COVID-19 Units Research Articles

Life-Threatening Spontaneous Hematoma in Unusual Sites in Patients with COVID-19 on Anticoagulant Therapy: A Case Series

Thromboembolic manifestations are a common phenomenon in patients affected by corona virus (SARS CoV-2). Recent studies have shown that patients with acute renal failure are also at a greater risk of venous and arterial thromboembolism, 15-30% in ICU, and 7% inpatient care. However, frequently unjudicial use of anticoagulants may develop severe life-threatening hematoma. In our hospital settings we had a dedicated COVID Unit with a Hemodialysis facility. Our Nephrology department had managed 381 patients being COVID positive along with renal impairment from March 2020 to January 2022. Among these patients, four patients developed spontaneous non traumatic hematoma in unusual sites. On admission all the patients received treatment according to our national guidelines for COVID-19. Cases: It is a retrospective analysis in a single-centered hospital. Four cases with confirmed COVID-19 with acute kidney injury and on anticoagulant therapy had developed sudden concealed bleeding. These patients had no previous history of anticoagulant therapy before admission. Case 1 developed hemorrhage in Right lower anterior paramedian deep parietal wall of abdomen, Case 2 had hematoma in retroperitoneal space and in lower third of Iliopsoas, Case 3 developed hemorrhage in left cerebral hemisphere, Case 4 had Intramuscular Hematoma in left rectus abdominis. Out of these four patients two of them required Hemodialysis and one of them went into shock. All patients included were male. The mean age was 57±19.64years. All the four patients were initially managed conservatively with keen monitoring and with proper volume resuscitation, blood transfusion and discontinuation of the anticoagulants. Three of the patients survived with conservative management and one patient died due to sudden massive cardiac arrest. The use of therapeutic anticoagulant can increase the risk of bleeding in atypical sites and may exhibit higher patient death with COVID-19 if not identified at early stage. So a risk-benefit ratio of usage of anticoagulants should be kept in mind and further clinical trials needed to justify its random use in COVID-19. J Bangladesh Coll Phys Surg 2024; 42: 393-400

Managing COVID-19 patients with mental illness in a specialized neuropsychiatric setting: An experience from a tertiary care hospital in India.

To explore the management and outcome of COVID-19 infection in mental illness at a specialized neuropsychiatric setting. A retrospective review of the clinical profile of 100 COVID-19 patients with mental illness, admitted to the Psychiatric COVID unit (PCU) from June 2020 to June 2022, was done, with a subgroup analysis of chronic institutionalized patients (n = 36). Schizophrenia, bipolar affective disorder, and schizoaffective disorder comprised 64% of the study population. Most patients (87%) were on antipsychotics. 56% of the patients had an infection of mild severity and 38% were asymptomatic. Corticosteroids and anticoagulants were given to 33.3% and 25% of the patients, respectively. 16% of the patients encountered medical complications in the PCU, and 14% were referred to a COVID-designated hospital. Patients with diabetes mellitus and/or hypertension were more likely to be referred. The chronic institutionalized patients (n = 36) had either an asymptomatic or mild infection. Three among these patients were referred to a COVID-designated hospital. Most psychiatric patients with medical illnesses, including COVID-19, pose unique challenges including complexity of symptoms, ensuring patient safety, and the need for trained professional staff to provide specialized psychiatric interventions, which can be taken care of in psychiatric care settings.

Function and activity capacity at 1 year after the admission to intensive care unit for COVID-19

Objective To describe hand grip strength, walking speed, functional mobility, and postural control at one year following intensive care unit admission for COVID-19, and to find any predictors that are associated with impaired hand grip strength, walking speed, functional mobility, or postural control at the 1-year follow-up. Design Retrospective cross-sectional and longitudinal observational study. Setting Intensive care unit and outpatient research clinic at Sahlgrenska University Hospital. Participants Of the 105 individuals in “The Gothenburg Recovery and Rehabilitation after COVID-19 and Intensive Care Unit” cohort, 78 participated in this study. Main measures Descriptive statistics for hand grip strength, walking speed, functional mobility, and postural control were presented and binary logistic regressions were performed to find their significant predictors. Results At 1-year following intensive care unit admission for COVID-19, impaired hand grip strength was found in 24.4% for the right hand and 23.1% for the left hand. Walking speed, functional mobility, and postural control were found to be impaired in 29.5%, 21.8%, and 5.1%, respectively. For impaired walking speed, longer length of stay at intensive care unit and presence of diabetes mellitus were risk factors. Diabetes mellitus was found to be the risk factor for impaired functional mobility. Conclusion In this study, 45% of the participants showed impairment in function, activity capacity or both. These results suggest that individuals who recovered after intensive care unit admission for COVID-19 would benefit from receiving long-term follow-up to enable identification of those with need of physical health assistance and rehabilitation.

In-depth mixed-method case study to assess how to support and communicate with the families of hospitalised patients during COVID-19: a social innovation embedded in clinical teams

ObjectivesThe purpose of this study is to describe and evaluate, in a real-life context, the support and communicate with families (SCF) team’s contribution to maintaining communication and supporting relatives when...

Mortality Impact of Severe COVID-19 in the ICU: A Study from the Târgu Mureș Support Unit.

(1) Background: Since the onset of the COVID-19 pandemic, it has been recognized that a considerable proportion of critically ill patients may die of this disease. The current study aims to assess the overall 1-year outcomes within the UMFST COVID-19 Unit, providing valuable insights into the efficacy of specialized care facilities in managing severe cases of COVID-19. (2) Methods: This is a retrospective monocentric observational study including 294 patients confirmed to have SARS-CoV-2 infection. Demographic data and clinical and paraclinical parameters were assessed. Survival probabilities were estimated using Kaplan-Meier curves. (3) Results: Overall, the 1-year mortality was 89.4%. All deaths occurred in-hospital, with two patients dying after 28 days. Diabetes mellitus, chronic kidney failure, cerebrovascular disease, and atrial fibrillation were more prevalent in deceased patients. Thirty percent of patients needed endotracheal intubation during the first 24 h. The incidence of hospital-acquired pneumonia was higher among deceased patients. The SOFA score was significantly different between deceased vs. survivors. The survival analysis showed that the use of noradrenaline increased the likelihood of surviving COVID-19. (4) Conclusions: The severe comorbidities of the patients were the primary factors contributing to the increased mortality rate in the COVID-19 unit.

High dose cotrimoxazole treatment in patients with severe COVID-19: A randomised controlled trial

Background: Cotrimoxazole for severe COVID-19 may have a better prognosis because of its antibacterial, immunomodulatory, and anti-inflammatory activities. We examined the efficacy of high-dose cotrimoxazole therapy in terms of duration of hospital stays and reduction in mortality in severe COVID-19 infections. Methods: From May to November 2021, we conducted a double blind randomised controlled trial with two parallel groups in the COVID units of Bangabandhu Sheikh Mujib Medical University and Anwar Khan Modern Medical College Hospital, Dhaka. One group received standard therapy in addition to an oral dose of 960 mg of cotrimoxazole twice daily for 7 days (intervention group), while the other group received standard treatment and a placebo (standard group). Pre-protocol analysis was done. Results: A total of 188 patients were enrolled, but 166 completed the study. Of them, 93 were in the intervention group and 73 were in standard group. The mean ages of the groups were similar (intervention, 56.2 and standard, 59.2 years) (P=0.10). The mortality at 28 days between groups was also similar (11.8% in the intervention group and 15.0% in the standard group) (P=0.56). The hospital stay was 13.7 days for the intervention group and 13.5 days for the standard group (P=0.86). However, the reduction in C-reactive protein was statistically significant in the intervention group, with a mean decline of 23.6 mg/L (95% confidence interval, 0.5–46.7 mg/L). Conclusion: High-dose cotrimoxazole did not benefit in shortening in-hospital stay or reducing mortality at day 28 in patients with severe COVID-19. However, the decline in the C-reactive protein level was significant, necessitating further research.

Role of Carcinoembryonic Antigen in Severity Assessment and Mortality Prediction in COVID-19 Patients.

Background Early risk stratification of COVID-19 may yield a better prognosisby tailoring effective treatment strategies. Recent studies have identified that elevated carcinoembryonic antigen (CEA) has prognostic value in terms of disease severity and mortality in patients with pneumonia. This study aims to explore the potential of CEA as a marker for both severity assessment and mortality prediction in COVID-19 patients. Methods From August 2020 to October 2021, we conducted this observational study in which patients who tested positive for COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) or had high-resolution computed tomography (HRCT) chest suggestive of COVID-19 were includedon day 0 of their admission to the COVID unit. Patients were classified into mild, moderate, severe, and critical according to the World Health Organization (WHO) guidelines. Blood samples were collected for complete blood count (CBC), C-reactive protein (CRP), ferritin, and CEA on days 0, 3, 7, and 14 of admission. The patient's profile was used to obtain lactate dehydrogenase (LDH), D-dimer, and HRCT scores [based on COVID-19 reporting and data system (CO-RADS) grade]. We used receiver operating characteristic (ROC) curves with Youden's index to find the initial (day 0) critical values of CEA for each of mild, moderate, severe, and critical COVID-19. The Kaplan-Meier survival curve was used to predict mortality with the best initial(day 0) cut-off value of CEA. Results Among 75 patients in this study, 15, 20, 19, and 21 were in the mild, moderate, severe, and critical groups, respectively;most were male (68%), and mortality was 18 (24%). Spearman's rank correlation test demonstrates a strong correlation between COVID-19 severity and changes in CEA. In the ROC curves, the area under the curve (AUC) value of CEA was higher among markers in all classifications except for mild to moderate disease. The AUC and critical values of CEA were as follows: for mild to moderate (0.948), 2.5 ng/ml; moderate to severe (1.000), 6.02 ng/ml; and severe to critical (0.769), 11.75 ng/ml. The survival curve shows the best initial cut-off values for mortality outcomes: CEA ≥7.15, CRP ≥81.52, ferritin ≥680.68, lymphocyte percentage ≤7.5, and neutrophil lymphocyte ratio ≥12.7. Conclusions The initial levels of CEA can serve as markersfor severity assessment and mortality outcome prediction of COVID-19.

Risk factors for infection after carbapenem-resistant Acinetobacter baumannii colonization

PurposePredicting infection risk in carbapenem-resistant Acinetobacter baumannii (CRAB) colonized patients may help in improving timely appropriate antibiotic therapy. This study aims to explore risk factors for developing infections in hospitalized patients with previous CRAB colonization.MethodsWe performed an observational retrospective cohort study at ASST Sette Laghi-Varese Hospital between January 2020 and December 2022. All consecutive adult (> 18 years old) hospitalized patients with documented colonization by CRAB at any anatomical site or with CRAB infections preceded by CRAB colonization were included. Univariate and multivariate analyses were performed to investigate infection risk factors.ResultsOverall, 144 patients were included in the study: 104 colonized only and 40 infected patients. Colonization and infection rates significantly changed over the years (2020–2022, p < 0.001). The incidence of infections in CRAB carriers was 27.8% (40/144). Median time from colonization to infection was 4 days (IQR 1-8.5). Overall, inhospital mortality was 32.7% and 55.0% in colonized only and infected patients, respectively. At the multivariable logistic regression cardiovascular disease (OR 5.83, 95% CI 1.12–30.43, p = 0.037), COVID-19 (OR 3.72, 95% CI 1.16–11.91, p = 0.027) and intensive care unit (ICU) admission (OR 8.83, 95% CI 2.94–26.51, p < 0.001) were risk factors independently associated with cardiovascular disease CRAB infection after colonization.ConclusionsWe observed an increased infection risk in patients colonized with CRAB with cardiovascular disease, COVID-19 and admitted in ICU setting. Additional evidence is needed to identify predictors of infection in colonized patients.

Nurse experiences and perspectives with missed nursing care during COVID-19: A qualitative study.

This study aimed to determine clinical nurse and nurse manager perspectives on missed nursing care (MNC) during the COVID-19 pandemic. This study utilized a qualitative exploratory descriptive design. Data were obtained through focus groups and virtual interviews. Purposive sampling was used to select nurse and nurse manager participants in COVID-19 units and the Emergency Department in one large healthcare organization in the northeastern United States of America. A total of 15 nurses and nurse managers participated in the study. Results revealed five categories: medication delivery, turning patients, double checks, communication and rapport, and patient surveillance. A variety of factors contributed to the perceptions and experiences of MNC of COVID-19 patients during the early stage of the pandemic. The COVID-19 crisis put additional and unparalleled pressure on a strained nursing workforce. Hospital leaders are responsible for ensuring their frontline nurses have the resources they need to feel supported in their roles regardless of the presenting circumstances. Nurse leaders should employ evidence-based strategies such as promoting and championing teamwork to support staff and reduce incidences of MNC during crises. Our current work may serve as a basis for informing future revisions of pre-pandemic measurement tools when applied in a pandemic-specific context. This manuscript adheres to the standards for reporting qualitative research (SRQR); a synthesis of recommendations. There was not patient or public contribution for this study.

Use of Melaleuca Essential Oil in Healing Pressure Injuries (LP): Case Series

To monitor and describe the healing process of pressure injuries (PI) grades I, II, III, and IV using tea tree essential oil (TTEO). A descriptive-exploratory study, using a multiple case study approach, was developed by monitoring patients with PI at different stages in a teaching hospital in the interior of Rio Grande do Sul, Brazil, from July to October 2021. The Bates-Jensen Wound Assessment Tool (BWAT) was used to assess wound characteristics. The study included 11 male patients hospitalized in the Intensive Care Unit (ICU) and the COVID-19 and clinical-surgical inpatient unit, with eleven PIs predominantly grade III in the sacral region. Regarding the characteristics evaluated by BWAT, a favorable progression in the lesions was observed in the following items when comparing the first and third days of TTEO use: peripheral skin color, exudate type, granulation tissue, wound edges, exudate amount, and epithelialization. However, an increase in scores was noted for necrotic tissue amount, undermining, necrotic tissue type, size, and depth, indicating regression in these aspects. The pharmaceutical formulations used in this study not only highlighted the benefits of TTEO in the healing process but also reinforced its advantages for being natural and more cost-effective compared to existing commercial formulations on the market.

Post COVID Guillain Barre Syndrome (GBS) in paediatric COVID unit of Dhaka Medical College: A case series

SARS Cov-2 infection presents with mild respiratory illness but has evidence of multisystem involvement in little percentage, though the severity of infection is variable in children. Neurological manifestations may vary from headache, dizziness, olfactory or taste dysfunction to specific syndromes including meningoencephalitis, stroke, and acute transverse myelitis and Guillain- Barre syndrome (GBS). But there is little evidence worldwide about neurological complications of COVID-19 in children. Here we reporting five cases of post COVID-19 GBS with relevant literature review. J Dhaka Med Coll. 2022; 31(2) : 232-236

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

&amp;lt;i&amp;gt;Introduction: &amp;lt;/i&amp;gt;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. &amp;lt;i&amp;gt;Objective: &amp;lt;/i&amp;gt;The aim of this study was to determine the outcome of RT-PCR of the patients with COVID-19 symptoms. &amp;lt;i&amp;gt;Methodology: &amp;lt;/i&amp;gt;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 &amp; Life Science, University of South Asia, and Dhaka, Bangladesh. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;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 &amp;gt;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%) &amp;lt;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. &amp;lt;i&amp;gt;Conclusion: &amp;lt;/i&amp;gt;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.

The Role of Obesity in the Poor Prognosis of COVID-19 Infection: A Review of 192 Patients.

We performed a retrospective study on all patients having COVID-19 infection and admitted to our institution between March 2020 and June 2021. Inclusion criteria included any patient over the age of 18 admitted to our institution's COVID-19 unit, or intensive care unit, with a positive COVID-19 PCR or positive COVID-19 serology (IgM). 192 patients met the inclusion criteria, with an average age of 62.68 years and a slight male predominance (64.58%). 76.04% of hospitalized patients and 80% of those admitted to the ICU were either overweight or obese. No statistically significant difference was found regarding the risk of in-hospital mortality and invasive ventilation. The same applies to the length of stay, admission to intensive care, O2 needs, and for the various complications (all p values were >0.05). Patients with obesity type II and III have an increased risk of cardiac arrests and need for intubation and mechanical ventilation. Obesity tends to be a major risk factor for a pejorative evolution in the COVID-19 infection.

The role of platelet large cell ratio in determining mortality in COVID-19 patients.

Inflammatory mechanisms have been implicated and have been subject to research in the clinical course of COVID-19 patients. In this study, platelet large cell ratio (P-LCR) has been examined as a novel prognostic and inflammatory parameter. A total of 1992 COVID-19-positive patients admitted to COVID-19 unit of Infectious Diseases were included. In order to identify a potential relationship between P-LCR and mortality, surviving patients were compared with subjects who died as a result of the disease. Although P-LCR levels showed a steady increase in all COVID-19 patients after admission, they were significantly higher in those who eventually died (P < .001), indicating a positive correlation between mortality and P-LCR. The P-LCR levels of patients followed up in the intensive care unit were statistically significantly higher than those followed up in the ward (P < .001). P-LCR levels of patients intubated in intensive care unit were statistically significantly higher than those who were not intubated (P < .001). Also, P-LCR levels were subdivided into 3 categories as normal, low, and elevated. Elevated P-LCR was found to be positively correlated with leukocyte count, neutrophil count, D-dimer, troponin, ferritin, and C-Reactive Protein (CRP) and showed negative correlation with fibrinogen, lymphocyte count, and platelet count. As P-LCR was correlated with the severity of inflammation in all COVID-19 patients, it was significantly higher in those patients who died. Elevated P-LCR was considered to be associated with the risk of severe disease and death. This inexpensive, readily available test may be incorporated into our clinical practice as a novel marker of poor prognosis in addition to other valuable laboratory parameters.

The financial burden of SARS-CoV-2 pregnancies in a tertiary exclusive COVID-19 maternity.

The COVID-19 pandemic had a major impact on health systems worldwide, and Romania was no exception. The impact on healthcare expenses for pregnant women was considerable, especially in COVID-19-only tertiary centers. This study aimed to analyze the impact of the COVID-19 pandemic on healthcare costs in a designated COVID-19 maternity ward. We conducted an observational study comparing pregnant women with SARS-CoV-2 (study group) to those without the infection (control group). Patients were recruited at Bucur Maternity Hospital from March 2020 to March 2022. We evaluated expenses for the entire period of hospitalization, treatment, medical supplies, and medical investigations. The study included 600 pregnant women, divided equally into two groups of 300 each. Significant cost differences were observed between the COVID-19 and non-COVID-19 groups: medication costs (664.56 EUR vs. 39.49 EUR), administrative costs (191.79 EUR vs. 30.28 EUR), and medical investigation costs (191.15 EUR vs. 29.42 EUR). The costs for a severe case of COVID-19 were about two times higher than a mild case and 70 times higher than a non-COVID-19 case (P <0.001). We identified a significant cost increase due to SARS-CoV-2 infection in our unit. The expenses were augmented by the time of hospitalization, medication, and medical investigations. COVID-19 had a significant impact on healthcare costs, mostly among pregnant women with severe disease. The strategy of operating exclusively as a COVID-19 unit proved to be inefficient and highly costly to our hospital.

Impact of influenza vaccination history in the clinical course of older adults hospitalized with COVID-19

Background and purposeSome studies have shown that influenza vaccination is associated with a lower risk of SARS-CoV-2 infection; in patients with COVID-19 infection, admission to intensive care is reduced, with less need for mechanical ventilation, shorter hospital stays, and reduced mortality. This study aimed to determine if a history of annual influenza vaccination impacts the clinical course of SARS-CoV-2 infection during hospitalization. MethodsThis was an observational, prospective, cohort study of patients older than 65 admitted to the COVID-19 unit from January to June 2021. The history of influenza vaccination over the last 5 years was assessed in each patient during hospitalization. We measured the length of hospital stay, the need for admission to the intensive care unit (ICU), the patient's oxygen requirements, complications during hospitalization, and outcome (medical discharge or death). Patients with a history of vaccination against SARS-CoV-2 were not included. ResultsWe analyzed 125 patients, 50.4% (n=63) with history of influenza vaccination and 49.6% (n=62) without a history of influenza vaccination. In-hospital mortality was 44.8%, higher in the unvaccinated (54.8%) population (p=0.008). ICU admission was 27% higher in vaccinated (35%) patients (p=0.05). Patients without a history of influenza vaccination had a higher prevalence of cardiac (8% vs. 5%, p=0.04) and renal complications (29% vs. 13%, p=0.02). Patients with a history of vaccination had a greater need for invasive mechanical ventilation (25.4%, p=0.02). ConclusionIn this study, a history of influenza vaccination in older adults with SARS-CoV-2 infection was related to lower in-hospital mortality.

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

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; 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 &amp; Life Science at the University of South Asia, located in Dhaka, Bangladesh&amp;lt;i&amp;gt;. Result:&amp;lt;/i&amp;gt; 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 &amp;gt;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%) &amp;lt;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. &amp;lt;i&amp;gt;Conclusions: &amp;lt;/i&amp;gt;This study investigated that the highest age group of COVID-19 positive cases was &amp;gt;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%).

Nurses' Views on Caring for Lonely Patients During the Pandemic: A Qualitative Study.

The implementation of safety measures in hospitals due to the COVID-19 pandemic, including family visitation restrictions, forced the family to be absent during the patient's hospitalization. Nurses were confronted with new roles and responsibilities, as caring for lonely patients was a new phenomenon that emerged during the pandemic. The purpose of this study was to explore the nurses' views on caring for lonely patients during the COVID-19 pandemic. A qualitative research method based on an inductive content analysis approach was used. Data collection was carried out using semi-structured interviews. The sample consisted of 11 nurses who worked in COVID-19 wards and units. Content analysis was used to analyze the interview data. The analysis of the data revealed three main themes: 1) caring for the patient and the family; 2) extending conventional care; and 3) developing supportive mechanisms for better care. Caring for lonely patients brought about changes in patients's management and care and significantly affected communication patterns as well as nurses' roles and responsibilities. Providing care beyond limits, supporting care through the utilization of new technologies, and transforming organization and care were mentioned as areas of challenge for nursing practice. Conclusions: Maintaining communication and supporting the family's involvement in patient care are considered to be equal to healing for the lonely patient. Reshaping working conditions and caring practices to meet the needs of the nurses, the patients, and their families during health crises may contribute positively to the provision of holistic care for patients and their families.

Impact of COVID-19 vaccination on liver transplant recipients. Experience in a reference center in Mexico.

COVID-19 vaccination has proved to be effective to prevent symptomatic infection and severe disease even in immunocompromised patients including liver transplant patients. We aim to assess the impact of COVID-19 vaccination on the mortality and development of severe and critical disease in our center. A retrospective cohort study of LT patients in a reference center between March 2020 and February 2022. Demographic data, cirrhosis etiology, time on liver transplantation, immunosuppressive therapies, and vaccination status were recorded at the time of diagnosis. Primary outcome was death due to COVID-19, and secondary outcomes included the development of severe COVID-19 and intensive care unit (ICU) requirement. 153 of 324 LT recipients developed COVID-19, in whom the main causes of cirrhosis were HCV infection and metabolic-associated fatty liver disease. The vaccines used were BNT162b2 (48.6%), ChAdOx1 nCoV-19 (21.6%), mRNA-1273 vaccine (1.4%), Sputnik V (14.9%), Ad5-nCoV-S (4.1%) and CoronaVac (9.5%). Case fatality and ICU requirement risk were similar among vaccinated and unvaccinated LT patients (adjusted relative case fatality for vaccinated versus unvaccinated of 0.68, 95% CI 0.14-3.24, p = 0.62; adjusted relative risk [aRR] for ICU requirement of 0.45, 95% CI 0.11-1.88, p = 0.27). Nonetheless, vaccination was associated with a lower risk of severe disease (aRR for severe disease of 0.32, 95% CI 0.14-0.71, p = 0.005). Vaccination reduces the risk of severe COVID-19 in LT patients, regardless of the scheme used. Vaccination should be encouraged for all.

Health professionals’ quality of life during the COVID-19 pandemic in the community: Impact on physical, mental, and social well-being

Background Severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) that caused the pandemic since March 2020, has affected among others, health professionals who work in coronavirus (COVID-19) units by facing social discrimination. The aim of this study was to record the experiences of health professionals working in the first line of treatment of the pandemic, to analyse the effects of the pandemic on the interpersonal relationships of health professionals, and to ask about the stigma they faced during their work with people with COVID-19. Methods This is a qualitative study with an ethnographic approach based on 160 semi- structured interviews with health professionals living and working in the Epirus Region, Greece. For data collection we used semi-structured interviews, discussions and participatory observation. Specifically, the interviews were conducted on health professionals and more specifically doctors, nurses, rescuers, physiotherapists and administrative staff, working in COVID-19 units at the University General Hospital of Ioannina (Reference hospital for Ioannina, in Epirus), which assists in the treatment of patients with COVID-19, and in the branch of the rescue department of Ioannina. Results The data were analysed in four thematic units based on their common characteristics: a) emotions and experiences of health professionals, b) interpersonal relations of health professionals, c) social exclusion and discrimination, and d) health professionals as patients. The results showed that the main emotions that health professionals experienced when they were moved to COVID-19 clinics were fear, anxiety, distress, anger and insecurity. Conclusions To conclude, health professionals faced discriminating behaviours and stigma both from their families and social environment, and from other health professionals. The government struggled to handle the situation in keeping a balance between both the security and well-being of health professionals as it was not prepared for a pandemic like this.