COVID-19 Wards Research Articles

Sleep Quality and Its Relationship to Anxiety and Hardiness in a Cohort of Frontline Italian Nurses during the First Wave of the COVID-19 Pandemic.

The COVID-19 pandemic has had a considerable impact on the psychological and psychopathological status of the population and health care workers in terms of insomnia, anxiety, depression, and post-traumatic stress disorder. The primary aim of this study was to describe and evaluate the impact of the pandemic on insomnia levels of a cohort of Italian nurses, particularly those involved in the care of COVID-19 patients. The secondary aim was to identify the interaction between insomnia and hardiness, anxiety, and sleep disturbances. A descriptive-exploratory study was conducted using an online survey during the first wave of the COVID-19 pandemic (March to July 2020). The questionnaire consisted of multiple-choice, open-ended, closed, and semi-closed questions. The psychometric tools administered were the Dispositional Resilience Scale (DRS-15), the State-Trait Anxiety Inventory (STAI-Y), and the Insomnia Severity Index (ISI). a cohort of 1167 nurses fully completed the questionnaire (86.2% of total respondents). The insomnia scale survey showed an increase in post-pandemic scores compared to those before the pandemic, implying that insomnia levels increased after the first pandemic wave. Insomnia scores were directly correlated with anxiety levels (r = 0.571; p ≤ 0.05) and inversely correlated with hardiness levels (r = -0.324; p < 0.001). Multivariate analysis revealed the following protective factors: not having worked in COVID-19 wards, high levels of hardiness (commitment), and the presence of high pre-pandemic insomnia disorder. The main risk factor for insomnia reported in the analysis was a high anxiety score. Anxiety represented the main risk factor for insomnia severity in our sample, while hardiness was confirmed as a protective factor. Thus, it is necessary to design further studies to identify additional risk factors for poor sleep quality and to develop educational courses and strategies aimed at enhancing rest and sleep quality, especially for frontline nurses.

The Effectiveness of Modular Cognitive-Behavioral Therapy (MCBT) on Nurses’ Rumination and Perceived Stress in the COVID-19 wards

The Effectiveness of Modular Cognitive-Behavioral Therapy (MCBT) on Nurses’ Rumination and Perceived Stress in the COVID-19 wards

Experiences of hospitalized patients with COVID-19 - A single centre qualitative study.

COVID-19 pandemic caused a huge impact on the healthcare system worldwide. With a spectrum of outcome ranging from mild symptoms to mortality, the experiences of patients admitted in isolation wards have not been documented. To explore the experience of COVID-19 patients during hospitalization during the early phase of pandemic. A qualitative study using in-depth interviews was conducted among 30 COVID positive patients admitted in COVID wards of a private medical college in Coimbatore, South India between May and June 2020. Qualitative data analysis was done using the seven steps of Colaizzi's descriptive phenomenological method. The experiences of COVID-19 patients during their hospitalization were categorized into three themes. Firstly, their initial reaction to being diagnosed positive for COVID-19. Secondly, experience during hospitalization with regards to their mental health, treatment providers, caregivers (family and relatives) and other COVID patients admitted in the same ward. Lastly, perceived change in their quality of life after discharge. The study highlights that the psychological experiences of COVID-19 patients admitted to the hospital were heterogeneous. Therefore, primary care physicians should provide individualized psychological interventions based on the needs. Since many expressed fear on diagnosis and stigma of the disease, hence policy makers and health care providers should plan intervention for control and treatment without causing stigma to patients and their families.

COVID-19 against humanity: The experiences of frontline nurses and physicians working in COVID-19 wards

Aims and objectives: This study aims to determine the experiences of Turkish nurses and physicians working in pandemic wards. &#x0D; Background: Nurses and physicians play vital roles in the management of the pandemic. Their experiences and expectations need to be carefully considered, in order to handle the pandemic in a healthier way. &#x0D; Methods: In-depth interviews were conducted with 22 participants (11 nurses and 11 physicians). Colaizzi's phenomenological method was used to qualitatively analyze the data. &#x0D; Results: Four main themes emerged: 1) “It was the first but not the last,” 2) “the earthquake effect,” 3) “call for help,” and, 4) “like a phoenix.” Participants reported having experienced intense anxiety, concern, stress, and fear at the onset of the pandemic, as their working conditions and daily lives had been adversely affected. They tried to heal their patients in humane and sensitive ways despite fears of losing their loved ones and being infected, as well as conflicts within their teams. They also reported that they found meaning in their experiences, that their professional image has increased, and that they have developed spiritually throughout the process. &#x0D; Conclusions: This study concludes that the pandemic has negatively affected nurses and physicians emotionally, physically, and psychologically, and that plans should be made to improve their working conditions and psychological support.

Seroprevalence of Apparently Healthy and Unvaccinated Healthcare Workers at the Ward of COVID Patients in a Referral Hospital, Dhaka, Bangladesh

Introduction: In Bangladesh, when a SARS-CoV-2 infected person comes to close contact with another person, especially unvaccinated healthcare workers (HCWs) during staying at the hospital, the disease spreads among the other patients also. This study was carried out in the initial stage of the Corona virus disease 2019 (COVID-19) pandemic before the vaccination program had started. It was observed that among the HCWs some were infected by the virus while they take care of the infected patients and some suffered from subclinical infection without significant symptoms whereas some were not infected at all. Objective: To observe the seroprevalence of SARS- CoV-2 antibodies in a specific group of people (HCWs) who were healthy and unvaccinated but exposed to the patients at the COVID ward in a referral hospital. Methods: This study was carried out in Immunology and Virology Department, Armed Forces Institute of Pathology (AFIP), Dhaka Bangladesh from the date of 21st April, 2020 to 31st May, 2020. As this study was carried out in very early stage of the COVID-19 pandemic, samples were collected within a short period that is for forty days only. In this study, 294 samples were collected from apparently healthy and unvaccinated HCWs who work at the COVID wards in a referral hospital. To detect SARS-CoV-2 antibodies, Immunochromatographic (ICT) method was applied which is a well-accepted method worldwide. Results: This study revealed that among 294 samples from healthcare workers, 36% (106) cases developed antibodies but 64% (188) cases didn’t develop any type of antibody and 19.3(57) cases were PCR positive which might be possible due to their duties in COVID ward. Among 106 seroconvert cases, 16.98% (18)were positive for only IgM, 50.9% (54) were positive for only IgG and 34(32.07%)) were positive for both IgG and IgM. Among 57 infected cases, 21.05% (12) were positive for only IgM, 45.61% (26) were positive for only IgG and 33.33% (34) were for both IgG and IgM antibodies. The ratio between male and female in health-workers were 2.58:1 respectively. Conclusion: This study revealed that the serological test of SARS-CoV-2 is useful for the identification of symptomatic, asymptomatic or subclinical infection among the persons who are the close contacts of COVID-19 patients; moreover, it will help to understand the disease outbreak, the contagiousness of SARS- CoV-2 and the immunity to SARS-CoV-2 in both the vulnerable and general populations. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 31-34

Dermatologist, orthopaedist, and psychiatrist walk into a COVID ward: on the permeability of professional boundaries in a competition-free context

In studies on professions, it has long been understood that relations between professions are charged with competition over jurisdictions. The literature describes several techniques, such as rhetorical boundary-work, that professionals use to expand jurisdictions, gain a monopoly, or protect autonomy. But there still needs to be discovered how professionals cooperate when they are not motivated or threatened by jurisdictional struggle. In this article, we offer an analysis of COVID-19 wards in Poland, where physicians from diverse specialisations were made to work together and treat patients with coronavirus disease. That allows us to expand theoretical debate about professions by showing that in a context free of competition, boundaries between professions become permeable.

Application of the 6S management strategies.

To explore the value of the 6S management strategies in COVID-19 wards. Nurses from the first Fujian medical team in aiding Hubei Province at Wuhan Jinyintan Hospital (2 February, 2020-24 March, 2020) were recruited and instructed to adopt the 6S management strategies for nursing management. The paired-sample t-test was performed to compare the nursing quality, core capabilities of nurses, nursing preparation time, and nursing error rates before and after implementation. After implementation of the 6S management strategies, a total of 93 nurses experienced significant improvements in nursing quality, especially in workplace stress, material preparation, and medication management (p < .001). Adoption of the 6S model for nursing management in COVID-19 wards effectively improves nursing quality, enhances the core capabilities of nurses, reduces nursing preparation time, and lowers nursing error rates.

DETERMINANTS OF MORTALITY IN PATIENTS OF COVID-19 BRONCHOPNEUMONIA: A PROSPECTIVE OBSERVATIONAL STUDY

Background &amp; objectives:COVID-19, an emerging viral disease affected more than 200 countries worldwide andnovel coronavirus pandemic has caused significant mortality throughout the world.The present study was undertaken to identify the determinants of mortality in COVID-19 bronchopneumonia patients. Methods:A total of160 COVID RT-PCR and RAT positive patients with evidence of bronchopneumonia were admitted in medicine covid ward and ICU above the age of 12 years were included in the study during a period of 2.5 years from July 2020- August 2022.Patients were divided into two groups- Survivors (119 patients) and non-Survivors (41 patients). Various sociodemographic factors, clinical symptoms, NEWS-2 scores inflammatory markers,imaging modalities,oxygen levels,type and duration of oxygenation support given were compared between two groups. Results:The sociodemographic data included age, gender and place of residence was not statistically significant with the outcome(mortality) whereas greater number of preexisting medical conditions, requirement of higher quantity of oxygen, various lab parameters (higher values of CRP, Ferritin, LDH, D-Dimer, N-L ratio) and a higher score in NEWS-2, HRCT and chest x-ray was statistically significant factor associated with mortality in our patients suffering from COVID-19 bronchopneumonia. Interpretation &amp; Conclusions:We thereby conclude that, patients in the mortality group had greater number of preexisting medical conditions higher requirement of oxygen at the time of admission, higher NEWS-2 score, N-L ratio, CRP, Ferritin, LDH, D-dimer, Chest x-ray score &amp; HRCT severity score and hence these parameters may be used to predict disease severity, especially in resource-limited settings.

Obesity decreases energy and protein intake in hospitalized COVID-19 patients undergoing continuous positive airway pressure treatment

Patients with SARS-CoV generally require noninvasive treatments including continuous positive airway pressure (CPAP), and appropriate nutritional therapy. Our hypothesis was that a higher body mass index (BMI) would result in greater respiratory difficulties during CPAP treatment and lead to a reduction in energy and protein intake. The study was conducted prospectively and retrospectively in a Brazilian public hospital. The sample comprised all patients (n = 70) hospitalized in COVID-19 wards and using the Elmo System (ELMO) helmet. To ensure proper nutritional support, the hospital established a standard ELMO diet and questionnaire for estimating dietary adherence. The median length of stay was 11 days (interquartile range, 9-20), and 84.3% of the patients received hospital discharge. The median duration of helmet use was 1.5 days (interquartile range, 1-4). From mid-upper arm circumference adequacy measurements, 35 patients (50%) were classified as being overweight or living with obesity and 36 adult patients (66.7%) were considered living with obesity based on their BMI. The prevalence of overweight elderly patients was 81.3%. The median energy and protein intake adequacy percentages were 65% and 72.5%, respectively. Patients with higher BMIs exhibited lower oxygen flows while wearing the ELMO helmet. Younger age and lower energy and protein intake characterized the obesity group. A correlation between oxygen therapy and food intake in COVID-19 patients undergoing CPAP treatment was observed. Patients with higher BMIs and/or mid-upper arm circumference adequacies were more susceptible to energy and protein intake declines, and patients with obesity presented the lowest intake values.

Ethical Challenges to the Self-care of Nurses during the Covid-19 Pandemic.

The emerging working conditions triggered by the COVID-19 pandemic have imposed numerous ethical challenges on the nurses, which, in turn, can negatively impact the nurses' physical and mental health, and thus their work performance through intensifying negative emotions and psychological pressures. The purpose of this study was to highlight the nurses' perceptions of the ethical challenges that they faced regarding their self-care during the COVID-19 pandemic. A qualitative, descriptive study with a content analysis approach. The data were collected through semi-structured interviews with 19 nurses working in the COVID-19 wards of two university-affiliated hospitals. These nurses were selected using a purposive sampling method and the data were analyzed using a content analysis approach. The study was approved by the TUMS Research Council Ethics Committee under the code: IR.TUMS.VCR.REC.1399.594. In addition, it is based on the participants' informed consent and confidentiality. Two themes and five sub-themes were identified, including ethical conflicts (the conflict between self-care and comprehensive patient care, prioritization of life, and inadequate care) and inequalities (intra- and inter-professional inequalities). The findings demonstrated that the nurses' care is a prerequisite for the patients' care. Considering that the ethical challenges faced by nurses are related to unacceptable working conditions, organizational support, and lack of access to facilities such as personal protective equipment, it seems essential to support nurses and provide adequate working conditions to provide patients with quality care.

Nurse-Patient Communication and Relationship When Wearing Personal Protective Equipment: Nurses' Experience in a COVID-19 Ward.

Little is known about which communication strategies nurses carried out and whether the nurse-patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse-patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme 'The in-out relationship: 'in here and out there' and 'inside me and out of me' included the main themes 'A closed system different from normal', 'Uncovering meaningful human gestures', and 'A deep experience to live''. The relational nature of nursing-where 'me and you' and the context are the main elements-leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care.

Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave).

The COVID-19 pandemic has led to significant challenges for frontline healthcare workers' (FHW), raising many mental health and wellbeing concerns for this cohort. To facilitate identification of risk and protective factors to inform treatment and interventions, this study investigated key predictors of psychological distress and subjective wellbeing in FHWs. During the Omicron wave of the COVID-19 pandemic (January 2022), Victorian (Australia) doctors, nurses, allied health and non-medical staff from Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), Coronavirus Health Impact Survey tool (COVID-19 related factors) and occupational factors. Multivariable linear regressions were used to evaluate unadjusted and adjusted associations. Relative weight analysis was used to compare and identify key predictors. Out of 167 participants, 18.1% screened positive for a probable mental illness and a further 15.3% screened positive for low wellbeing. Key risk factors for greater psychological distress included COVID infection worries, relationship stress and younger age. For both psychological distress and lower wellbeing, health status and supervisor support were key protective factors, while infection risks were key risk factors. Only positive changes in relationship quality was protective of lower wellbeing. This study highlights the significance of social determinants and individual level factors alongside work related factors, in influencing FHWs' mental health and wellbeing during public health crises, such as the COVID-19 pandemic. Findings suggest that future interventions and supports should take a more holistic approach that considers work, social and individual level factors when supporting FHWs' mental health and wellbeing.

A Qualitative Study to Assess the Experience of Midwives Caring for Women in COVID-19 Wards

Abstract Background: The COVID-19 pandemic has created unique challenges to the world, especially for the healthcare professionals. Although nurses are well able to think outside the box and develop creative and innovative solutions to all manner of problems and are able to cope up to the situation, there remains much about this current situation that is new and frightening. Like anyone else nurses are also experiencing fear of the unknown. Hence, the investigator was interested to know the experience of midwives working at a tertiary care hospital, South India, so that appropriate measures will be taken to help the midwives to face the crisis. Objective: The objective of this study is to explore the unique experiences of the midwives while caring for women in COVID-19 wards and identify the themes related to it during the crisis which will help the health professionals to understand and tailor interventions in the healthcare setting. Methods: The data in this study were generated by in-depth one-to-one, face-to-face interview with the midwives who fulfil the inclusion criteria until data saturation was achieved. A semi-structured questionnaire was used to elicit participants experience in COVID-19 wards. The sample size was 20. Analysis: Data from the translated interviews were coded and categorised to identify the themes. The unique experiences of midwives while caring for COVID-19 patients were presented as research reports. Results: The results of the qualitative study were categorised under four themes such as resistance and hesitation, acceptance, adaptation and recognition. Initially, the midwives were having resistance and hesitation, which was due to the various fears, lack of self-confidence and burden of personal protective equipment. Although they had hesitation and resistance, they started to accept the situation understanding that as frontline health workers they cannot escape the situation hence worked under pressure, in spite of lack of support, facility and the stigma around them. As they accepted to work, they were able to adapt to the situation by taking care of themselves. Conclusion: The qualitative study helped to explore the experiences of the midwives while caring for COVID-19 suspected and affected woman which has brought to the notice of the administrators the needs of the midwives so that appropriate interventions can be planned.

Ease of Intubation with McGrath Videolaryngoscope and Incidence of Adverse Events During Tracheal Intubation in COVID-19 Patients: A Prospective Observational Study.

Tracheal intubation in critically ill patients remains high-risk despite advances in equipment, technique, and clinical guidelines. Many patients with COVID-19 were in respiratory distress and required intubation that is considered an aerosol-generating procedure (AGP). The transition to videolaryngoscopy as a routine first line option throughout anesthetic and ICU practice has been reported. We evaluated the ease of intubation, success rate, use of accessory maneuvers and adverse outcomes during and 24 hours after intubation with the McGrath videolaryngoscope. This was a prospective, observational single center study conducted at non-operating room locations that included all adults (>18 years old) with suspected or confirmed COVID-19 infection and were intubated by McGrath videolaryngoscope. The anesthesiologist performed tracheal intubation were requested to fill online data collection form. A co-investigator was responsible to coordinate daily with assigned consultants for COVID intubation and follow up of patients at 24 hours after intubation. A total of 105 patients were included in our study. Patients were predominantly male (n=78; 74.3%), their COVID status was either confirmed (n=97, 92.4%) or suspected (n=8, 7.6%). Most were intubated in the COVID ward (n=59, 56.2%) or COVID ICU (n=23, 21.9%). The overall success rate of intubation with McGrath in the first attempt was 82.9%. The glottic view was either full (n=85, 80.95%), partial (n=16, 15.24%) or none (n=4, 3.81%). During intubation, hypoxemia occurred in 18.1% and hypotension in 16.2% patients. Within 24 hours of intubation, pneumothorax occurred in 1.9%, cardiac arrest and return of spontaneous circulation in 6.7% and mortality in 13.3% of patients. These results illustrate the ease and utility of the McGrath videolaryngoscope for tracheal intubation in COVID-19 patients. Its disposable blade is of significant value in protectin during tracheal intubation.

The Grief, Impact of Event and Coping Strategy among Doctors Working on COVID-19 Ward: An Online Survey in India

Abstract Objectives: In this cross-sectional study, we intended to assess grief, impact of event, and coping strategies of doctors who were working in the COVID-19 ward/intensive care unit (ICU), and to compare it with controls (people not working in COVID-19 ward/ICU). Methods: Online survey was done in the western state of India. Study participants completed structured quantitative interview for grief, Impact of Event Scale Revised and Brief Cope Inventory (BCOPE). Results: We found that 11 study doctors (9.8%) had severe grief (n = 112) and 28 controls (27.2%) had severe grief. We also found that 28 study doctors (25%) and 58 controls (56.3%) had a severe impact of event. Overall grief (t = −3.75) and impact of event (t = −5.07) were significantly higher in controls than doctors (p &lt; 0.001). Hyperarousal type of impact of event significantly predicted grief in study doctors (β = 0.450, p &lt; 0.01). A higher level of avoidance type of impact of the event (β = 0.430, p &lt; 0.001), a higher level of seeking social support type of coping strategies (β = 0.190, p &lt; 0.05), and lesser level of problem-solving type coping (β = −0.193, p &lt; 0.05) significantly predicted a higher level of grief in controls. Conclusion: We found a clear evidence of higher grief and event impact in controls than in study doctors. In this study, doctors, who had experienced the hyperarousal type of impact of event predicted the development of grief, whereas, in controls, the avoidance type of impact of event predicted grief. In the study doctors, self-distraction and self-blame were the coping mechanisms associated with more severe grief, while coping with humor lessened grief. Self-blame coping increased grief in controls, and a higher seeking of social help and less problem-solving could predict grief. In the study of doctors, the most commonly used coping strategies were acceptance, positive reframing, and religion, while controls used acceptance, positive reframing, and active coping.

Exploring heterogeneity in reported venous thromboembolism risk in COVID-19 and comparison to other viral pneumonias: a systematic review and meta-regression

BackgroundSources of heterogeneity in venous thromboembolism (VTE) risk in COVID-19 are unclear and comparisons to other viruses are lacking. ObjectivesTo describe VTE risk in patients with COVID-19, explore sources of heterogeneity, and make comparisons with other viral pneumonia. MethodsPubMed and Embase data were searched on March 14, 2021, for studies on VTE in adults hospitalized with viral pneumonia. VTE risk estimates were pooled in a random effects meta-analysis stratified by virus type. Heterogeneity in COVID-19 was explored in multivariable meta-regression. ResultsSeventy studies in COVID-19 (intensive care [ICU] [47] vs ward [23]), 4 studies in seasonal influenza (ICU [3] vs ward [1]), 2 ICU studies in H1N1 and 1 ICU study in SARS-CoV-1 were included. For COVID-19 ICU, pooled VTE risk was 19.6% (95% confidence interval [CI], 16.2%–23.5; I2 = 92.8%) for nonscreening studies and 30.0% (95% CI, 17.9%–45.7%; I2 = 81.9%) for screening studies. For COVID-19 ward, pooled VTE risk was 3.4% (95% CI, 2.4%–4.7%; I2 = 91.3%) and 22.5% (95% CI, 10.2%–42.7%; I2 = 91.6%) for nonscreening and screening studies, respectively. Higher sample size was associated with lower VTE risk. Pooled VTE risk in seasonal influenza and H1N1 at ICU were 9.0% (95% CI, 5.6%–14.2%; I2 = 39.7%) and 29.2% (95% CI, 8.7%–64.2%; I2 = 77.9%), respectively. At ward, VTE risk of seasonal influenza was 2.4% (95% CI, 2.1%–2.7%). In SARS-CoV-1, VTE risk was 47.8% (95% CI, 34.0–62.0). ConclusionPooled risk estimates in COVID-19 should be interpreted cautiously as a high degree of heterogeneity is present, which hinders comparison to other viral pneumonia. The association of VTE risk in COVID-19 to sample size suggests publication bias.

Clinical features and short-term clinical outcomes in Covid-19 infected Adult Population during fourth wave

Objective: To evaluate the clinical characteristics and comorbidities in COVID 19 patients and analyze its impact on outcome of COVID 19 during fourth wave. Study Design: Prospective observational study. Place and Duration: Department of Medicine of Fazaia Ruth Pfau Medical College for six months i.e. from 1st June 2021 to 1st December 2021 during fourth wave of Covid 19. Methodology: The patients with confirmed nasal swab test in SARI specialized acute respiratory illness unit of hospital (report available within 12 hours) were included in the study who required admission in medical COVID ward or intensive care unit. For data collection two residents were trained and assigned to collect the data by recording history of clinical features, comorbidities. Their physical examination along with vitals, oxygen saturation, and relevant laboratory workup was carried out. They recorded all the investigations carried out in admitted patients and observed them till they got better and discharged or could not survive. Results: A total of 113 patients were enrolled, mean age of recovered patients in our study was 45.99 ± 17.80 years whereas for expired it was 71.38 ± 11.62 years (p value &lt;0.05). In the recovered group 70.10% (68) were males and 29.90 %( 29) were females whereas expired group included 62.50% (10) males and 37.5% (6) females. Fever, cough and body aches were observed in 72.57%, 49.56% and 46.02% respectively in recovered patients and 11.50%, 9.73% and 8.85% respectively in expired patients. Diabetes mellitus, hypertension and ischemic heart disease were found as comorbidities in 5.31%, 8.85% and 2.65% of recovered patients’ whereas18.75 %, 6.25% and18.75 % in expired group respectively. Conclusion: Our findings suggest that patients with COVID-19 who have presented with shortness of breath and have diabetes mellitus or ischemic heart disease are at increased risk of mortality. These patients should be closely monitored and provided with appropriate supportive care. Keywords: Clinical Features, Comorbidities, COVID 19, Outcome. How to Cite This: Zahra f, kidwai SS, Ahmed A, Umar M, Waseem F, et al. Clinical features and short-term clinical outcomes in Covid-19 infected adult Population during fourth wave. Isra Med J. 2023; 15(1): 20-24. DOI: https://doi.org/10.55282/imj.oa1359. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Clinical features and short-term clinical outcomes in Covid-19 infected Adult Population during fourth wave

Objective: To evaluate the clinical characteristics and comorbidities in COVID 19 patients and analyze its impact on outcome of COVID 19 during fourth wave. Study Design: Prospective observational study. Place and Duration: Department of Medicine of Fazaia Ruth Pfau Medical College for six months i.e. from 1st June 2021 to 1st December 2021 during fourth wave of Covid 19. Methodology: The patients with confirmed nasal swab test in SARI specialized acute respiratory illness unit of hospital (report available within 12 hours) were included in the study who required admission in medical COVID ward or intensive care unit. For data collection two residents were trained and assigned to collect the data by recording history of clinical features, comorbidities. Their physical examination along with vitals, oxygen saturation, and relevant laboratory workup was carried out. They recorded all the investigations carried out in admitted patients and observed them till they got better and discharged or could not survive. Results: A total of 113 patients were enrolled, mean age of recovered patients in our study was 45.99 ± 17.80 years whereas for expired it was 71.38 ± 11.62 years (p value &lt;0.05). In the recovered group 70.10% (68) were males and 29.90 %( 29) were females whereas expired group included 62.50% (10) males and 37.5% (6) females. Fever, cough and body aches were observed in 72.57%, 49.56% and 46.02% respectively in recovered patients and 11.50%, 9.73% and 8.85% respectively in expired patients. Diabetes mellitus, hypertension and ischemic heart disease were found as comorbidities in 5.31%, 8.85% and 2.65% of recovered patients’ whereas18.75 %, 6.25% and18.75 % in expired group respectively. Conclusion: Our findings suggest that patients with COVID-19 who have presented with shortness of breath and have diabetes mellitus or ischemic heart disease are at increased risk of mortality. These patients should be closely monitored and provided with appropriate supportive care. Keywords: Clinical Features, Comorbidities, COVID 19, Outcome. How to Cite This: Zahra f, kidwai SS, Ahmed A, Umar M, Waseem F, et al. Clinical features and short-term clinical outcomes in Covid-19 infected adult Population during fourth wave. Isra Med J. 2023; 15(1): 20-24. DOI: https://doi.org/10.55282/imj.oa1359. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Molecular epidemiology of carbapenem-resistant Enterobacteriaceae isolated from patients in COVID-19 wards and ICUs in a Bulgarian University Hospital.

Many studies report an increase in antimicrobial resistance of Gram - negative bacteria during the COVID-19 pandemic. Our aim was to evaluate the epidemiological relationship between carbapenem-resistant (CR) Enterobacteriaceae isolates from patients in COVID-19 wards and to investigate the main mechanisms of carbapenem resistance in these isolates during the period April 2020-July 2021. A total of 45 isolates were studied: Klebsiella pneumoniae (n = 37), Klebsiella oxytoca (n = 2), Enterobacter cloacae complex (n = 4) and Escherichia coli (n = 2). Multiplex PCR was used for detection of genes encoding carbapenemases from different classes (blaKPC, blaIMP, blaVIM, blaNDM, blaOXA-48). For epidemiological typing and analysis, ERIC PCR was performed. Two clinical isolates of E. cloacae, previously identified as representatives of two dominant hospital clones from the period 2014-2017, were included in the study for comparison. In the CR K. pneumoniae group, 23 (62.2%) carried blaKPC, 13 (35.1%) blaNDM, 10 (27.0%) blaVIM, and 9 (24.3%) were positive for both blaKPC and blaVIM. The blaKPC was identified also in the two isolates of K. oxytoca and blaVIM in all E. cloacae complex isolates. The two CR isolates of E. coli possessed blaKPC and blaOXA-48 genes. Epidemiological typing identified 18 ERIC profiles among K. pneumoniae, some presented as clusters of identical and/or closely related isolates. The carbapenem resistance in the studied collection of isolates is mediated mainly by blaKPC. During the COVID-19 pandemic intrahospital dissemination of CR K. pneumoniae, producing carbapenemases of different molecular classes, as well as continuing circulation of dominant hospital clones of multidrug-resistant E. cloacae complex was documented.

The COVID-19 pandemic impact on the Polish medical personnel work: a survey and in-depth interviews study.

The objective of the study was to examine the impact of the COVID-19 pandemic on the work of medical personnel in terms of: task scope, preparation to perform medical tasks related to the pandemic, team collaboration, involvement in tasks performed, concerns about performing tasks related to the pandemic, stress levels. The mixed-method approach was applied to this cross-sectional study. The online questionnaire which included 40 questions was completed via Google among medical personnel in Poland. Eight semi-structured, in-depth interviews were conducted to deepen the data obtained with the questionnaires. The questionnaire was completed by 215 healthcare professionals, with the largest group being nurses (56.3%) followed by physicians (22.3%), midwives (11.6%) and other healthcare professionals (e.g., physiotherapists, paramedics, nutritionists - 9.8%). Among the respondents were people who worked in the hospital in the so-called "covid wards" (31.2%) and other hospital wards (60%) as well as people who were employed outside the hospital (8.8%). The pandemic affected the nature and range of tasks performed by health professionals. Initially, respondents felt unprepared to work under pandemic conditions, but over time their ratings increased in all areas studied. More than half of respondents reported no change in interpersonal relationship within the team, but nearly 35% noted a worsening and only one in 10 claimed improvement. Study participants rated their own commitment to tasks slightly higher than that of their colleagues (mean 4.9 and 4.4 respectively) but the overall rating was high. The mean self-rating of work stress increased from 3.7 before the pandemic to 5.1 during the pandemic. Most of the respondents were afraid of transmission of the infection to their relatives. Other fears included the possibility of making a medical error, not being able to help the patient, not having enough personal protective equipment (PPE) and contracting SARS-CoV-2. The conducted study revealed that the organization of medical care in the initial period of the pandemic, especially the hospital care of patients infected with SARS-CoV-2, was quite chaotic. The most affected were the people who were transferred to work in the covid wards. Not all medical professionals were prepared to work with the COVID-19 patients, as they lacked experience working in such facilities, especially in intensive care units (ICU). Working under time pressure and under new conditions led mainly to an increase in perceived stress and conflicts between staff.