COVID-19 Units Research Articles

The pharmacy service facing the logistics of safely dispensing, storing and preserving drugs in healthcare units

In response to the SARS-CoV-2 pandemic, the Hospital Pharmacy Services have quickly adapted to respond to a critical situation characterized by the constant and continuous admission of patients with severe pneumonia who needed treatment, requiring a transformation of the hospital in order to increase the number of hospital and critical beds. Moreover, other out-of-hospital spaces have been transformed into hospitalization units to absorb the large number of patients that had to be treated and isolated.To guarantee the distribution of medicines and the quality of the pharmaceutical care, drug distribution systems, such as unit dose and automated dispensing systems, have undergone transformations. Standard stocks were assigned for COVID units, and different dispensing circuits to avoid the risk of cross-contamination between COVID and non-COVID units were created, as well as disinfection protocols for medication transport systems and medication return protocols. All this without forgetting COVID treatment protocol's changes that were affected by the availability of the drugs.The increase in the number of beds in out-of-hospital spaces, such as field hospitals, hotels, socio-medical centers and nursing homes, has challenged Pharmacy Services, since new medication dispensing and conciliation circuits have been created forcing the increase of pharmacy staff's presence and modifying work shifts, to afford all the new tasks successfully.Development of contingency plans for the different Pharmacy Service activities and providing fluent communication channels are key elements for crisis situations or health emergencies such as the current pandemic.

How is COVID nursing different? A phenomenological analysis of the nurses’ experience from a tertiary care COVID units

Healthcare workers face specific challenges during infectious disease outbreak. Along with fear of getting infection, performing new, unfamiliar tasks in unfamiliar setting with new outfit (PPE) complicates their working. We explore perceptions and lived experiences of front-line nurses who cared for COVI9-19 confirmed patients in a tertiary hospital of North India eighteen in-depth, telephonic, semi structured interviews were conducted. Interviews were transcribed and analysed using Colaizzi’s phenomenological method. Nurses were challenged by risk of infection or fear of transmission, working in a new setting, unfamiliar clinical roles, heavy workloads, ineffective communication and discomforts of protective gear. Despite facing various challenges, nurses showed great strength and resilience. Good administrative support, PPE surveillance, developing nurses’ task force with distinct responsibilities, orientation, training and empowerment are suggested strategies to overcome the challenges and enhance the resilience. Nurses lived experiences will be helpful to healthcare organizations preparing for or responding to outbreaks or disaster.

Epidemiological state, patient’s characteristics, and COVID-19 vaccination levels in Algeria

Since the global spread of the SARS-CoV-2 virus, responsible for COVID-19 disease, has been declared a “public health emergency of international concern” by the World Health Organization, epidemiological plans of control and investigation were established. In this study we aim to identify the epidemiological situation, mortality rates, and vaccination response in the population of Oum el Bouaghi, Algeria from March 2021 to March 2022. Clinical characteristics of COVID-19 confirmed cases, and vaccination data were collected from the Health and Population Directorate (HPD), as well as the COVID-19 unit in the Mohemed Boudiaf Public Hospital Establishment. The epidemiological profiles of the COVID-19 patients, along with cumulative number of people vaccinated depending on vaccine’s type were reported by numbers, percentages, curves and graphic histograms. The epidemiology of Covid-19 infection in Oum el Bouaghi, was similar to that recorded in many countries during the study period. It experienced two peaks, in August 2021 and in January 2022 which coincided with Delta and Omicron variants respectively. A total of 2068 COVID-19 cases were reported, with the average age of 54 and a female predominance (57%). Furthermore, people beyond the age of 40, especially over 65 years were the most hospitalized category (43% and 31% respectively), and presented the highest rate of morality (36% and 56% respectively).Among the 1510 hospitalized cases 169 (11%) patients passed away. They had a high profile of chronic diseases, especially cardiovascular diseases (high blood pressure/heart disease) 48% and diabetes 43%.Of a total of 84.047 people vaccinated, 59% were men, and 77% preferred Sinovac. People over 65 years had the highest vaccination rate (42%). People with chronic diseases accounted for 74% of the vaccinated population, clinicians and health professionals 7% and the rest of the population presented only 19%.In conclusion, People above 65 years with comorbidities appeared to be more susceptible to present the severe form of the infection. The quarantine adopted by Algeria and the strict precautionary measures has allowed the return to stability and a gradual reduction of positive cases. Additionally OEB had a medium participation in vaccination, with a dominance of people with chronic diseases. This perfectly meets the mechanism of COVAX and the indications of the Algerian High Authority of Health.

Impact of Immuno-Nutrition on the Nutritional Status, Inflammatory Response and Clinical Outcome of Clinic-Admitted Mild-Intensity-COVID-19 Patients: A Pilot, Perspective-Concluding Study.

The SARS-CoV-2 pandemic has impacted our lives since early 2020. Both malnutrition and an overweight status significantly correlate with worse patient outcomes and mortality. Immuno-nutrition (IN) has shown promising results in the inflammatory bowel disease (IBD) clinical course and the extubation time and mortality of patients admitted to intensive care units (ICUs). Thus, we wanted to assess the impact of a standardized IN oral formula on COVID-19 patients admitted to our mild-intensity clinic in late 2021. We prospectively enrolled patients admitted to the Internal Medicine COVID-19 Unit of San Benedetto General Hospital. All patients had biochemical, anthropometric, HRCT chest scan, and nutritional assessments at the time of admission and, after oral immuno-nutrition formula administration, at 15 days of the interval follow up. We enrolled 52 consecutive patients (mean age of 60.9 ± 5.4 years, 17 F, and BMI of 23.5 Kg/m2). The main comorbidities were diabetes (20%, type 2: 90%), hyperuricemia (15%), hypertension (38%), chronic ischemic heart disease (12%), COPD (13%), anxiety (10%), and depression (8%). Upon informed consent, 14 patients (mean age of 67.9 ± 5.4 years, 7 F, and BMI of 26.7 Kg/m2) were accepted to be administered IN. A moderate to severe overweight status was present in 59% of the patients; MNA test (4.4 ± 0.7) and phase angle (PA) values, suggestive of malnutrition, were present in 13% of the patients. After 15 days of admission, we recorded three deaths (mean age of 68.9 ± 4.1 years, 3 F, and BMI of 27.5 Kg/m2). An overweight status significantly correlated with the exitus occurrence (r = 0.65). One death was reported among the IN-treated patients. IN administration was followed by a significant decrease in inflammatory markers with a tendency to be higher than those of non-treated patients. IN prevented the worsening of BMI and PA vs. non-treated patients. In this overweight COVID-19 population, immuno-nutrition prevented malnutrition development with a significant decrease in inflammatory markers.

Transforming Adversity Into Opportunity: Assessing User Satisfaction in Hospital Transformation in Lieu of a Pandemic Through the Multi-Corridor Expansion Model for Epidemic Management and Environmental Design Enhancement

The COVID-19 pandemic brought the world to a standstill, demonstrating the critical importance of preparedness and adaptation in the face of pandemics and epidemics. Pandemics and epidemics have been a persistent threat throughout human history, causing significant mortality and morbidity, as well as disrupting economies, societies, and politics. The COVID-19 pandemic, caused by the SARS-CoV-2 virus, had a profound impact on healthcare systems worldwide, leading to hospitals transforming into pandemic centers. This case study, conducted at Riphah International Hospital (RIH) in Islamabad, Pakistan, explores the transformation of an existing facility into a pandemic center, highlighting the challenges faced in managing the pandemic conditions and ensuring the safety of the public and medical teams. The study was based on an observational study and data collection from end users with respect to transformation satisfaction and issues faced. Spatial segregation, logistics, air flow control, managing infection control, etc were major challenges faced and managed. Stress was high for the end users who facilitated in medical teams. The study emphasizes the critical importance of preparedness and adaptation in the face of pandemics/epidemics, including the need for specialized training of medical personnel, dedicated COVID-19 units in hospitals, and a robust and resilient healthcare system that can manage future epidemics.

Impact of the COVID-19 Public Health Crisis and a Structured COVID Unit on Physician Behaviors in Code Status Ordering.

Purpose: Code status orders are standard practice impacting end-of-life care for individuals. This study reviews the impact of a COVID unit on physician behaviors towards goal-concordant end-of-life care at an urban academic tertiary-care hospital. Methods: We conducted a retrospective cohort study of code status ordering on adult inpatients comparing the pre-pandemic period to patients who tested positive, negative and were not tested during the pandemic from January 1, 2019, to December 31, 2020. Results: We analyzed 59,471 unique patient encounters (n = 35,317 pre-pandemic and n = 24,154 during). 1,631 cases of COVID-19 were seen. The rate of code status orders among all inpatients increased from 22% pre-pandemic to 29% during the pandemic (P < .001). Code status orders increased for both patients who were COVID-negative (32% P < .001) and COVID-positive (65% P < .001). Being in a cohorted COVID unit increased code status ordering by an odds of 4.79 (P < .001). Compared to the pre-pandemic cohort, the COVID-positive cohort is less female (50% to 56% P < .001), more Black (66% to 61% P < .001), more Hispanic (6.5% to 5%) and less white (26% to 30% P < .001). Compared to Black patients, white patients had lower odds (.86) of code status ordering (P < .001). Other race/ethnicity categories were not significant. Conclusions: Code status ordering remains low. Compared to pre-pandemic rates, the frequency of orders placed significantly increased for all patients during the pandemic. The largest increase occurred in patients with COVID-19. This increase likely occurred due to protocols in the COVID unit and disease uncertainty.

Implementing Brief Mindfulness-Based Interventions to Reduce Compassion Fatigue.

Nurses in surgical-trauma units are susceptible to compassion fatigue due to work-related stressors. Mitigating and preventing compassion fatigue are critical to supporting the health and well-being of surgical-trauma nurses. During the COVID-19 pandemic, a surgical-trauma unit was converted to a designated COVID-19 unit. Nurses verbalized feelings of burnout and stress during the pandemic and did not have a mechanism to cope with work-related stress. This project evaluated the impact of brief mindfulness-based interventions on compassion fatigue. From February 2021 to March 2022, mindfulness champions led 5 minutes of mindfulness-based interventions, including meditation, deep breathing, and self-compassion exercises, during shift huddles. The Professional Quality of Life, version 5, questionnaire was used to evaluate preintervention and postintervention burnout, secondary traumatic stress, and compassion satisfaction. Paired-sample t tests were used to evaluate the results. Twenty-nine of 34 nurses responded (85% response rate) with matched preintervention and postintervention questionnaires. All subscale scores showed significant improvement after intervention. The mean burnout subscale score decreased by 9.35% (P = .003), mean secondary traumatic stress subscale score decreased by 11.89% (P = .005), and mean compassion satisfaction subscale score increased by 6.44% (P = .03) after intervention. After implementing brief mindfulness-based interventions in shift huddles, nurses reported reductions in elements of compassion fatigue (burnout and secondary traumatic stress). Nurses reported that adding brief mindfulness-based interventions to shift huddles helped them cope with work-related stress. Brief mindfulness-based interventions can improve nurses' compassion satisfaction while reducing compassion fatigue measurements.

'We are not here to enforce; we are here for the people' Factors influencing performance of contact tracing during the COVID-19 pandemic: A qualitative study.

Provider-initiated contact tracing (CT) is an important measure to slow down the spread of infectious diseases such as COVID-19. However, carrying out effective CT depends on the collaboration between the patient and the contact tracer. To improve CT, it is important to understand which factors influence contact tracers in being able to carry out CT during large pandemics. We performed individual semi-structured interviews with nine contact tracers working for the COVID-19 unit of the Public Health Service (PHS) Rotterdam-Rijnmond, the Netherlands, to explore their experiences with carrying out CT. Data were collected between July 2020 and December 2020. The interview protocol was structured based on the CT tasks and guided by the literature and the framework explaining adherence to clinical practice guidelines. In general, CT seemed to be carried out satisfactorily. Individual factors (interviewing techniques and skills, attitude towards the patient and attitude towards CT), factors related to the patient (cooperativeness and engagement, emotions, language and culture and (mis)information), guideline-related factors (characteristics) and factors related to the organisation (interactions with colleagues, support from management, workload and training) were found to influence the carrying out of CT. To be well prepared for future pandemics, it is important to explore strategies that can be effective to support the contact tracer in performing CT, support patients in feeling comfortable to be engaged and ways to reach more consistency in policies and protocols.

Giant lung bulla as a late-onset complication of mild SARS-CoV-2 pneumonia.

A 49-year-old Caucasian man was admitted to the Emergency Department for shortness of breath and cough. CT imaging showed bilateral a mild COVID-19 related pneumonia. He was hospitalized in the low-intensity COVID-19 unit where he received O2 therapy and oral corticosteroids (CS). Three weeks after discharge a high-resolution computed tomography (HRCT) find a giant bulla of the inferior lobe. The bulla was resected by video-assisted thoracoscopic surgery (VATS) and the patient recovered completely. In our patient, it is reasonable to suspect that the development of the bulla is a result of SARS-CoV-2 infection, since no bulla was observed in the first HRCT two months before. SARS-CoV-2 related pneumonia may be responsible for lung remodeling due to diffuse alveolar damage and later interstitial myofibroblastic proliferation. Corticosteroids might have played a role in increasing SARS-CoV-2 dystrophic action. COVID-19 leads to pulmonary damages, which are still partially unknown and might result in development of bullae. In fit patient surgical treatment can be carried out safely.

Clinical and epidemiological factors causing longer SARS-CoV 2 viral shedding: the results from the CoviCamp cohort

IntroductionThe aim of this study was to investigate how long hospitalized patients stayed positive to the nasopharyngeal swab, and what demographic and clinical factors influence the time-to-negative swab.MethodsWe enrolled in a multicenter, observational, retrospective study involving 17 COVID-19 units in eight cities of the Campania, southern Italy all patients hospitalized from March 2020 to May 2021 diagnosed with Severe Acute Respiratory Distress Syndrome-Coronavirus-2 (SARS-CoV-2) infection for whom time-to-negative swab was available.Results963 patients were enrolled. We defined three groups considering time-to-negative swab: the first including patients with time-to-negative swab before the 26th day, the second including patients with time-to-negative swab from day 26 to day 39, and the third including patients with time-to-negative swab > 39 days. 721 (74.9%) patients belonged to the first group, 194 (20.1%) to the second, and 52 (5.4%) belonged to the third group. Belonging to group 2 and 3 seemed to be influenced by age (p value < 0.001), Charlson comorbidity index (p = 0.009), arterial hypertension (p = 0.02), cardiovascular disease (p = 0.017), or chronic kidney disease (CKD) (p = 0.001). The multivariable analysis confers a leading role to CKD, with an odds ratio of 2.3 as factor influencing belonging to the groups showing a longer time-to-negative swab. Patients with CKD and diabetes were more frequently in the third group.DiscussionOur analysis showed that CKD is a factor related to longer time-to-negative swab, probably because of immunosuppression related to this condition.

Women healthcare professionals' experiences and needs regarding the COVID-19 pandemic from a gender perspective.

Accounting for 70% of healthcare workers worldwide, and 56% in Turkey, women continue to be the frontline fighters in the battle against the COVID-19 pandemic. Their needs may be overlooked as a result of their growing responsibilities both in their professional and private lives. This descriptive study aimed at identifying the gendered needs and experiences of women healthcare workers in Turkey throughout the pandemic. This study consists of 1082 healthcare professionals' responses of various positions across several provinces and facilities, collected through a web-based survey of 50 questions. Almost all participants (94%) expressed feeling anxious over the pandemic regardless of their working units. Four out of ten (38%) respondents noted working for 41h or more on average weekly, and most of the participants who worked for long hours were assigned in COVID-19 units. Non-clinical personnel reported less difficulty in work/life balance. 64% of the respondents reported not having gone through any training on COVID-19, and eight out of ten (81%) said they had information needs. Research findings suggest that 92% of participants' needs remained unmet. While 74% of the respondents pointed out not having an income that is worthwhile, 72% referred to the need for psychosocial support, 58% need for support in domestic work and 37% support for child care as their primary needs. Results of the research highlighted the gendered needs of women healthcare professionals during the COVID-19 pandemic, and disseminate protective and preventive health policies and practices through a gender responsive approach.

Social Stigma in Children with Long COVID.

Children with a previous SARS-CoV-2 infection evaluated at 3 month follow-ups in a pediatric post COVID unit were asked to fill in an online Long COVID Stigma Scale survey before they were assessed by a pediatrician. Doctors were unaware of children's responses when they performed a diagnosis of Long COVID or full recovery from previous infection, according to the World Health Organization definition of pediatric Long COVID. Responses to the Stigma scale were then compared in the two cohorts of children. 224 patients responded to the questionnaire; 40 patients were diagnosed with Long COVID. Children with Long COVID significantly more frequently felt embarrassed about having Long COVID (p 0.035), felt embarrassed about having physical limitations (p < 0.001), felt they were valued less due to Long COVID (p 0.003), felt they were different from other peers due to Long COVID (p 0.033), felt significantly more frequently that people behaved differently towards them because they might be lying since the diagnosis of Long COVID (p 0.006), that they were less respected by others due to Long COVID (p 0.017), that other people thought that Long COVID is not a real disease (p 0.007), that other people thought that developing Long COVID is a sign of weakness (p 0.008), and that other people might judge them negatively due to their diagnosis of Long COVID (p < 0.001). Children with Long COVID, similar to adults, are suffering from stigmata due to their condition,. These data may have implication and should be used by the public, policy makers, and healthcare professionals regarding pediatric Long COVID.

Feasibility and safety of oxygen saturation remote monitoring in COVID-19: A descriptive research

BackgroundThe COVID-19 pandemic created an urgent need to implement digital health solutions for remote clinical management of infected patients who could be monitored at home. Since the first wave, the “A. Gemelli” Polyclinic in Rome supported the Lazio Region with a digital health program (SatCov) to monitor at home newly diagnosed COVID-19 patients, or after an early discharge from the COVID units. A digital application and a wireless oximeter were provided to patients. Oxygen saturation, heart rate and body temperature were monitored at least twice a day, for at least 14 consecutive days.Clinicians personalized their remote assistance defining specific alerts for each patient and could plan video-consultation with the patient and/or require a timely hospitalization in a dedicated COVID unit if necessary. ObjectivesThe aim of this research was to evaluate the feasibility and safety of the oxygen saturation telemonitoring in COVID-19 patients. To cover these aspects, primary endpoints were expressed as the adherence to the remote monitoring and the hospitalization ratio in the overall telemonitored population. ResultsAt the end of December 2020, 105 patients have been enrolled and followed remotely. The study population had acceptable adherence to telemonitoring, with more than 85% of measurements sent out of the total of those required by the protocol. Only 3 patients required hospitalization, indicating that telemonitoring is feasible in patients with COVID-19 and could be helpful in reducing both unnecessary hospitalizations and duration of hospital stay.

Clinical Characteristics and Risk Factors Analysis of COVID-19 Infections- A Single Center Observational Study

Introduction: COVID-19 emerged as a major public health outbreak in late 2019. Bangladesh reported its first case on 8th March 2020 and at Sylhet Div area, first case detected in April 2020, authority adopted a policy of extensive contact tracing, quarantine and initially hospitalizing of all cases. Clinical characteristics of COVID-19 cases have been described as per national and WHO guideline. Objectives: To analyze clinical characteristics and the risk factors of COVID-19 infection. Methods: Clinical records of all COVID-19 confirmed cases aged ≥12 years admitted to COVID Unit or treated at home isolation with complete outcomes at Sylhet area were included in the study. Duration of this study was 1st April to 27th December 2020. Epidemiological history, comorbidities, clinical features, investigations, management and complications of all cases were recorded in preform data sheet and analyzed. Variables were compared between mild and severe diseases. Results: The sample comprised of 515 cases (mean age 30.98 years, male 81.55%). Majority were mild (92%) and 6.4% required intensive care, with 85% admitted within the first five days. Older age (≥51 years), underlying comorbidities, cough, breathlessness, reduced oxygen saturation and abnormal chest radiographs on admission were significant determinants for severity. The case fatality rate was 0.77% and the four commonest complications were ARDS (4.40%). liver injuries (4.07%), bacteraemia (2.33%) and kidney injuries (1.16%). Conclusion: Lower case fatality rate was possibly contributed by young cases with mild diseases and early hospitalization. Abnormal chest radiographic, elderly and other comrbidities require frequent measurement of oxygen saturation with pulse oximetry and close monitoring within the first few days to detect early deterioration and to take appropriate measures. Ivermectin seems to be effective in the treatment of Covid-19 infection but need further large multi-center case control study. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 19-23

Comparison of Clinical, Hematological and Biochemical Characteristics of Patients Suffering from Delta and Non-Delta Variant of COVID-19

Objective: To compare the clinical, hematological and biochemical characteristics of patients suffering from delta and non-delta variants of COVID-19. Method: This cross-sectional study was conducted at Farooq Hospital Westwood Lahore during 1st March 2022 to 31st August 2022. After obtaining informed written consent, nasopharyngeal swabs and 5 ml of blood samples in both EDTA and clotted vacutainers of eighty two infected patients with COVID-19, who were admitted in COVID-19 unit, were collected. The viral nucleic acid was isolated from nasopharyngeal swabs by using a Qiagen nucleic acid extraction kit. RT-PCR was performed to detect the delta variant in COVID-19 infected patients by using SARS-CoV-2 Variant B.1.617 identification kit. Further hematological and biochemical parameters were performed. Results: We did a comparative analysis of clinical and laboratory characteristic of delta and non-delta COVID19 patients admitted in Farooq Hospital Westwood, confirmed by RT-PCR and found that patients presented with delta variant had more severe disease with significantly more cough, fever, shortness of breath and lower SpO2 at the presentation. The hematological and biochemical markers showed more lymphopenia, greater CRP,Interleukin 6,LDHand ferritin.Hospitalstay of delta variants ofCOVID-19 patients had longer duration as compared to the non-delta COVID-19 patients. Conclusion: Delta COVID-19 had more severe disease with more dyspnea, hypoxia, hematological and biochemical parameters abnormalities compared to the non-delta COVID-19 patients. Patients suffering from delta variant of COVID-19 had greater length of hospital stay as compared to the non-delta variant of COVID-19 with more oxygen requirement and more mortality rate.

Association of Delirium and Depression with Respiratory and Outcome Measures in COVID-19 Inpatients.

Delirium (DEL) and depression (DEP) may impair the course and severity of acute respiratory illness. The impact of such syndromes on respiratory and outcome parameters in inpatients with COVID-19 needs clarification. To clarify the relationship between DEL and DEP and respiratory outcome measures, we enrolled 100 inpatients from COVID-19 units of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome. Participants were divided into those with DEL, DEP, or absence of either delirium or depression (CONT). Delirium severity was assessed with the Neelson and Champagne Confusion Scale (NEECHAM). Psychopathology was assessed with the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), and the Brief Psychiatric Rating Scale (BPRS). Dependent variables include: (a) respiratory parameters, i.e., partial pressure of oxygen in arterial blood (PaO2), oxygen saturation (SpO2), ratio between arterial partial pressure of oxygen (PaO2), and fraction of inspired oxygen (PaO2/FiO2); (b) outcome parameters, i.e., duration of hospitalization and number of pharmacological treatments used during the hospitalization. We investigated between-group differences and the relationships between severity of delirium/depression and the dependent variables. Duration of hospitalization was longer for DEL than for either DEP or CONT and for DEP compared to CONT. NEECHAM and HAM-D scores predicted lower PaO2 and PaO2/FiO2 levels in the DEL and DEP groups, respectively. In DEP, BPRS scores positively correlated with duration of hospitalization. Delirium impacted the course of COVID-19 more severely than depression. The mechanisms by which delirium and depression worsen respiratory parameters differ.

Prognostic Value of Creatinine Levels at Admission on Disease Progression and Mortality in Patients with COVID-19-An Observational Retrospective Study.

Acute kidney disease and chronic kidney disease are considered conditions that can increase the mortality and severity of COVID-19. However, few studies have investigated the impact of creatinine levels on COVID-19 progression in patients without a history of chronic kidney disease. The aim of the study was to assess the impact of creatinine levels at hospital admission on COVID-19 progression and mortality. We performed a multicenter, observational, retrospective study involving seventeen COVID-19 Units in the Campania region in southern Italy. All adult (≥18 years) patients, hospitalized with a diagnosis of SARS-CoV-2 infection confirmed by a positive reverse transcriptase-polymerase chain reaction on a naso-oropharyngeal swab, from 28 February 2020 to 31 May 2021, were enrolled in the CoviCamp cohort. Evaluating inclusion/exclusion criteria, 1357 patients were included. Considering in-hospital mortality and creatinine value at admission, the best cut-off point to discriminate a death during hospitalization was 1.115 mg/dL. The logistic regression demonstrated that factors independently associated with mortality were age (OR 1.082, CI: 1.054-1.110), Charlson Comorbidity Index (CCI) (OR 1.341, CI: 1.178-1.526), and an abnormal creatinine value at admission, defined as equal to or above 1.12 mg/dL (OR 2.233, CI: 1.373-3.634). In conclusion, our study is in line with previous studies confirming that the creatinine serum level can predict mortality in COVID-19 patients and defining that the best cut-off of the creatinine serum level at admission to predict mortality was 1.12 mg/dL.

Hematological Parameters and its Association with Disease Severity among COVID-19 Patient

Objective: To find out the relationship between hematological parameters and disease severity among COVID-19 patients. Methods: This cross-sectional analytical study was conducted in the COVID unit of Dhaka Medical College and Hospital (DMCH). The study was conducted from October 2020 to September 2021. Patients diagnosed with COVID-19 infection detected by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) admitting in the Corona unit of DMCH, Dhaka, Bangladesh. Purposive sampling technique was applied to collect the samples. 96 patients were included for the study. Result: In case of severity of patients, 17 (17.7%) patients had mild illness, 29 (30.2%) had moderate illness and 50 (52.1%) patients had severe illness due to COVID-19 infection. Furthermore, according to gender, the proportion of male patients (70.0%) were significantly more in severe group compared to mild/moderate group (47.8%). Moreover, the mean age of the patients in severe group (56.2± 14.3) were significantly higher than the mean age of the patients in mild/moderate group (48.7±12.5) as p=0.007. Patients in severe group had significantly higher neutrophil count than mild/moderate group (p&lt;0.001). On the other hand, patients in severe group had significantly lower lymphocyte, eosinophil and platelet count than mild/moderate group (p&lt;0.05). The neutrophil-to-lymphocyte ratio (NLR) was significantly higher in severe group compared to mild/moderate group (p&lt;0.001).

Nationwide Outbreak of Candida auris Infections Driven by COVID-19 Hospitalizations, Israel, 2021-2022

We report an outbreak of Candida auris across multiple healthcare facilities in Israel. For the period of May 2014-May 2022, a total of 209 patients with C. auris infection or colonization were identified. The C. auris incidence rate increased 30-fold in 2021 (p = 0.00015), corresponding in time with surges of COVID-19-related hospitalization. Multilocus sequence typing revealed hospital-level outbreaks with distinct clones. A clade III clone, imported into Israel in 2016, accounted for 48.8% of typed isolates after January 2021 and was more frequently resistant to fluconazole (100% vs. 63%; p = 0.00017) and voriconazole (74% vs. 5.2%; p<0.0001) than were non-clade III isolates. A total of 23% of patients had COVID-19, and 78% received mechanical ventilation. At the hospital level, outbreaks initially involved mechanically ventilated patients in specialized COVID-19 units and then spread sequentially to ventilated non-COVID-19 patients and nonventilated patients.

Evaluation of Nurses' Vaccine Hesitancy, Psychological Resilience, and Anxiety Levels During COVID-19 Pandemic.

This study aimed to evaluate the vaccine hesitancy, psychological resilience, and anxiety levels of nurses during the COVID-19 pandemic. This cross-sectional study was conducted with 676 nurses working at the survey time. Sociodemographic features, the status of hesitancy against the COVID-19 vaccine, the Coronavirus Anxiety Scale, and the Brief Resilience Scale were used in the questionnaire form to collect the data. Most participants (68.6%; n=464) stated they were hesitant about the COVID-19 vaccine. A sig- nificantly higher rate of hesitancy was detected in the age group of 20-39 years, those who did not have COVID-19 vaccine, and those who did not think the COVID-19 vaccine is protective (P < .05). It was determined that 6.8% (n=46) of the nurses had COVID-19 anxiety. A significantly higher rate of anxiety was detected in the age group of 40 years and older, those working in the emergency department, and those working in the COVID-19 unit during the pandemic period (P < .05). The median Brief Resilience Scale score of nurses is 19(6). A negative, weak, and significant relationship was found between the Brief Resilience Scale and Coronavirus Anxiety Scale scores (P = .001). During the pandemic, higher rates of anxiety were detected in healthcare personnel and those working in COVID-19 units. It was also found that as the level of anxiety increased, the level of psychological resilience decreased. To reduce the anxiety level and strengthen the psychological resilience of nurses, the cornerstones of the health system, fast, effective, and curative interventions should be made.