sentence denotes Pedicular fixation
T175 14761-14765 Sentence denotes Sno.
T176 14767-14915 Sentence denotes Age/sex Mode of trauma Diagnosis ASIA Score TLICS Score Surgery COVID testing Indication for COVID test Result Time interval Hospital Stay
T177 14916-15006 Sentence denotes 1 21/M RTA Burst # L1 A 7  Decompression and  PF  D12-L2 No NA NA 24 hrs 3 days
T178 15007-15069 Sentence denotes 2 40/M Fall #D8 E 2 Conservative No NA NA Na 1 days
T179 15070-15220 Sentence denotes 3 50/M Fall #D11 A 7 Decompression and PF D10 to D12 Yes 1)residence at High prevalence area 2)Spo2 – 88% on room air Negative 48 hrs 3 day
T180 15221-15347 Sentence denotes 4 30/M fall # L1 A 7 Decompression and PF D12to L2 Yes 1) Residence at High prevalence area Negative 48  hrs 3 days
T181 15348-15432 Sentence denotes 5 25/M Fall # L1 A 7 Decompression and PF D12to L2 NO NA NA 24 hrs 3 days
T182 15433-15495 Sentence denotes 6 22/F Fall # L2 E 2 Conservative No NA NA NA 1 day
T183 15496-15580 Sentence denotes 7 63/F Fall # L1 D 8 Decompression and PF D10 to L3 No NA NA 48hrs 3 days
T184 15581-15678 Sentence denotes 8 43/M Fall #Dislocation D6/D7 A 7 Decompression and PF D5to D8 No NA NA 48 hrs 3 days
T185 15679-15856 Sentence denotes 9 42/M Infective pathology Tuberculosis of spine from D8,D9,D12,L1,L2,L3 with paravertebral abscess E NA Transpedicular Biopsy from D12 vertebra No NA NA 24 hrs 1 day
T186 15857-16016 Sentence denotes 10 33/F Infective apthology Tuberculosis of spine L4-L5 with paravertbral abscess E NA Transpedicular Biopsy from L5  vertebra No NA NA 24 hrs 1 day
T187 16017-16232 Sentence denotes 11 25/M Infective apthology Tuberculosis of spine L2 to L3 with  paravertebral abscess C NA Decompression and PF D12to L5 Yes 1) Residence at High prevalence area 2)Fever 3) Fatigue Negative 24 hrs 5 days
T188 16233-16463 Sentence denotes 12 42/M Infective apthology Tuberculosis of spine L4-L5 vertebrae with paravertebral abscess D NA Decompression and PF from L3 to S1 Yes 1) Residence at High prevalence area 2)Fever 3)Sore throat Negative 24 days 5 days
T189 16464-16587 Sentence denotes 13 24/F Cauda Equina Syndrome Proloapsed intervertebral Disc L4-L5 B  NA Discectomy L4-L5 NO NA NA 24 hrs 3 days
T190 16589-16599 Sentence denotes Discussion
T191 16600-16699 Sentence denotes Covid-19 crisis has exhausted the capacity of national health services even in developed countries.
T192 16700-16833 Sentence denotes Most of the medical resources have been channeled for the management of this crisis and the elective services have been kept on hold.
T193 16834-17016 Sentence denotes Still, there would be some unavoidable surgical conditions when a delay in surgery would significantly increase the morbidity and warrants consideration for appropriate intervention.
T194 17017-17223 Sentence denotes Since there is a difference in the burden of disease, availability of resources, and the ability to surge capacity in a short span, the policy to deal with this crisis must be individualized to some extent.
T195 17224-17381 Sentence denotes We tried to develop a standard operating procedure for the management of patients needing emergent/urgent spine surgery taking input for the recent evidence.
T196 17382-17472 Sentence denotes The most common mode of injury in vertebral fractures is a motor vehicle accident [13,14].
T197 17473-17554 Sentence denotes However, in our study, fall from height (87.5%) was the commonest mode of trauma.
T198 17555-17965 Sentence denotes The possible explanation is that due to the nationwide lockdown, there was a significant reduction in surface transportation and people were generally refraining from traveling for non-essential work. Due to the limited capacity for SARS-Cov-2 RT-PCR testing and the centers performing COVID tests, comprehensive screening history, and physical examination becomes important to triage the patient for the test.
T199 17966-18084 Sentence denotes History should focus on the symptoms of COVID-19, travel to high prevalence area, or any contact with a known patient.
T200 18085-18312 Sentence denotes It is also important to enquire whether the patient had been infected with COVID-19 earlier or ever been tested as there are reports of individuals who got infected with COVID-19, recovered, and then again tested positive [14].
T201 18313-18403 Sentence denotes Secondly, it will also help in assessing if the patient might be in the incubation period.
T202 18404-18474 Sentence denotes However, in case of an emergency, the surgeries should not be delayed.
T203 18475-18589 Sentence denotes A sample can be sent for RT-PCR and surgery should be performed donning proper PPE without waiting for the result.
T204 18590-18881 Sentence denotes As asymptomatic patients can transmit the infection it becomes prudent to assume that all patients requiring orthopedic intervention as COVID-19 positive and they should be managed accordingly from their admission into the hospital to their exit from the hospital during their discharge [1].
T205 18882-19037 Sentence denotes Trans-pedicular screw fixation is one of the main modalities of spinal instrumentation today and patients are stabilized with pedicle screws and rods [15].
T206 19038-19320 Sentence denotes Patient and attendant education regarding the administrative policies to prevent contracting/transmitting infection while in hospital as well as education regarding wearing a mask, hand hygiene, social distancing serves the purpose of making patients aware of their safety [4,7,10].
T207 19321-19468 Sentence denotes In the operation theatre complex, it is mandatory to avoid overcrowding in all areas (patient waiting area, operating room, and the recovery room).
T208 19469-19829 Sentence denotes Inside operation theatre it is important to limit the number of staff allowed as SARS-CoV-2 is mainly transmitted via aerosolized droplets, so by decreasing the air turbulence and the number of air particles decreases the disease transmission; it will help in implementing the social distancing concept while also decreasing the demand for PPE [8,10,11,16-18].
T209 19830-19917 Sentence denotes To decrease the risk of transmission from airborne droplets it is mandatory to use PPE.
T210 19918-20101 Sentence denotes The surgical team must wear PPE which includes AAMI III gowns, gloves, face masks, and N95 with face shield/goggles to minimize the risk of transmission and cross-infection [8,11,12].
T211 20102-20277 Sentence denotes Association for the Advancement of Medical Instrumentation (AAMI) ratings are based on the level of fluid protection in the critical zone or chest region of the surgical gown.
T212 20278-20451 Sentence denotes Surgical gowns AAMI-level-III (typically those found in operating rooms) are recommended for use during surgical and aerosolized blood-generating procedures [8,11,12,17-19].
T213 20452-20523 Sentence denotes At our institute, N-95 masks are reused unless they are visibly soiled.
T214 20524-20658 Sentence denotes Each HCW is given a set of five N-95 masks that are numbered from 1 to 5 and HCWs are supposed to write their name and number over it.
T215 20659-20766 Sentence denotes After the duty shift, HCWs are supposed to put it in sealable plastic cover and next day use the next mask.
T216 20767-20951 Sentence denotes The masks are deposited at the designated place from where the infection control nurse (ICN) collects them for drying under the sun on two consecutive days for at least nine hours/day.
T217 20952-21029 Sentence denotes The masks are issued to the same user only after the fifth day of submission.
T218 21030-21071 Sentence denotes Each mask is used maximum for five times.
T219 21072-21124 Sentence denotes Subsequently, the mask is disposed of appropriately.
T220 21125-21272 Sentence denotes Single-use of the N-95 mask is recommended if it is contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.
T221 21273-21470 Sentence denotes It should be discarded following close contact with or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions, and if it is damaged or clogged.
T222 21471-21595 Sentence denotes The rationale behind this is dry heat 70oC exposure for 60 minutes as an accepted method for decontaminating the N-95 masks.
T223 21596-21723 Sentence denotes Further, it is documented that the COVID-19 virus does not survive on inanimate surfaces beyond a period of five days [20,21]. 
T224 21724-22020 Sentence denotes As per the advisory issued by the Ministry of health and family welfare on re-processing and re-use of eye-protection (goggles), the goggles are to be reused; after each use, the goggles are cleaned with soap and water and then immersed in freshly prepared 1% sodium hypochlorite for ten minutes.
T225 22021-22130 Sentence denotes This is followed by cleaning with water and then allowed to air dry completely and then store in clean cover.
T226 22131-22223 Sentence denotes The goggles are to be discarded if broken or rendered optically non-clear on repeated usage.
T227 22224-22282 Sentence denotes The recommended maximum reuse is for up to six times [22].
T228 22283-22431 Sentence denotes These methods devised to reuse N-95 and goggles are very helpful in the judicious use of limited resources without increasing the risk of infection.
T229 22432-22547 Sentence denotes The proper and meticulous technique of donning and doffing should be practiced each time to prevent infection [23].
T230 22548-22701 Sentence denotes Our surgical team was on HCQ prophylaxis as recommended by the ICMR in a dose of 400 mg twice a day on day one and 400 mg once a week for seven days [9].
T231 22702-22879 Sentence denotes HCQ has antiviral efficacy and has shown a reduction of infectivity/log reduction in viral RNA copy of SARs-CoV2 and has a low incidence of infection to those who are taking it.
T232 22880-23123 Sentence denotes The drug is contraindicated in persons with a known case of retinopathy, hypersensitivity to HCQ or 4-aminoquinoline compounds, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and pre-existing cardiomyopathy and cardiac rhythm disorders. 
T233 23124-23237 Sentence denotes It is not recommended for prophylaxis in children under 15 years of age and during pregnancy and lactation [24]. 
T234 23238-23447 Sentence denotes The aerosols generating procedures in orthopedic surgery include the use of electrocautery, high-speed burr, ultrasonic devices, and power tools like an oscillating saw, drills, reamers, and pulse lavage [12].
T235 23448-23618 Sentence denotes While it is unknown if the COVID-19 particles can survive electrocautery, minimizing the amount of smoke in the operating room helps in decreasing potential transmission.
T236 23619-23795 Sentence denotes Similarly, it is unknown that a virus can spread through body fluids, soft tissue, or bone particulate, it is wise to avoid harmonic scalpels and high-speed burrs [8,11,12,18].
T237 23796-23865 Sentence denotes The postoperative length of stay in the hospital should be minimized.
T238 23866-23998 Sentence denotes The post-operative care (like dressing, intravenous antibiotics, etc.) can be managed at the patient’s home or the nearest hospital.
T239 23999-24215 Sentence denotes The patient is instructed to perform self-directed physical therapy at home and transfer to inpatient rehabilitation should be minimized which can significantly reduce the length of hospital stay [10,11,16,17,19,25].
T240 24216-24376 Sentence denotes Before the COVID-19 pandemic, we were transferring the paraplegic patients to our hospital-based rehabilitation center where discharge time was about six weeks.
T241 24377-24516 Sentence denotes During this pandemic, we started teaching physiotherapy and care to attendants from day one which decreased the hospital stay to 3.7 days. 
T242 24517-24715 Sentence denotes Post-discharge visits to the hospital have been minimized with the majority of the follow-up by the surgical team through telemedicine or remote consultations (e.g. telephone or video consultation).
T243 24716-24905 Sentence denotes The hospital visits were limited to those who are having issues/complications such as wound healing problems, suspected fracture, stiffness, and non-compliance to physiotherapy [4,7,11-13].
T244 24906-25042 Sentence denotes There are chances of a “second wave” which were seen in SARS and Spanish flu which may lead to a sudden increase in COVID-19 cases [10].
T245 25043-25089 Sentence denotes We need to be vigilant and be prepared for it.
T246 25090-25188 Sentence denotes We should strictly adhere to infection control policy, use masks, and practice social distancing. 
T247 25189-25441 Sentence denotes The above structural organization and management protocol helped us to provide efficient care to emergency spine conditions, without undue stretching the resources of a tertiary care center which is also catering to a large number of COVID-19 patients.
T248 25442-25559 Sentence denotes An attempt is made to reduce infection transmission to health care workers without compromising the patient's safety.
T249 25560-25656 Sentence denotes We recognize that the small patient number is a limitation of this study and follow up is short.
T250 25657-25771 Sentence denotes We have not assessed the problem faced by a home-based rehabilitation program and is a subject of further research
T251 25773-25784 Sentence denotes Conclusions
T252 25785-25964 Sentence denotes In these unusual times of the COVID-19 pandemic, the healthcare institutions must adopt the emerging pieces of evidence on the safety of HCW’s into the existing hospital policies.
T253 25965-26107 Sentence denotes Usual theatre practices need to be modified to reduce the risk of virus transmission during surgical procedures to the operation theatre team.
T254 26108-26232 Sentence denotes The protocol we described has enabled our surgical team to work efficiently and safely without compromising on patient care.