COVID-19 Referral Hospital Research Articles

Could Anemia Impact the Severity of Infections? COVID-19 as an Example

Background The association between anemia and severity of infection as well as mortality rates among patients infected with COVID-19 has scarcely been studied. This is the first study from the UAE aimed to assess the influence of anemia on COVID-19 severity, ICU admission, and mortality rate. Methods A retrospective chart review of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The study included adult patients with confirmed COVID-19. Clinical and laboratory data, severity of the disease, ICU admissions, and mortality rates were analyzed and correlated to the presence of anemia among the patients. Results A total of 3092 patients were included. 362 patients (11.7%) were anemic and most of the cases were between asymptomatic and mild COVID-19 (77.4%, n=2393). Among patients with anemia, 30.1% (n=109) had moderate to severe COVID-19. Statistically, anemia was associated significantly with a higher risk for severe COVID-19 outcome compared to nonanemic patients (AOR:1.59, 95% CI:1.24-2.04, p<0.001). Intensive care unit (ICU) admission was almost 3 times higher among anemic patients compared to nonanemic (AOR:2.83,95% CI:1.89-4.25, p<0.001). In addition, the overall mortality rate of 2.8% (n=87) was 2.5-fold higher in anemic than nonanemic patients (OR:2.56, CI: 1.49-4.06, p<0.001). Moreover, older age (≥48-year-old) and male gender were independent predictors for severe illness (Age: OR=1.26, CI:1.07-1.51, p=0.006; Gender: OR:1.43,CI:1.15-1.78, p<0.001)) and ICU admission (Age: OR:2.08, CI:1.47-2.94, p<0.001; Gender: OR: 1.83, CI:1.12-3.00, p=0.008) whereas only age ≥48 years old contributed to higher mortality rate (OR:1.60, CI:1.04-2.46, p=0.034). Conclusion Anemia was a major risk factor for severe COVID-19, ICU admission and mortality among hospitalized COVID-19 patients. Thus, healthcare providers should be aware of monitoring the hematological parameters among hospitalized patients with COVID-19 and anemia to reduce the risk of disease complications and mortality. This association should also be considered in other infectious diseases.

Outcome of RT-PCR in the Diagnosis of Patients with COVID-19 Symptoms: A Study in a COVID-19 Referral Hospital

<i>Introduction: </i>Corona virus (SARS-CoV-2) (COVID-19) outbreak was first reported in China rapidly spread around the world within short period causing global public health emergency. COVID 19 is a highly infectious disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). The initial symptoms were fever, cough, dyspnea, myalgia or fatigue, headache, hemoptysis, diarrhea and acute respiratory distress syndrome (ARDS). Hence in diagnosis of COVID-19 RT-PCR of viral nucleic acid is regarded as the reference standard to detect the COVID-19 positive cases. <i>Objective: </i>The aim of this study was to determine the outcome of RT-PCR of the patients with COVID-19 symptoms. <i>Methodology: </i>This was a cross-sectional prospective study carried out in the department of Radiology and imaging in collaboration with the department of Virology and COVID unit in IbnSina Hospital, Dhaka, Bangladesh during January, 2022 to June, 2022. A total of 239 OPD patients with COVID-19 symptoms aged above 18 years were enrolled in this study. The collected data were cleaned, edited and entered into computer for analysis. The data were analyzed using Statistical Package for Social Sciences (SPSS) software, version 23.0. The ethical clearance of this study was obtained from the Ethics Committee of School of Public Health & Life Science, University of South Asia, and Dhaka, Bangladesh. <i>Results: </i>In this study a total of (n=239) patients with COVID-19 symptoms were enrolled. According to age distribution, the majority., 142 (59.42%) patients belonged to the age group >52 years, which was the highest and followed by 44 (18.42%) age group (43-52) years, 36 (15.06%) (33-42) years, 14 (5.85%) (22-32) years and 3 (1.25%) <22 years. According to sex distribution, the majority, 167 (69.85%) were male and 72 (30.12%) were female. Distribution by symptoms, all the patients239 (100%) had general weakness and followed by sneezing 221 (92.46%), fever 236 (98.74%), headache 228 (95.39%), cough 232 (97.07%), respiratory distress, 225 (94.14%), cough and SOB, 237 (99.16%), loss of smell, 212 (88.74%), lac of apatite, 224 (73.72%), asthma 218 (91.21%) and pneumonia, 118 (49.37%). In RT_PCR lab test results, the majority 195 (81.58%) were observed COVID-19 Negative (-) and 44 (18.41%) were observed COVID-19 Positive (+). Among the positive cases, the majority 26 (60%) were male and 18 (40%) were female. <i>Conclusion: </i>This study prevailed around 20 % of the patients with COVID-19 symptoms got COVID-19 Positive in RT-PCR lab test results. Therefore, the patients with COVID-19 symptoms must conduct RT-PCR lab test for their being sure of their COVID-19 affection. At the same time, the male are more vulnerable to COVID-19 than their counter part female.

Dukungan Sosial, Self-Efficacy dan Resiliensi pada Perawat yang Menjaga Pasien Covid-19

Changes in the Covid-19 pandemic situation require resilience to deal with it, especially for healthcare workers, including nurses. This study aims to examine the effect of social support and self-efficacy on resilience in nurses who care for Covid-19 patients. This study uses a questionnaire, in the form of resilience scale, social support scale, and self-efficacy scale. This study involved 50 nurses working in the Covid-19 referral hospital with characteristics that took care of Covid-19 positive patients directly. The sampling technique used was purposive sampling. Analysis of the data used in this study is multiple regression analysis. The result of this study showed resilience among nurses was significantly affected by social support and self-efficacy.

Factors Associated with Adverse Outcomes among SARS-CoV-2 Positive Children in a Tertiary Government COVID-19 Referral Hospital in the Philippines.

Pediatric COVID-19 epidemiology and factors associated with adverse outcomes - mortality, need for invasive mechanical ventilation, and ICU admission, are largely unstudied. We described the clinico-demographic characteristics of Filipino pediatric COVID-19 patients and determined the factors associated with adverse outcomes. This is a retrospective cohort study of 180 hospitalized SARS-CoV-2-confirmed cases 0-18 years old from April 2020 to August 2021 in a tertiary COVID-19 referral hospital in Manila, National Capital Region. Crude associations were determined using chi-squared or Fisher's exact tests; and medians were compared using the Mann-Whitney test. Factors predictive of mortality were determined using Cox proportional hazards regression analysis. The survivor functions were depicted in graphs. About 41.67% had mild disease, 58.33% were males, 39.4% aged 0-4 years, and 69.44% had at least one comorbidity. About 9.44% died (adjusted 9.2 persons per 1000 patient-days, 95% CI 5.5%-15.2%), 17.78% needed invasive mechanical ventilation, and 20% needed ICU admission. Independently, severe-critical COVID-19 (HRc 11.51, 95% CI 3.23, 41.06), retractions (HRc 10.30, 95% CI 3.27, 32.47), alar flaring (HRc 4.39, 95% CI 1.53, 12.58), cyanosis (HRc 4.39, 95% CI 1.72, 14.11), difficulty of breathing (HRc 7.99, 95% CI 2.25, 28.71), poor suck/appetite (HRc 4.46, 95% CI 1.59, 12.40), ferritin (HRc 1.01, 95% CI 1.00, 1.01), IL-6 (HRc 1.01, 95% CI 1.00, 1.01), aPTT (HRc 1.05, 95% CI 1.01, 1.10), IVIg (HRc 4.00, 95% CI 1.07, 14.92) and corticosteroid (HRc 6.01, 95% CI 2.04, 17.67) were significant hazards for mortality. In adjusted Cox analysis, only retractions (HRa 34.96, 95% CI 3.36, 363.79), seizure (HRa 9.98, 95% CI 1.76, 56.55), and corticosteroids (HRa 8.21, 95% CI 1.12, 60.38) were significantly associated with mortality while alar flaring appeared to be protective (HRa 0.10, 95% CI 0.01, 0.95). Several clinical characteristics were consistently associated with adverse outcomes. Majority of hospitalized pediatric COVID-19 patients were very young, males, had mild disease, and had at least one comorbidity. Mortality, invasive mechanical ventilation, and ICU admission were relatively low. Except for alar flaring which appeared to be protective, retractions, seizure, and use of corticosteroids were associated with adverse outcomes.

Follow-up SARS-CoV-2 serological study of a health care worker cohort following COVID-19 booster vaccination

BackgroundStudies have shown that Omicron breakthrough infections can occur at higher SARS-CoV-2 antibody levels compared to previous variants. Estimating the magnitude of immunological protection induced from COVID-19 vaccination and previous infection remains important due to varying local pandemic dynamics and types of vaccination programmes, particularly among at-risk populations such as health care workers (HCWs). We analysed a follow-up SARS-CoV-2 serological survey of HCWs at a tertiary COVID-19 referral hospital in Germany following the onset of the Omicron variant.MethodsThe serological survey was conducted in January 2022, one year after previous surveys in 2020 and the availability of COVID-19 boosters including BNT162b2, ChAdOx1-S, and mRNA-1273. HCWs voluntarily provided blood for serology and completed a comprehensive questionnaire. SARS-CoV-2 serological analyses were performed using an Immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA). Antibody levels were reported according to HCW demographic and occupational characteristics, COVID-19 vaccination and SARS-CoV-2 infection history, and multivariate linear regression was used to evaluate these associations.ResultsIn January 2022 (following the fourth COVID-19 wave in Germany including the onset of the Omicron variant), 1482/1517 (97.7%) HCWs tested SARS-CoV-2 seropositive, compared to 4.6% in December 2020 (second COVID-19 wave). Approximately 80% had received three COVID-19 vaccine doses and 15% reported a previous laboratory-confirmed SARS-CoV-2 infection. SARS-CoV-2 IgG geometric mean titres ranged from 335 (95% Confidence Intervals [CI]: 258–434) among those vaccinated twice and without previous infection to 2204 (95% CI: 1919–2531) among those vaccinated three times and with previous infection. Heterologous COVID-19 vaccination combinations including a mRNA-1273 booster were significantly associated with the highest IgG antibody levels compared to other schemes. There was an 8-to 10-fold increase in IgG antibody levels among 31 HCWs who reported a SARS-CoV-2 infection in May 2020 to January 2022 after COVID-19 booster vaccination.ConclusionsOur findings demonstrate the importance of ongoing COVID-19 booster vaccination strategies in the context of variants such as Omicron and despite hybrid immunity from previous SARS-CoV-2 infections, particularly for at-risk populations such as HCWs. Where feasible, effective types of booster vaccination, such as mRNA vaccines, and the appropriate timing of administration should be carefully considered.

Could Anemia Impact the Severity of Infections? COVID-19 as an Example

Background The association between anemia and severity of infection as well as mortality rates among patients infected with COVID-19 has scarcely been studied. This is the first study UAE aimed to assess the influence of anemia on COVID-19 severity, ICU admission, and mortality rate. Methods A retro-prospective chart review of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The study included adult patients with confirmed COVID-19. Clinical and laboratory data, severity of the disease, ICU admissions, and mortality rates were analyzed and correlated to the presence of anemia among the patients. Results A total of 3092 patients were included. 362 patients (11.7%) were anemic and most of the cases were between asymptomatic and mild COVID-19 (77.4%, n=2393). Among patients with anemia, 30.1% (n=109) had moderate to severe COVID-19. Statistically, anemia was associated significantly with a higher risk for severe COVID-19 outcome compared to nonanemic patients (AOR:1.59, 95% CI:1.24-2.04, p<0.001). Intensive care unit (ICU) admission was almost 3 times higher among anemic patients compared to nonanemic (AOR:2.83,95% CI:1.89-4.25, p<0.001). In addition, the overall mortality rate of 2.8% (n=87) was 2.5-fold higher in anemic than nonanemic patients (OR:2.56, CI: 1.49-4.06, p<0.001). Moreover, older age (≥48-year-old) and male gender were independent predictors for severe illness (Age: OR=1.26, CI:1.07-1.51, p=0.006; Gender: OR:1.43,CI:1.15-1.78, p<0.001)) and ICU admission (Age: OR:2.08, CI:1.47-2.94, p<0.001; Gender: OR: 1.83, CI:1.12-3.00, p=0.008) whereas only age ≥48 years old contributed to higher mortality rate (OR:1.60, CI:1.04-2.46, p=0.034). Conclusion Anemia was a major risk factor for severe COVID-19, ICU admission and mortality among hospitalized COVID-19 patients. Thus, healthcare providers should be aware of monitoring the hematological parameters among hospitalized patients with COVID-19 and anemia to reduce the risk of disease complications and mortality. This association should also be considered in other infectious diseases.

Demographic and Clinical Characteristics of COVID-19 Positive Cases: A Prospective Study in a COVID-19 Referral Hospital

<i>Background:</i> The emergence of the SARS-CoV-2 virus, also referred to as COVID-19, was first identified in China and rapidly spread throughout the globe, leading to a worldwide public health crisis. COVID-19 is an extremely transmissible disease caused by the SARS-CoV-2 virus. The main symptoms were of heightened body temperature, inflammation of the lungs, breathing difficulties, muscular discomfort or fatigue, headache, hemoptysis, gastrointestinal disturbance, and acute respiratory distress syndrome (ARDS). Objective: To determine the demographic and clinical characteristics of people who have tested positive for COVID-19. Methods: This study was conducted as a cross-sectional prospective investigation in partnership with the Radiology and Imaging department and the Virology and COVID unit at IbnSina Hospital in Dhaka, Bangladesh. The study took place from January 2022 to June 2022. This study included a cohort of 120 individuals who tested positive for COVID-19 and were above the age of 18. The data acquired underwent analysis using the Statistical Package for Social Sciences (SPSS) software, specifically version 23.0. The study gained ethical clearance from the Ethics Committee of the School of Public Health & Life Science at the University of South Asia, located in Dhaka, Bangladesh<i>. Result:</i> In this study a total of 120 (n=120)) confirmed COVID-19 positive cases were enrolled. According to age distribution, the majority 63 (52.5%) patients belonged to the age group >52 years and followed by 30 (25%) age group (43-52) years, 18 (15%) (33-42) years, 6 (5%) (22-32) years and 3 (2.5%) <22 years. According to sex distribution, the majority, 82 (68%) were male and 38 (32%) were female. According to distribution of residence, the maximum, 96 (80%) were from urban area and 24 (20%) were from rural area Distribution by clinical presentation, general weakness 120 (100%) and followed by sneezing 114 (95%), fever 116 (96.66%), headache 117 (99.16%), cough 115 (95.83%), respiratory distress, 119 (98.33%), cough and SOB, 118 (99.16%), loss of smell, 212 (88.74%), lac of apatite, 116 (96.66%), asthma 81 (68.50%) and pneumonia, 40 (33.33%)., the Majority 116 (96.66%) had Diabetes Mellitus (DM) and followed by 113 (94.16%) had Hypertension (HTN), 7 (5.83%) Chronic Liver Disease (CLD) 22 (18.33%) had Chronic Kidney Diseases (CKD) and 12 (10%) Thyroid. <i>Conclusions: </i>This study investigated that the highest age group of COVID-19 positive cases was >52 years (52.5%). The majority of the COVID-19 positive cases were male (68%). The majority of the patients were from urban area (80%). Respiratory 119 (98.33) and general weakness 120 (100) were the most common clinical presentations. The maximum patients had Diabetes 116 (96.66% and hypertension 113 (94.16%).

Prevalence and predictors of burnout among nurses during the COVID-19 pandemic: A survey in teaching hospitals.

Occupational burnout is one of the most important consequences of the coronavirus disease pandemic, associated with psychological well-being, quality of care, and intention to leave the nursing profession. This is a major health problem with serious adverse consequences not only for nurses but also for patients and healthcare systems. To assess burnout and its associated factors in nurses who worked in teaching hospitals during the COVID-19 pandemic in Iran. A cross-sectional study was conducted on nurses of two COVID-19 referral hospitals in Tehran, Iran. Data were collected using the sociodemographic form and Maslach burnout inventory-human service survey (MBI-HSS) questionnaire. Data were evaluated using SPSS software version 26. A total of 264 participants, 52.7% (n = 139) were males and the mean of them age was 34.41±9.71 years. Almost 50% of nurses experienced burnout, in each dimension. Emotional exhaustion was associated significantly with job retention intention (P = 0.01) and depersonalization was significantly associated with gender (P = 0.02), age (P = 0.01), educational level (P = 0.004), work shifts (P = 0.006), and job retention intention (P = 0.02). In addition, personal accomplishment score was significantly associated with age (P = 0.002), marital status (P = 0.03), educational level (P = 0.03), work shift (P = 0.04) and job retention intention (P = 0.01). The burnout rate in the COVID-19 era is high among nurses associated with improper care. Psychosocial support is needed to improve mental well-being among health care workers during unpredictable conditions like pandemics.

Bio-Risk Management Systems: Biosafety Assessment in COVID-19 Referral Hospitals in Indonesia

Numerous hospital laboratories in Indonesia need to implement improved bio-risk management (BRM) systems. There are many potential biohazards in laboratory activities that can impact health and the environment, leading to laboratory incidents. To minimize the impact and occurrence of such incidents, it is necessary to evaluate the implementation of BRM in every hospital laboratory that uses biological agents. This study was conducted in eight COVID-19 reference hospitals in Indonesia in the regions of Sumatra, Kalimantan, and Java, which have committed to implementing BRM systems in their laboratory activities. This research employed a descriptive study design and quantitative methods, with the aim of analyzing and evaluating the implementation of BRM systems in laboratories by assessing the achievements and gap analysis obtained from each laboratory. This research utilized primary data in the form of checklist forms referencing ISO 35001:2019 for the laboratory BRM system. Then, the assessments were based on virtual interviews conducted by the researcher with laboratory personnel as the primary data. The evaluation conducted on gap analysis from the seven clauses in ISO 35001:2019 across all hospitals revealed large gaps, particularly in three clauses: leadership, support, and performance. However, the aspects concerning organization, improvement, and performance evaluation were relatively satisfactory. Hence, there is a need for further improvement in leadership, support, and performance evaluation clauses. Additionally, it is essential to highlight the importance of comprehensive performance assessment, including proactive audits and continuous enhancements to achieve optimal bio-risk management.

COVID-19 Death Risk in Surabaya: Modeling by Spatial Point Process

The total death rate or Case Fatality Rate (CFR) due to COVID-19 in Surabaya is high, that is almost twice of the global CFR (1.4%). Utilization of high-resolution data has the potential to explore COVID-19 cases, not only recording cases at the district or city level but also at the patient’s domicile level so that they can provide more detailed spatial information. Meanwhile, research exploring the risk of death from COVID-19, especially in Surabaya using spatial point process model, has not yet been carried out. In this study, an analysis of the risk of death from COVID-19 in Surabaya will be carried out using the inhomogeneous Poisson point process model with covariates or external factors used including the density of the COVID-19 referral hospital location and the proportion of confirmed COVID-19 population aged > 60 years per districts. Our model shows that referral hospitals (exp( ) = 1.03295) and places of worship (exp( ) = 1.03835) have a significant effect on death risk from COVID-19. So, there is a need for special handling for areas that have a population with a vulnerable age (> 60 years) where at this age the human immune system will decrease.
 Keywords: COVID-19, heath risk, spatial point process, surabaya

Identification of Pending Claim Factors at X Hospital City of Medan in 2021

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>An overview of Covid 19 claims in the city of Medan submitted for the period March 2020 to November 2021 amounted to IDR 5.046 trillion, of which IDR 4.767 trillion has been verified (94.71%) and IDR 1994 trillion is pending (33,868 cases). This research aims to identify pending claim factors at one of the Covid-19 referral hospitals in Medan City in 2021. The location that will be used in this research is the Murni Teguh Memorial National Health Insurance Billing Unit. Researchers conducted interviews with informants regarding Covid-19 claims and the sample used in this research was purposive sampling, namely a sample that was considered representative of the research data by meeting the criteria, namely inclusion and exclusion. Data analysis was carried out through several stages, namely data reduction, data display and verification. The results of the research are that the factors that cause delays in hospitals are the INACBG application update, communication between patients and the doctor in charge is less open regarding clinical complaints and travel history out of town or abroad, the number of human resources is insufficient compared to patients numbering up to thousands with an HR ratio of 1: 1685 patients and DPJP 1:96 patients, this was also experienced by several other hospitals as stated in the journal entitled Review of Inpatient Claim Dispute Settlement for Corona Virus Disease 2019 (Covid-19) Patients at Ajibarang Regional Hospital in 2020 and officers had problems in implementing Covid-19 claims, namely changes in regulations up to 6 times in 3 years, so that it caused a lot of miscommunication with officers on duty within the scope of Covid-19 services, but this change in regulations was due to adapting to Covid-19 conditions</em><em>.</em><em></em></p><p><em> </em></p></td></tr></tbody></table></div><strong><em>Keywords: </em></strong><strong><em> Covid-19, Identification, Pending, Social Security Administrator</em></strong>

Work-Family Conflict in Nurses During the COVID-19 Pandemic

Background: During the COVID-19 pandemic, nurses were praised as the main heroes of the fight against the disease, but pandemic conditions affected the balance between their work and family responsibilities. To this end, the present study aimed to explore the incidence of work-family conflict in nurses during the COVID-19 pandemic. Methods: This descriptive cross-sectional study was conducted at COVID-19 referral hospitals in Mazandaran Province, Iran, in 2021. The participants were 200 nurses who were selected using convenience and purposive sampling. The data were collected using the Work-Family Conflict Scale (WAFCS), which was distributed and completed online. The collected data were analyzed with SPSS-16 software using descriptive and inferential statistics. Results: Most of the participants were working as nurses for an average of seven years and had been caring for COVID-19 patients for at least 4-6 months until the time of data collection. The mean work-family conflict score was 78.80±1.1. The data also showed that the severity of work interference with family (WIF) in both time and strain dimensions (83.81±0.3) was significantly higher than the severity of family interference with work (FIW) (65.90±0.3) in these two dimensions. Conclusion: Nurses faced an imbalance between work and family functions during the COVID-19 pandemic. Since nurses are at the forefront of the fight against the pandemic, it is necessary to pay special attention to their working conditions and family life. Moreover, effective and practical solutions should be provided by managers to resolve work-family challenges.

Profil Penggunaan Antibiotik untuk Pengobatan Pasien COVID-19 di Salah Satu Rumah Sakit Kota Bitung

Background: The overuse and misuse of antibiotics during the COVID-19 pandemic is one of the biggest concern that needs attention, considering antimicrobioal resistance has been a major threat to global health. According to WHO, this condition can make the infection difficult to treat, increasing the risk of disease spread and mortality. The significant increase in the number of COVID-19 cases in North Sulawesi and the excessive use of antibiotics in COVID-19 patients, shows that research that aims to describe the use of antibiotics in COVID-19 is needed as an early detection of irrational use of antibiotics.Methods: This study was carried out in one of the COVID-19 Referral Hospital in the city of Bitung. The data of this study was collected by purposive sampling and conducted retrospectively. Sources of secondary data is from the patient medical records and patient treatment records. In this study 148 samples that meet the inclusion criteria are used. The inclusion criteria is hospitalized patients which is confirmed with COVID-19 during the period of July-December 2021, received antibiotic therapy during the treatment period, and medical record data.Result: The result shows that the mostly used antibiotics for COVID-19 theraphy are Azithromycin tablets 47.97% from the macrolide groups; Ceftriaxone injection 20.32% and Cefixime tablets 16.67% from the cephalosporin groups; and Levofloxacin infusion 8.94% from the fluoroquinolones group.Conclusion : Patients at the productive age is most likely to get exposed with COVID-19. The clinical symptoms frequently occur in the mild category (68.92%). The use of antibiotics in COVID-19 patients at one of the COVID-19 Referral Hospitals in Bitung City is in accordance with the 3rd edition of the COVID-19 Management Guidelines, and the mostly used antibiotics is Azithromycin tablets as many as 118 patients (47.97%).

The association between vitamin D deficiency and the clinical outcomes of hospitalized COVID-19 patients

Background Vitamin D deficiency is an emerging public health problem that affects more than one billion people worldwide. Vitamin D has been shown to be effective in preventing and reducing the severity of viral respiratory diseases, including influenza. However, the role of vitamin D in COVID-19 infection remains controversial. This study aimed to analyze the association of vitamin D deficiency on the clinical outcome of hospitalized COVID-19 patients. Methods A prospective cohort study was conducted among hospitalized COVID-19 patients at two COVID-19 referral hospitals in Indonesia from October 2021 until February 2022. Results The median serum 25(OH)D level in 191 hospitalized COVID-19 patients was 13.6 [IQR=10.98] ng/mL. The serum 25(OH)D levels were significantly lower among COVID-19 patients with vitamin D deficiency who had cardiovascular disease (p-value=0.04), the use of a ventilator (p-value=0.004), more severe COVID-19 cases (p-value=0.047), and mortality (p-value=0.002). Furthermore, serum 25(OH)D levels were significantly different between patients with mild and severe COVID-19 cases (p-value=0.019). Serum 25(OH)D levels in moderate and severe COVID-19 cases were significantly different (p-value=0.031). Lower serum 25(OH)D levels were significantly associated with an increased number of comorbidities (p-value=0.03), the severity of COVID-19 (p-value=0.002), and the use of mechanical ventilation (p-value=0.032). Mortality was found in 7.3% of patients with deficient vitamin D levels. However, patients with either sufficient or insufficient vitamin D levels did not develop mortality. Conclusions COVID-19 patients with vitamin D deficiency were significantly associated with having cardiovascular disease, mortality, more severe COVID-19 cases, and the used of mechanical ventilation. Lower serum 25(OH)D levels were associated with an increased number of comorbidities, COVID-19 severity, and the use of mechanical-ventilation. Thus, we suggest hospitalized COVID-19 patients to reach a sufficient vitamin D status to improve the clinical outcome of the disease.

The Role of Good Corporate Governance on Hospital Performance During Covid-19

This study focuses on the role of corporate governance in mediating the relationship between the public sector, specifically government-owned hospitals, and financial performance during the Covid-19 pandemic. While there is existing research on corporate governance, there is limited attention given to the public sector and government hospitals in the context of the pandemic. The study highlights government hospitals as they are on the front lines of healthcare services during the pandemic and have experienced a significant influx of patients, particularly in Covid-19 referral hospitals. This has created financial challenges for hospitals, with increased workloads and disrupted cash flows. The objective of this study is to determine the extent to which corporate governance can help manage the financial difficulties faced by government hospitals during the pandemic. The findings of this research are expected to provide valuable insights for the government and hospital managers, aiding in the improvement of corporate governance and financial performance during emergencies such as the Covid-19 pandemic

A Comparison of Psychological Distress and Coping Styles among Physicians and Nurses in a COVID-19 Referral Hospital in Manila: A Cross-sectional Study.

This study aimed to compare the levels of depression, anxiety, and stress, and the coping styles among physicians and nurses in a COVID-19 referral hospital in Manila from June to July 2020. A cross-sectional study among medical residents and nurses selected via convenience sampling was employed. Data were obtained through COVID Stressors and Stress Reduction Questionnaire, Depression, Anxiety, and Stress Scale-21, and Filipino Coping Strategies Scale. Descriptive and inferential analysis of data was done. Five hundred seventy-one (571) healthcare workers (total population: 1,650 nurses and physicians) participated in the study, representing 81.6% of the computed sample size of 700 respondents. Among the participants, 60.6 %, 69.0%, 48.9% reported symptoms of depression, anxiety, and stress, respectively. Nineteen percent (19%) of nurses reported severe to extremely severe depression, and 42.0% reported severe to extremely severe anxiety. In contrast, 30.8% of residents reported severe to extremely severe depression, and 28.4% conveyed severe to extremely severe anxiety. There was no association observed between perceived levels of stress between the two healthcare professions.There were more mildly to extremely severe anxious healthcare workers in the COVID areas (74.6%) compared to the non-COVID areas (61.2%). Differences in coping styles were observed among the participants' clinico-demographic characteristics. Top healthcare worker stressors include being negligent and endangering co-workers (88.6%), frequent modification of infection control procedures (87.0%), and discomfort from protective equipment (81.4%). Top stress-reducing factors include provision of food and vitamins (86.7%), sufficient rest (84.2%), and support from higher-ranking colleagues (73.7%). This study has shown that more than half of the healthcare workers reported mild to extreme levels of depression and anxiety, while a little less than half reported mild to extreme levels of stress. The development and implementation of hospital interventions and programs based on the sources of distress and stress-reducing factors is recommended to mitigate the impact of sustained psychological distress on mental health and physical wellbeing of hospital healthcare workers.

Characteristics and Clinical Outcomes of COVID-19 Patients with Hyperglycemia: Retrospective Cohort Study from a COVID-19 Referral Hospital, Bandung, Indonesia

Background: COVID-19 often causes severe complications in patients with metabolic disorders such as diabetes mellitus. On the other hand, inflammation caused by infection may also trigger insulin resistance resulting in hyperglycemia and related to disease severity. This study aimed to describe the characteristics and clinical outcomes of COVID-19 patients with hyperglycemia at one of the COVID-19 referral hospital in Bandung, Indonesia.Methods: This study was a retrospective cohort study using secondary data from medical records of COVID-19 patients admitted to Dr. Hasan Sadikin General Hospital from March 2020 to March 2021. This study included all patients with confirmed COVID-19, aged >18 years, and had at least one blood glucose test at admission. Patients were grouped based on three possible types of hyperglycemia namely diabetes mellitus, reactive hyperglycemia, and steroid-induced hyperglycemia, and then compared their characteristics and disease outcomes.Results: This study identified 1,114 patients’ medical records and included 1,013 data in the analysis. Hyperglycemia occurred in 45.1% of COVID-19 patients. The most common hyperglycemia types were diabetes mellitus (55.7%), reactive hyperglycemia (37.4%), and steroid-induced hyperglycemia (7%). The steroid-induced hyperglycemia group had similar characteristics as the diabetes group. The reactive hyperglycemia group exhibited a metabolic syndrome pattern resembling pre-diabetic conditions. The highest rates of severe disease and mortality were seen in the steroid-induced hyperglycemia group, followed by the diabetes group.Conclusion: There is an elevated prevalence of hyperglycemia in COVID-19 patients with diabetes. The steroid-induced hyperglycemia group has the most unfavorable outcomes. These observations emphasize the importance of identifying hyperglycemic conditions to improve management and outcomes.

Risk Factors of Death in Mechanically Ventilated COVID-19 Patients: A Multi-Center Study From Iran

Despite the improvement in COVID-19 therapeutic management the mortality of mechanically ventilated COVID-19 patients remains high. In this study, we determined the risk factors of death in these cases. This cross-sectional study evaluated clinical and paraclinical features of mechanically ventilated COVID-19 patients at the time of hospital admission until death or discharge from hospital between April and September in 2021 in three COVID-19 referral hospitals. The patients were divided into survivors and non-survivors and then the characteristics were compared. One hundred twenty-five patients (60% male, mean age 62±15.18, range 17 to 97 years old) were recruited to the study. 51(40%) survived and 74 (60%) didn’t survive. At the time of hospital admission, the vital signs were not significantly different between the survivors and non-survivors, although diarrhea was not reported in non-survivors, but reported in 9.5% of survivors (P=0.02). The mean age of non-survivors was higher (65.1±14.17 vs 56.9±15.41, P=0.003). The intubation time since the patients were admitted was not significantly different between the two groups (3.38±2.88 days vs 4.16±3.42 days, P=0.34). The mean of serum LDH and D-dimer at the time of ICU admission were significantly higher in the non-survivors (863±449 vs 613±326, P=0.01; 4081±3342 vs 542±634, P=0.009; respectively). However, the mean CRP was not significantly different between the two groups (76±66.4, 54±84.3; P=0.1). Mean APACHE-II score was higher in the non-survivors than the survivors (15 vs 13; P=0.01). Use of remdesivir, interferon beta-1a, and low dose corticosteroids were significantly higher in the survivors group (P=0.009, P=0.001, P=0.000). Success of weaning and ICU discharge among mechanically ventilated COVID-19 patients are probably higher in younger patients with lower D-dimmer and LDH that received remdesivir, interferon beta-1a and low dose corticosteroids, while the intubation time did not seem to play a role on patients' outcome.

2321. Prevalence and determinants of depression among healthcare workers during the COVID-19 pandemic in Khujand, Tajikistan, 2022

Abstract Background Healthcare workers experienced substantial work overload and stress during the COVID-19 response. Increase in prevalence of mental health conditions among healthcare workers have been reported globally. Low-resource settings, such as Tajikistan, experienced additional challenges related to the COVID-19 pandemic and have scare resources to mitigate mental health consequences. To inform program planning, we aimed to determine prevalence of depression, associated factors, and care gap among healthcare workers. Methods We conducted a cross-sectional study of all healthcare providers (physicians, nurses, and nurse assistants) working from July to August 2022 in three COVID-19 referral hospitals and three polyclinics in Khujand city, Tajikistan. We systematically sampled every fifth provider. Depression was assessed using the Hospital Anxiety and Depression Scale. We used multivariable logistic regression model adjusting for random effect of hospital to identify factors associated with depression. Results Among 400 healthcare workers, 277 (69%) had depression (Table 1). Half (44%) no longer enjoyed the things they used to (Figure 1). Prevalence of depression was significantly higher (p< 0.01) among females than males (71% vs 59%), nurses than physicians (77% vs 56%). Among providers with depression, 20% had received professional services, 32% had taken a vacation, 32% had severe COVID-19, and 53% experienced frequent respiratory issues, and 56% felt people avoided them because of work. In multivariable analysis depression was associated with being a nurse (adjusted odds ratio [aOR]=3.5; 95% confidence ratio [CI]: 1.7-7.2), having had severe COVID-19 disease (aOR=4.0; 95% CI: 1.4-11.8) and having felt that people avoided them because of work (aOR=1.6; 95% CI: 1.0-2.6) (Table 2). Providers who used respirators >3 hours had lower odds of depression (aOR=0.4; 95% CI: 0.2-0.9). General characteristics of healthcare providers by depression, Tajikistan, 2022 External pressures, physical conditions and supportive services among and depression among healthcare workers, Tajikistan, 2021 Factors associated with depression among healthcare workers, Tajikistan, 2021 Conclusion We found high prevalence of depression among healthcare workers in Khujand city, Tajikistan. Timely screening and increase in provision of supportive services for providers is needed. These services should be offered to all providers, and especially targeted towards those with prior severe COVID-19 disease and nurses. Disclosures All Authors: No reported disclosures

Comparative Analysis of Hematological and Inflammatory Biomarkers in Moderate and Severe COVID-19 Patients

In COVID-19 patients, abnormal blood clotting is common, characterized by elevated D-dimer and fibrinogen levels, reduced platelets, and prolonged clotting times. The second week of infection can trigger a cytokine storm, marked by heightened proinflammatory Interleukin-6 (IL-6) levels, associated with Acute Respiratory Distress Syndrome (ARDS) and organ failure. This study compared hematological biomarkers, D-dimer, and IL-6 in moderate and severe COVID-19 cases. In a cross-sectional study, 81 patients meeting inclusion criteria were examined at a leading private COVID-19 referral hospital in Malang Regency. Data from clinical records and lab results encompassing blood counts, D-dimer, and IL-6 levels were collected. D-dimer was assessed through immunoturbidimetry (STA-Procoag-PPL, Diagnostica Stago S.A.S.), while IL-6 was measured using a chemiluminescent immunoassay (Cobas e411 Elecsys, Roche). Data distribution normality was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Non-normally distributed data were analyzed using the Mann-Whitney U test for numerical data and the Fisher exact test for comorbidity-severity correlation. Moderate COVID-19 cases disproportionately affected females, while severe cases had an even gender distribution. The median age was comparable, but mild cases were typically younger. Hemoglobin, hematocrit, leukocyte, neutrophil, platelet, and procalcitonin levels were normal in both groups, with lowered lymphocyte counts. Severe cases displayed a higher Neutrophil-to-Lymphocyte Ratio (NLR). D-dimer and IL-6 were significantly elevated in extreme cases. This study underscores potential gender and age-related discrepancies in COVID-19 severity, emphasizing the significance of monitoring specific blood parameters for disease progression indicators. Further investigation is vital to unveil underlying mechanisms and clinical implications, aiding the management of COVID-19 patients.