Severe COVID-19 Infection Research Articles

A Prediction Model for Severe COVID-19 Infection and Intensive Care Unit Admission in Pregnant Women

A Prediction Model for Severe COVID-19 Infection and Intensive Care Unit Admission in Pregnant Women

Severe COVID-19 and its cardiopulmonary effects 6 and 18 months after hospital discharge.

SARS-CoV-2 infection affects the cardiopulmonary system in the acute as well as long-term phase. The aim of the present study was to comprehensively assess symptoms and possible long-term impairments 6 and 18 months after hospitalization for severe COVID-19 infection. This prospective registry included patients with PCR-confirmed COVID-19 infection requiring hospitalization. Follow-up approximately 6 months post discharge comprised a detailed patient history, clinical examination, transthoracic echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a laboratory panel. At the time of the second follow-up visit at 18 months, patients without pathologic findings during the first study visit were contacted by phone to inquire about the course of their symptoms. In all other patients all initial examinations were repeated. Two hundred Patients, who were hospitalized for COVID-19, were contacted by phone and were recruited for the study. Due to dropouts the second study visit was performed in 170 patients. A comparison between the two study visits at 6 and 18 months post discharge showed the following results: Six months after discharge, 73% and 18 months after discharge 52% fulfilled the criteria for Long COVID with fatigue being the most common symptom (49%). Echocardiography at 6 months post discharge showed an impaired left ventricular function in 8% of which 80% returned to normal. Six months post discharge, cMRI revealed pericardial effusion in 17% which resolved in 47% of the 15 patients who underwent a control cMRI. Signs of peri- or myocarditis were present in 5% of the patients and were resolved in all 4 patients who attended control studies. At 6 months, chest CT scans identified post-infectious residues in 24%. In the 25 repeated chest CT scans 20% showed full recovery. Length of in-hospital stay was identified as a significant predictor for persisting Long COVID (95% CI: 1.005-1.12, p = 0.03). Comparing 6 to 18 months, the prevalence of Long COVID decreased over time, but a high symptom burden remained. Structural and functional abnormalities were less frequent than the portrayed symptoms, and it thus remains a challenge to substantiate the symptoms.

A Rare Combination of Breast, and Thyroid Carcinoma, with Superadded COVID-19 Infection in Mother: Struggle of a Doctor as a Daughter – Case Report

Introduction: COVID-19 pandemic has severely affected the diagnosis and management of cancer patients to a large extent, with many patients being diagnosed at a later stage, and many are not able to get appropriate treatment. Furthermore, cancer patients are more prone to suffer from severe COVID-19 infection and its associated morbidity and mortality. Breast cancer is one of the commonest cancers affecting women worldwide and its number is projected to increase sharply in the post- COVID-19 era due to a serious fall in screening modalities, as patients stopped reporting to the hospital because of lockdown, movement restrictions, and fear of contracting the infection. Case Presentation: The present case report briefs a mother's sufferings and the impact it has on a daughter who is a doctor herself. It reports a rare combination of two primaries in the breast and thyroid in an asymptomatic patient with a rare mutation of the BLM gene detected incidentally. The patient was successfully operated on for stage IB ductal carcinoma breast with hemithyroidectomy and was put on chemotherapy with Cyclophosphamide 1000mg (600mg/m2) and Doxorubicin 100 mg (60mg/m2) per cycle on day one every fortnightly followed by four cycles of Paclitaxel 175mg/m2 every fortnightly. After the second cycle, the patient developed severe neutropenia and COVID-19 infection with atypical symptoms that severely involved her lungs, leading to the loss of the patient. Conclusion: With the onset of the COVID-19 pandemic, thousands of cancer patients have lost their lives, not due to cancer directly but due to failed early detection, treatment, loss of follow-up, and superadded severe COVID-19 infection.

Comparing the Emergency Care of Iranian and Afghan Patients During the COVID-19 Pandemic.

This study investigated the quality of inpatient care provided to Afghan immigrants in Iran during the COVID-19 pandemic (February 2019 to March 2021). For this purpose, the services received by Afghan immigrants were compared with those received by Iranian citizens. Two emergency services (traumas with 8080 victims and 8,686 patients hospitalized with severe COVID-19 infection) were taken into consideration. The records of all patients, including the Afghan immigrants, in two referral hospitals in Kerman were reviewed, and the main variables were the length of hospitalization (LoH), intensive care unit (ICU) admission rate, and death rate. Quantile regression, multiple logistic regression, and Cox regression were used to analyze the data. The median and interquartile range of LoH for Afghan and Iranian nationals admitted due to traumas were 3.0±4.0 and 2.0±4.0, respectively (P<0.01). Moreover, the chance of Afghan nationals being admitted to the ICU (38%, odds ratio=1.38; 95% confidence interval [CI]=1.12; 1.69) and the hazard of death (60%, hazard rate=1.60; 95% CI=1.03; 2.49) were higher compared to Iranian nationals, which is statistically significant. However, no significant differences were observed between the COVID-19 patients from the two nationalities in terms of the median LoH, the odds of being admitted to the ICU, and the hazard of death due to COVID-19. Afghan nationals admitted to the hospital due to traumas were more likely to be admitted to ICUs or die compared to Iranian citizens. It seems that Afghan patients who had traumas went to the hospitals with more serious injuries. There was no difference between Afghan and Iranian patients in terms of COVID-19 consequences. Following the findings of this study, it seems that justice in treatment has been fully established for Afghan patients in Iran.

Gastrointestinal Bleeding in COVID-19 Infected Patients, and Management Outcomes.

Gastrointestinal bleeding in COVID-19-infection poses unique challenges to patients owing to the high risk of concomitant respiratory failure. However, endoscopic care providers are prone to transmission. This study aimed to understand the risk and management outcomes of gastrointestinal bleeding in COVID-19-infected patients. Data were abstracted from electronic patient medical records, using ICD 10 codes, and demographic and clinical data were collected, for COVID-19-infected patients who developed gastrointestinal (GI) bleeding. Complications related to COVID-19 infection and management outcomes of GI bleeding were studied. Statistically, descriptive analysis was used because of the small sample size. Eighteen COVID-19-infected patients developed episodes of GI bleeding, yielding a prevalence of 0.45%. Their mean age was 74.8 years, 55.5% were female, and 66.6% of patients (n=12) had upper GI bleeding symptoms, predominantly melena (55.5%), followed by coffee ground nasogastric aspirates (n=2). Only two patients (11.11%) had episodes of lower GI bleeding, and the remaining four patients (22.2%) had recurrent acute anemia requiring blood transfusion. The Glasgow-Blatchford score (GBS) at presentation ranged between 6 to 16 (mean 8.8) and seven patients (38.8%) underwent endoscopic evaluation for GI bleeding. The predominant comorbid conditions included hypertension (22.2%), diabetes mellitus (27.7%), chronic kidney disease (50%), ischemic heart disease (33%), atrial fibrillation (11.1%), and peripheral vascular disease (11.1%). The median hospitalization was 24.6 days (range: 3-54 days). The 30-day mortality rate in our cohort was 22.2%, (4/18) mainly noted in older patients aged> 60 years with comorbid conditions and severe COVID-19 infection. The prevalence of GI bleeding observed in our cohort was approximately 0.45%, significantly lower than the global prevalence observed, majority (66%) had upper GI bleeding. The exact reasons for the observed low prevalence of GI bleeding cannot be explained and will be the subject of future research.

Predicting COVID-19 outcomes with the Edmonton Obesity Staging System.

Multiple studies have demonstrated a correlation between a high body mass index and discriminatory COVID-19 outcomes. Studies appear to indicate that there is a correlation between obesity-related comorbidities and less favorable outcomes. The primary aim of the current investigation is to conduct a thorough assessment of the correlation between BMI and comorbidities associated with obesity, and their potential impact on the severity and consequences of COVID-19 infection among patients receiving care in a tertiary healthcare setting. Retrospective cohort. Tertiary rehabilitation center, Riyadh, Saudi Arabia. The study included all individuals who received medical treatment and tested positive for COVID-19 by means of RT-PCR during the period from March to September 2020. COVID-19 patients were classified using Edmonton Obesity Staging System (EOSS). COVID-19-related complications, including pneumonia and cytokine release syndrome, as well as the time length to COVID-19 negativization. 315 patients. The median (25th-75th percentiles) age of the patients was 38 (31.5-49) years old. Males outnumbered females, and 66% of patients were non-Saudis. Forty-eight patients (15.2%) had obesity class I, whereas 13 patients (4.1%) had class II. Thirty-two patients (10.2%) were classified as EOSS stage 1, 105 patients (33.3%) were classified as EOSS stage 2, and 25 patients (7.9%) were assigned to EOSS stage 3. Males predominated in EOSS stages 1 and 2, whereas females predominated in stage 3. In EOSS stage 3, 52% of cases had moderate severity and 48% had severe illness. EOSS distinguishes the COVID-19 risks of poor outcomes beyond BMI. Patients who were overweight or obese but remained in the stage 1 of the EOSS had a lower risk of a poor COVID-19 outome than normal-weight patients. The health status of obese patients is a more precise indicator of the progression of COVID-19 during hospitalization than BMI alone. Given the limited capacity of urgent care facilities to conduct a comprehensive evaluation of comorbidities and other relevant outcomes in all patients, it is plausible that certain patients may have been erroneously classified with an EOSS stage 2 diagnosis, when in fact they ought to have been assigned a stage 3 diagnosis.

A Three-Year Cross-Sectional Analysis of Depression, Anxiety, and Quality of Life in Patients with Post-COVID-19 Syndrome.

This study explores the longitudinal psychosocial impact of Long-COVID syndrome, also known as Post-COVID-19 syndrome, characterized by enduring symptoms after coronavirus disease (COVID-19) infection, over the years 2020, 2021, and 2022. It aimed to examine the variations in depression, anxiety, and quality of life among Post-COVID-19 patients during these years, hypothesizing significant inter-year differences reflecting the pandemic's evolving influence. Conducted at Victor Babes Hospital for Infectious Diseases and Pulmonology, Romania, this cross-sectional research involved 324 patients diagnosed with mild to moderate COVID-19, assessed six months post-hospitalization. Standardized instruments, namely Short Form (SF-36) for quality of life, Generalised Anxiety Disorder Assessment (GAD-7) for anxiety, and Patient Health Questionnaire (PHQ-9) for depression, were utilized. The study observed a consistent average patient age of around 55 years across the years. A notable increase in COVID-19 vaccination rates was recorded, rising from 20.9% in 2020 to over 70% in 2022 (p<0.001). Trends in key post-COVID symptoms like fatigue and cognitive issues varied over the years. Importantly, there was a consistent decrease in feelings of sadness or depression, with scores declining from 7.3 in 2020 to 4.8 in 2022 (p<0.001). The SF-36 survey indicated a steady improvement in overall health, reaching 55.8±7.1 in 2022 (p=0.035). Both GAD-7 and PHQ-9 scores showed significant reductions in anxiety and depression over the years, with p-values of 0.030 and 0.031, respectively. Factors such as smoking status, substance use, and the initial severity of COVID-19 infection were significantly associated with depression levels. The findings suggest that despite persistent physical symptoms, Long-COVID patients experienced enhancements in mental well-being and quality of life over the studied period. The increasing vaccination rates might have contributed to this improvement. Addressing modifiable risk factors like smoking and substance use could further optimize post-COVID care and mental health outcomes.

COVID-19 detection in lung CT slices using Brownian-butterfly-algorithm optimized lightweight deep features

Several deep-learning assisted disease assessment schemes (DAS) have been proposed to enhance accurate detection of COVID-19, a critical medical emergency, through the analysis of clinical data. Lung imaging, particularly from CT scans, plays a pivotal role in identifying and assessing the severity of COVID-19 infections. Existing automated methods leveraging deep learning contribute significantly to reducing the diagnostic burden associated with this process. This research aims in developing a simple DAS for COVID-19 detection using the pre-trained lightweight deep learning methods (LDMs) applied to lung CT slices. The use of LDMs contributes to a less complex yet highly accurate detection system. The key stages of the developed DAS include image collection and initial processing using Shannon's thresholding, deep-feature mining supported by LDMs, feature optimization utilizing the Brownian Butterfly Algorithm (BBA), and binary classification through three-fold cross-validation. The performance evaluation of the proposed scheme involves assessing individual, fused, and ensemble features. The investigation reveals that the developed DAS achieves a detection accuracy of 93.80% with individual features, 96% accuracy with fused features, and an impressive 99.10% accuracy with ensemble features. These outcomes affirm the effectiveness of the proposed scheme in significantly enhancing COVID-19 detection accuracy in the chosen lung CT database.

Improved Clinical Outcome with Cyclosporine in Patients with Moderate to Severe COVID-19 Infection

Objective: To investigate the potential benefits of adding cyclosporine to the presently recommended conventional treatment for COVID-19 disease. Methodology: A retrospective cross-sectional research was carried out on COVID-19 patients with moderate-to-severe severity who were admitted to Lahore General Hospital's ICU (intensive care unit) or HDU (high dependency care unit from 2020 to 2021. Patients aged 18 to 70 with moderate to severe illness were included, while those with specific conditions were excluded. Data on symptoms, oxygen saturation levels, and medication usage were collected and analyzed using statistical tests. The assessment of outcome decreased dependence on oxygen in ICU/HDU was assessed through a combination of different drugs (treatment), especially the inclusion of Cyclosporine, which was done with Chi-square and Binomial tests. Results: In the study 46% are male and 54%are females. 71% of patients suffer fever while 69% observed shortness of breath out of which 44% had cough. On presentation 30.8% were mild cases (out of which27% converted to moderate on second day), 17.3% fall in moderate cases while 51.9% are severe COVID cases while on treatment day 7 results shows 30.6% patients are oxygen free, 10% cases are moderate cases while 19% were severe cases.53.8% remain alive while deaths are 46.2% which is a good number in ICU/HDU cases. Conclusion: Cyclosporine use should be considered in SARS-CoV-2 moderate and severe disease because it not only improves the disease severity, reduces oxygen demand and improves mortality.

Health-Related Quality of Life for Patients with Post-Acute COVID-19 Syndrome: Identification of Symptom Clusters and Predictors of Long-Term Outcomes

BackgroundFollowing COVID-19 infection, as many as a third of patients have long-term symptoms, known as post-acute sequelae (PASC). The mechanisms contributing to PASC remain largely unknown and, due to the heterogeneity of symptoms, treating PASC provides unique challenges.ObjectiveOur study sought to (1) identify clinical symptom profiles based on PROMIS Global Health (GH) items, (2) evaluate demographic and clinical differences across profiles, and (3) identify predictors of change in health-related quality of life (HRQL) over time.DesignThis was an observational cohort study of patients with PASC who completed PROMIS-GH between 2/11/21 and 12/3/21 as part of routine care, with data extracted from the electronic health record.ParticipantsThere were 1407 adult patients (mean age 49.6 ± 13.7, 73% female, 81% White race) with PASC seen in the recovery clinic between 2/11/21 and 12/3/21, with 1129 (80.2%) completing PROMIS-GH as routine care.Main MeasuresHRQL was measured with PROMIS-GH at initial visit and after 12 months.Key ResultsLatent profile analysis identified symptom classes based on five PROMIS-GH items (mental health, ability to carry out physical activities, pain, fatigue, and emotional problems). Four latent profiles were identified: (1) “Poor HRQL” (n = 346), (2) “Mixed HRQL: good mental/poor physical” (n = 232), (3) “Mixed HRQL: poor mental/good physical” (n = 324), and (4) “Good HRQL” (n = 227). Demographics and comorbidities varied significantly across profile with patients with more severe COVID-19 infection more likely to be in profiles 1 and 2. Overall, patients improved 2 T-score points on PROMIS-GH after 12 months, with differences by profile. Predictors of improved HRQL included profile, lower body mass index, and fewer COVID symptoms.ConclusionsPatients with PASC have distinct HRQL symptom profiles which were able to differentiate across COVID-19 severity and symptoms. Improvement over 12 months differed by profile. These profiles may be used to better understand the mechanisms behind PASC. Future research should evaluate their ability to guide treatment decisions to improve HRQL.

Valsalva Manoeuvre-Induced Pneumothorax and Pneumomediastinum in a Covid-19 Patient with ARDS: An Unusual Mechanism for this Complication.

Until now, only a few cases of Valsalva-induced barotraumas (pneumothorax, pneumomediastinum and subcutaneous emphysema) have been described, and none of them among COVID-19 patients. A man in his 50s was admitted for SARS-CoV-2-related acute respiratory distress syndrome (ARDS). Initial evolution was favourable with non-invasive ventilatory support, high-flow oxygen nasal cannula and the best supportive drugs available at the time. During the Valsalva manoeuvre while defecating, the patient reported sudden chest pain and showed a new acute hypoxemic respiratory failure due to a pneumothorax. It led to multiple complications (pulmonary embolism, haemoptysis, and cardiac arrest), and despite the best supportive care, led to the patient's death. The Valsalva manoeuvre can be an overlooked cause of pneumothorax in patients with COVID-19. Predisposition to barotrauma in COVID-19 patients could be explained by several factors, including the extensive use of non-invasive and invasive ventilation during the pandemic, and the histological changes observed in the lungs of those infected with COVID-19. We report the first description of a Valsalva-induced barotrauma in a COVID-19 infection. We emphasise the importance of treating constipation particularly in severe COVID-19 cases, to prevent complications such as barotrauma. Pneumothorax is a common complication of severe COVID-19 infection, but Valsalva manoeuvre-induced pneumothorax in COVID-19 patients has never been reported previously.Particular care should be taken to prevent and treat constipation in hospitalised patients as it may cause a wide range of complications, including barotraumatism.The extensive use of non-invasive and invasive ventilation may play a role in barotrauma, but causal association has not been proven.

Association of Inflammatory Markers With Disease Progression and the Severity of COVID-19.

Introduction InDecember 2019, there was a massive outbreak of viral pneumonia, which had a high case fatality rate. Genetic sequencing of the virus showed similarity with severe acute respiratory syndrome coronavirus (SARS-CoV). It was later named novel coronavirus 2019 while the disease it caused was given the nomenclature of COVID-19. This deadly pneumonia outbreak was declared a pandemic by the World Health Organization (WHO). Aim To derive the strength of the correlation between blood levels of various inflammatory markers with the severity of COVID-19 pneumonia in patients affected with novel coronavirus 2019. Materials and methodology A prospective study was conducted on 300 confirmed cases of COVID-19 infection from August 2020 to July 2021 in SSG Hospital, Vadodara. Diagnosis of patients as confirmed cases of COVID-19 infection was done according to the WHO interim guidance for COVID-19. Their inflammatory markers were done for this study. All COVID-19-positive patients who had given negative consent for enrollment were excluded from the study. Patients were classified based on the severity of acute respiratory distress syndrome (ARDS). Comprehensive medical record information, encompassing biodata, clinical symptoms, comorbidities, and laboratory investigations, was systematically collected. Patients were given the standard treatment protocol as per guidelines. Patients were subjected to detailed investigations comprising complete blood counts and inflammatory markers like C-reactive protein (CRP), lactate dehydrogenase (LDH), serum ferritin, and D-dimer. Patients were further investigated by chest X-ray (posteroanterior view) or high-resolution computed tomography of the thorax. Results A total of 300 confirmed cases of COVID-19 infection were included in this study. Most of them were males (52%) with a mean age of 51 years and 48% were females with a mean age of 55 years. The majority of patients(40%) did not have ARDS, 23.3% of patients had mild, 16.7% of patients had moderate, and 20% of patients had severe ARDS. Higher CRP levels, serum ferritin, and serum D-dimer were significantly associated with the severity of COVID-19 infection as compared to those having no symptoms (p < 0.05). Increased levels were associated with severe clinical manifestations of COVID-19. The sensitivity of CRP is 69% and specificity is 100% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of ferritin is 88% and specificity is 81% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of D-dimer is 94% and specificity is 89% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of LDH is 93% and specificity is 84% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. Conclusions Current evidence from our study showed that higher levels of inflammatory markers such as CRP, LDH, D-dimer, and ferritin are associated with the severity of COVID-19 in terms of ARDS and thus could be used as significant prognostic factors of the disease.These indicators might support clinical decisions to identify highfatality casesand poor diagnosis in the initial admission phase.

The role of nutrition on the treatment of Covid 19

The rapid and extensive transmission of the SARS-CoV-2 virus has led to a worldwide COVID-19 pandemic. Initially thought to be an acute illness, many patients have reported persistent and recurring symptoms even after the infectious period. This has given rise to a new epidemic known as "long-COVID" or post-acute sequelae of coronavirus disease, which has significantly impacted the lives of millions of individuals globally. The symptoms of both COVID-19 vary from person to person, but they share similarities with other respiratory viruses, such as chest pain, shortness of breath, and fatigue, as well as adverse effects on metabolic and pulmonary health. Nutrition plays a crucial role in immune function and metabolic health, and therefore, it is believed to have an impact on reducing the risk or severity of symptoms for both COVID-19. However, despite the importance of nutrition in these physiological functions related to COVID-19, the exact role of nutrition in the onset or severity of COVID-19 infection is still not fully understood. This review aims to explore established and emerging nutrition approaches that may have a role in COVID-19, while emphasizing the significance of established nutrition and clinical practice guidelines as the primary resources for patients and healthcare practitioners.

Changes in the Adaptive Cellular Repertoire after Infection with Different SARS-CoV-2 VOCs in a Cohort of Vaccinated Healthcare Workers.

Currently approved vaccines are highly effective in protecting against hospitalization and severe COVID-19 infections. How pre-existing immunity responds to new variants with mutated antigens is crucial information for elucidating the functional interplay between antibodies and B and T cell responses during infection with new SARS-CoV-2 variants. In this study, we monitored the dynamics and persistence of the immune response versus different SARS-CoV-2 variants of concern that emerged during the pandemic period (2021-2022) in a cohort of vaccinated healthcare workers, who experienced breakthrough infection in the Pre-Delta, Delta, and Omicron waves. We evaluated both the humoral and cell-mediated responses after infection. We also evaluated the anti-SARS-CoV-2 antibodies levels produced by infection in comparison with those produced after vaccination. Our results highlighted that the immune response against the Delta VOC mainly involved an adaptive humoral and switched memory B cells component, even 3 months after the last vaccine dose, conversely showing a high percentage of depleted adaptive T cells. Omicron infections triggered a consistent production of non-vaccine-associated anti-N antibodies, probably to balance the spike epitope immune escape mechanisms. Our results suggest a direct dependence between the VOC and different humoral and B and T cell balances in the post-infection period, despite the administration of a different number of vaccine doses and the elapsed time since the last vaccination.

Characteristics and Outcomes of Stem Cell Transplant Patients during the COVID-19 Era: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aims to identify the outcomes of stem cell transplant (SCT) patients during the COVID-19 era. Pooled event rates (PER) were calculated, and meta-regression was performed. A random effects model was utilized. In total, 36 eligible studies were included out of 290. The PER of COVID-19-related deaths and COVID-19-related hospital admissions were 21.1% and 55.2%, respectively. The PER of the use of hydroxychloroquine was 53.27%, of the receipt of immunosuppression it was 39.4%, and of the use of antivirals, antibiotics, and steroids it was 71.61%, 37.94%, and 18.46%, respectively. The PER of the time elapsed until COVID-19 infection after SCT of more than 6 months was 85.3%. The PER of fever, respiratory symptoms, and gastrointestinal symptoms were 70.9, 76.1, and 19.3%, respectively. The PER of acute and chronic GvHD were 40.2% and 60.9%, respectively. SCT patients are at a higher risk of severe COVID-19 infection and mortality. The use of dexamethasone improves the survival of hospitalized SCT patients with moderate to severe COVID-19 requiring supplemental oxygen or ventilation. The SCT patient group is a heterogeneous group with varying characteristics. The quality of reporting on these patients when infected with COVID-19 is not uniform and further prospective or registry studies are needed to better guide clinical care in this unique setting.

Psychological Status of Medical Staff in Obstetrics and Gynecology Hospitals during the Omicron Pandemic Outbreak in China.

Medical staff in China faced great challenges and psychological and physiological changes of varying degrees during the omicron epidemic outbreak. It is important to recognize the potential impact of these challenges on the mental health of medical staff and to provide appropriate resources and support to mitigate their effects. A total of 354 medical staff in two obstetrics and gynecology hospitals of different grades were included in this survey using convenience sampling. The cross-sectional self-report questionnaires survey was conducted using the Basic Characteristics Questionnaire, Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Insomnia Severity Index (ISI). There were 169 (47.7%) participants suffering from anxiety disorder. Working with fever, working in obstetrics, and working with protective clothing were the risk factors for anxiety in medical staff (p < 0.05). One hundred and ninety-six (55.4%) participants were depressed. Working with fever and working in obstetrics were the risk factors for depression in medical staff (p < 0.05). There were 117 (33.1%) participants suffering from insomnia. Working with fever, high educational level, and severe COVID-19 infection status were the risk factors for insomnia in medical staff (p < 0.05). Moreover, medical staff in a provincial hospital were more anxious and depressed than those in a county hospital. At last, there were more participants working with fever in obstetrics (p < 0.05). Anxiety disorder, depression, and insomnia were common among obstetrics and gynecology medical staff during the outbreak of omicron pandemic. During this period, more resources for psychological counselling should be provided to the hospital as well as more reasonable staffing arrangements, and working while having a fever is prohibited, especially in provincial hospital.

THE CORRELATION BETWEEN TYPE 2 DIABETES MELLITUS WITH BACTERIAL INFECTION IN COVID-19 PATIENTS ADMITTED TO INTENSIVE CARE UNIT AT CENTRAL GENERAL HOSPITAL PROF. DR. I.G.N.G. NGOERAH DENPASAR IN 2021-2022

Type 2 Diabetes Mellitus (T2DM) has a detrimental impact on the immune system, resulting in a decrease in the body's immune response, making patients highly susceptible to bacterial infections. Patients with T2DM, especially those treated in the Intensive Care Unit (ICU) of a hospital, face an increased risk of infection. The emergence of COVID-19, which also infects T2DM patients, further diminishes the immune system's function in these patients. Consequently, individuals with both T2DM and COVID-19 are at a heightened risk of developing secondary infections, commonly referred to as Hospital-Acquired Infections.This research aims to explore the relationship between T2DM, assessed through blood sugar levels, and the occurrence of bacterial infections in COVID-19 patients treated in the ICU of Prof. Dr. I.G.N.G. Ngoerah Central Hospital from 2021 to 2022. The research design employed is quantitative analytical correlational study using a cross-sectional approach, with a sample size of 98 patients collected from the Medical Records and Hospital Management System of Prof. Dr. I.G.N.G. Ngoerah Central Hospital in Denpasar. This study found that there is a significant correlation between patient’s infection profile with random blood glucose levels with an Odds Ratio (OR) of 1.15 (95% CI: 1.04 – 1.27; p = 0.013). Additionally, a significant relationship was observed between the severity of COVID-19 and bacterial infections in patients, with an Odds Ratio of 1.12 (95% CI: 1.01 – 1.26; p = 0.04).&#x0D; Keywords : T2DM, ICU, Hospital-Acquired Infection

Attitudes towards COVID-19 Vaccination in Adults with Haematological Malignancies

Introduction: Despite people with haematological malignancies being particularly vulnerable to severe COVID-19 infection and complications, vaccine hesitancy may be a barrier to optimal vaccination. This study explored attitudes towards COVID-19 vaccination in people with haematological malignancies. Methods: People with haematological malignancies at nine Australian health services were surveyed between June and October 2021. Sociodemographic and clinical characteristics were collected. Attitudes towards COVID-19 vaccination were explored using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, and the Disease Influenced Vaccine Acceptance Scale-Six. Open-ended comments were qualitatively analysed. Results: A total of 869 people with haematological malignancies (mean age 64.2 years, 43.6% female) participated. Most participants (85.3%) reported that they had received at least one COVID-19 vaccine dose. Participants who were younger, spoke English as a non-dominant language, and had a shorter time since diagnosis were less likely to be vaccinated. Those who were female or spoke English as their non-dominant language reported greater vaccine side-effect concerns. Younger participants reported greater concerns about the vaccine impacting their treatment. Conclusion: People with haematological malignancies reported high vaccine uptake; however, targeted education for specific participant groups may address vaccine hesitancy concerns, given the need for COVID-19 vaccine boosters.

RISK FACTORS ASSOCIATED WITH IN-HOSPITAL MORTALITY IN PATIENT WITH SEVERE COVID-19 INFECTION

Background: Coronavirus disease (COVID-19) is a pandemic disease, infecting more than 673 million people. Accurate prediction of the risk of progression of COVID-19 is needed at the time of hospitalization. Material and Methods: A retrospective study was conducted between December, 2020 and December, 2021. A total of 165 patients admitted with severe COVID-19 infection were enrolled. The data were collected from the electronic medical records of Alexandrovska Hospital. Results: The mean age of the patients was 64.6±15, of whom 44.8% were men. The median duration from symptom onset to hospitalization was 8.2 days, and from symptom onset to discharge or death was 24.00 days respectively. In-hospital mortality was 23.3%, and post-discharge one-year mortality was 3.7%. 27 (16.7%) patients received invasive mechanical ventilation, 37 (23%) were admitted to the ICU, and 26 (15.8%) received vasopressors. Common acute complications among inpatients included acute pulmonary embolism (2.6%), acute stroke (0.6%), and minor bleeding (3.7%). 12 patients (7.7%) who survived COVID-19 hospitalization were readmitted for additional treatment of other diseases. Several laboratory markers were linked with increased in-hospital mortality: GFR &lt; 55 ml/min, ferritin &gt; 705 µg/L, PaO2 &lt; 7.93 kPa; SpO2 &lt; 93%, oxygen requirements &gt; 12.5 l/min. Mortality risk was higher in patients having hypertension, coronary artery disease, previous ischemic stroke, valvular heart disease, chronic heart failure and atrial fibrillation. Conclusion: The mortality rate was higher in older patients with cardiovascular comorbidities and reduced renal function. Early recognition of high-risk patients may help to improve care and reduce mortality.

Risk of Early Postoperative Cardiovascular and Cerebrovascular Complication in Patients with Preoperative COVID-19 Undergoing Cancer Surgery.

As the COVID-19 pandemic shifts to an endemic phase, an increasing proportion of patients with cancer and a preoperative history of COVID-19 will require surgery. This study aimed to assess the influence of preoperative COVID-19 on postoperative risk for major adverse cardiovascular and cerebrovascular events (MACEs) among those undergoing surgical cancer resection. Secondary objectives included determining optimal time-to-surgery guidelines based on COVID-19 severity and discerning the influence of vaccination status on MACE risk. National COVID Cohort Collaborative Data Enclave, a large multi-institutional dataset, was used to identify patients that underwent surgical cancer resection between January 2020 and February 2023. Multivariate regression analysis adjusting for demographics, comorbidities, and risk of surgery was performed to evaluate risk for 30-day postoperative MACE. Of 204,371 included patients, 21,313 (10.4%) patients had a history of preoperative COVID-19. History of COVID-19 was associated with an increased risk for postoperative composite MACE as well as 30-day mortality. Among patients with mild disease who did not require hospitalization, MACE risk was elevated for up to 4 weeks after infection. Postoperative MACE risk remained elevated more than 8 weeks after infection in those with moderate disease. Vaccination did not reduce risk for postoperative MACE. Together, these data highlight that assessment of the severity of preoperative COVID-19 infection should be a routine component of both preoperative patient screening as well as surgical risk stratification. In addition, strategies beyond vaccination that increase patients' cardiovascular fitness and prevent COVID-19 infection are needed.