COVID-19 Units Research Articles

Pituitary-Adrenal Axis and Peripheral Immune Cell Profile in Long COVID.

In Long COVID, dysfunction in the pituitary-adrenal axis and alterations in immune cells and inflammatory status are warned against. We performed a prospective study in a cohort of 42 patients who suffered COVID-19 at least 6 months before attending the Long COVID unit at Althaia Hospital. Based on Post-COVID Functional Status, 29 patients were diagnosed with Long COVID, while 13 were deemed as recovered. The hormones of the pituitary-adrenal axis, adrenocorticotropin stimulation test, and immune cell profiles and inflammatory markers were examined. Patients with Long COVID had significantly lower EuroQol and higher mMRC scores compared to the recovered individuals. Their symptoms included fatigue, myalgia, arthralgia, persistent coughing, a persistent sore throat, dyspnoea, a lack of concentration, and anxiety. We observed the physiological levels of cortisol and adrenocorticotropin in individuals with or without Long COVID. The results of the adrenocorticotropin stimulation test were similar between both groups. The absolute number of neutrophils was lower in the Long COVID patients compared to recovered individuals (p < 0.05). The total count of B lymphocytes remained consistent, but Long COVID patients had a higher percentage of mature B cells compared to recovered participants (p < 0.05) and exhibited a higher percentage of circulating resident memory CD8+ T cells (p < 0.05) and Treg-expressing exonucleases (p < 0.05). Our findings did not identify adrenal dysfunction related to Long COVID, nor an association between adrenal function and clinical symptoms. The data indicated a dysregulation in certain immune cells, pointing to immune activation. No overt hyperinflammation was observed in the Long COVID group.

Exercise reconditioning in the post-acute phase of COVID-19 rehabilitation in patients with chronic respiratory insufficiency: a retrospective observational study

INTRODUCTION: The COVID-19 pandemic has had a profound impact on a global scale, affecting various aspects of society, health, and well-being. It has strained healthcare systems and led to social and welfare repercussions. In the context of post-acute COVID-19 rehabilitation, there is a need to explore effective interventions for individuals, particularly those with chronic respiratory insufficiency. This study aims to evaluate the effectiveness of exercise reconditioning as a rehabilitation strategy in this specific population METHODS: A retrospective observational study was conducted at the Rehabilitation Unit in an Italian hospital between March 2020 and May 2022. The study included individuals who had been diagnosed with COVID-19 pneumonia, required hospitalization in the COVID-19 unit or intensive care unit (ICU) due to severe respiratory failure and with “post-COVID pathology syndrome” (PCS) picture. Various assessments, including the 6 Minutes Walking Test (6MWT), were conducted to determine exercise capacity. A personalized reconditioning program based on international guidelines was designed for each patient, focusing on aerobic training. Measurements of vital signs were taken during training sessions. RESULTS: A total of 24 individuals, with a mean age of 65.41 years, were included in the study. The average duration of hospitalization in the rehabilitation department was 53.17 days. Most participants had pre-existing respiratory and non-respiratory pathologies. All individuals developed COVID-19 interstitial pneumonia, and some required intensive interventions such as intubation or ECMO support. Pulmonary fibrosis and Critical Illness Myopathy (CIM) were observed in a significant portion of the participants. Significant improvements were observed in the 6MWT distance traveled, Functional Independence Measure (FIM) scale score, fraction of inhaled oxygen (FiO2), and dyspnea scores. Perceived exerction measures also showed positive changes. DISCUSSION AND CONCLUSION: The findings of this study indicate that personalized reconditioning plan is effective in improving the functional capacity and overall condition and quality of life of individuals with post-COVID pathology syndrome. These findings highlight the importance of an interdisciplinary approach and tailored rehabilitation programs in this population. Further research is needed to explore the long-term effects of exercise reconditioning in this population.

Antibiotic Consumption 2017-2022 in 30 Private Hospitals in France: Impact of Antimicrobial Stewardship Tools and COVID-19 Pandemic.

Our aim was to determine the impact of antimicrobial stewardship tools (ASTs) and the COVID-19 pandemic on antibiotic consumption (AC). We used the national software Consores® to determine AC in DDD/1000 days of hospitalization from 2017 to 2022 in voluntary private hospitals in France. The ASTs considered were: 1. internal guidelines; 2. the list of antibiotics with restricted access; 3. the presence of an antibiotic referent or 4. an ID specialist; and 5. proof of an annual meeting on antimicrobial resistance. Institutions with dedicated units for COVID-19 patients were specified. In 30 institutions, the total AC varied from (means) 390 to 405 DDD/1000 DH from 2017 to 2022. Fluoroquinolones and amoxicillin/clavulanate consumption decreased from 50 to 36 (p = 0.003) and from 112 to 77 (p = 0.025), respectively, but consumption of piperacillin/tazobactam increased from 9 to 21 (p < 0.001). Over the study period, 10 institutions with ≤2 AST had lower AC compared to 20 institutions with ≥3 AST (p < 0.01). COVID-19 units opened in 10 institutions were associated with a trend toward higher macrolide consumption from 15 to 25 from 2017 to 2020 (p = 0.065) and with an acceleration of piperacillin/tazobactam consumption from 2020 to 2022 (p ≤ 0.003). Antibiotic consumption in 30 private hospitals in France was inversely related to the number of AST. The COVID-19 pandemic was associated with limited impact on AC, but special attention should be paid to piperacillin/tazobactam consumption.

Assessment of pneumonia rates associated with mechanical ventilation in a covid-19 unit after insertion of the dentist into the multidisciplinary team

The aim of this research is to evaluate whether there was a difference after the insertion of the dental surgeon in an Intensive Care Unit (ICU) that cares for patients with COVID-19 in relation to ventilator-associated pneumonia (VAP) control, length of stay and mortality. The dentist was added to the multidisciplinary team for three months. A training session with the nurses and nursing technicians was held at the start of every month. The Hospital Infection Control Service gathered data on VAP, hospital stay length, and ICU mortality in the three months before and three months after the dentist joined the team. After statistical analysis, the hospitalization rate increased in the period in which the dentist was working in the COVID-19 unit, but the p value was not significant in this variant (p &gt; 0.062). The percentage of VAP in the period before and after the dentist's intervention in the COVID-19 unit decreased with a significant difference between the evaluated periods (p &lt; 0.0001). Regarding mortality, it was found that there was an increase in the number of deaths over time, however without statistical significance (p &gt; 0.2790). The pandemic came to confirm the importance of dental care in the hospital environment and the integration of the professional dentist in the health team, contributing to the oral health and quality of life of critical patients.

Point prevalence of antibiotic usage in major referral hospital in Turkey.

The most important and undesirable consequence of inappropriate antibiotic use is the spread of antibiotic resistance, increased adverse effects, increased mortality and healthcare costs. We aimed to assess antibiotic usage characteristics in inpatient setting in our center. A one-day, single center point-prevalence study was carried out on June 9th 2021, in Ankara City Hospital in Turkey. Data of antibiotic consumption, appropriateness of usage and predictors of inappropriate use in adult patients were evaluated. Out of 2640 adult patients, 893 (33.8%) were receiving at least one antibiotic. A total of 1212 antibiotic prescriptions with an average of 1.44±0.64 were found. Antibiotics were most commonly used for therapeutic purpose (84.7%), followed by surgical prophylaxis (11.6%). Majority of therapeutically used antibiotics were empirical (67.9%). Infectious diseases consultation was present in 68.3% with a compliance rate of 95.7%. Rate of inappropriate use was 20%. The most frequent cause of inappropriateness was unnecessary use (52.5%). Most commonly and most inappropriately used antibiotics were carbapenems (17.5%) and first generation cephalosporins (38.7%), respectively. Most of the inappropriateness observed in first-generation cephalosporins was due to inappropriate longer surgical prophylaxis. While age is an independent risk factor for inappropriate antibiotic use (p = 0.042), COVID-19 unit admission, use for therapeutic purpose and infectious diseases consultation were protective factors (p<0.001, p<0.001, p<0.001). Rate of inappropriate use was low, but inappropriate surgical prophylaxis remains an important problem in surgical units. There is a considerable need to implement an antimicrobial stewardship program that focuses on surgical prophylaxis practices.

Clinical characteristics and outcomes of patients admitted with COVID-19 at a public-sector hospital over the first two waves of SARS-CoV-2 infection in Harare, Zimbabwe: A prospective cohort study.

We investigated the clinical profile, complications, and outcomes of inpatients with COVID-19 at Parirenyatwa Hospital, Harare, across the first two waves of SARS-CoV-2 infection, and factors associated with mortality. We conducted a prospective cohort study on all patients admitted to the COVID-19 unit. Data were extracted from medical records and negative binomial regression with robust standard errors was used to assess the association between sociodemographic and clinical characteristics and mortality. Cox Regression was used for sensitivity analysis. Of 563 people admitted with COVID-19 between 2 July 2020 and 19 March 2021, 214 (38.0%) died, 340 were discharged and 9 transferred. The median age was 56 (IQR 44-68) years and 53.8% were male. Overall, 38.8% experienced a complication, the most common being acute kidney injury (17.9%) and hyperglycaemia (13.1%). The most common comorbidity was hypertension (41.3%) followed by diabetes (28.6%), HIV (12.1%), cardiovascular disease (10.9%) and chronic kidney disease (7.8%). Among participants who stayed in the ward for more than 1 night, mortality was higher in patients with comorbidity compared to those without any comorbidity (38.7% vs 25.5%, risk ratio (RR) = 1.52 (95% CI 1.11, 2.07), p = 0.008). After adjusting for oxygen saturation, comorbidities, sex and pregnancy, mortality was higher in the second wave than in the first (adjusted RR 1.23, 95% CI 1.00-1.51, p = 0.05). In the second wave 57/161 (35.4%) deaths were attributed to lack of resources, mainly human resources. The mortality rate was high and clinical COVID-19 care needs to pay careful attention to patient monitoring for complications and management of comorbidities. This will require addressing the critical health workforce shortage issues. Prevention of COVID-19 including vaccination particularly among individuals with comorbidities remains a high priority.

Hand hygiene compliance in a Brazilian COVID-19 unit: the impact of moments and contact precautions

BackgroundHealthcare-associated infections are among the most common complications during hospitalization. These infections increase morbidity and mortality and they increase length of hospital stay and the cost of healthcare. The aims of our study were to monitor hand hygiene (HH) compliance, HH technique quality and factors related to HH practice among health professionals in a COVID-19 Intensive Care Unit (ICU).MethodsAn observational, prospective study. Between September and December 2021, we observed 69 healthcare professionals in an eight-bed ICU for patients with COVID-19 in midwestern Brazil. We used the WHO observation form to collect data. The dependent variable was HH compliance and independent variables were professional category, sex, HH quality (3-step technique for at least 15 s), number of HH opportunities observed, observation shift and inappropriate glove use.ResultsWe observed 1185 HH opportunities. The overall compliance rate was 26.4%, but only 6.5% were performed with the correct 3-step technique for the minimum time. HH compliance was considerably lower for moments “before” tasks (6.7%; 95% CI 4.8%, 9.2%) compared with moments “after” tasks (43.8%; 95% CI 39.9%, 47.8%). The logistic model found that inappropriate glove use, night shift and physicians (p < 0.001) were associated with low HH compliance. The infrastructure analysis found that the unit had an insufficient number of alcohol-based handrub (ABHR) dispensers at the point of care and that the mechanism for activating them was poorly designed.ConclusionsHH compliance was very low. Inappropriate glove use was associated with low compliance and the unit’s infrastructure did not support good HH practice. The fact that healthcare professionals were more likely to do HH after tasks, suggests that they use HH to protect themselves rather than the patients. Adequate infrastructure and ongoing health education with a focus on HH while caring for patients in contact precautions are essential for improving HH compliance and patient safety.

Association of Serum Ferritin Level with Severity of COVID-19 Infection During Third Trimester of Pregnancy

Background: World has been passing through COVID-19 pandemic by a newly emergent coronavirus named SARS-CoV-2 since December 2019 and officially declared as a pandemic by WHO on 11th March 2020. Till mid-March 2022, around 460 million people already suffered from COVID-19, among them around 6 million people died and globally death rate was 2%. In Bangladesh till mid-March 2022, around 1.9 million people suffered from COVID-19 and around 29 thousand people had died. As pregnancy is a physiological immunosuppressive state, so pregnant women might be more susceptible to this infection. Studies on COVID-19 during pregnancy have showed, this infection occurred more during third trimester of pregnancy (about 64%). Reviewing several other studies on COVID-19 infection we found that, elevated serum ferritin level was associated with its severity; and ferritin could effectively discriminate severity and non-severity with sensitivity 96% and specificity 70%. We conducted this study to evaluate association of serum ferritin level with severity of COVID-19 infection during third trimester of pregnancy. Objectives: To evaluate association between rise of serum ferritin level and severity of COVID-19 infection during third trimester of pregnancy. Methods: This cross-sectional study was carried out in Department of Obstetrics and Gynaecology, COVID-19 Unit, BSMMU and DMCH. Sampling method was purposive. Total 77 cases were included in this study after matching eligibility criteria. After collecting intravenous blood, serum ferritin level was measured. Results: Among 77 cases of third trimester COVID-19, 19 cases (24.7%) were asymptomatic, 31 cases (40.3%) were mild, 19 cases (24.7%) were moderate and 8 cases (10.4%) were severe COVID-19. Non- severe COVID-19 group included 50 cases of asymptomatic &amp; mild COVID-19; and their mean serum ferritin level was 51.48 ng/ml. Severe COVID-19 group included 27 cases of moderate &amp; severe COVID-19; and their mean serum ferritin level ......

Comparison of Mean Serum Ferritin Levels between Non-severe and Severe COVID-19 Infection Groups During Third Trimester of Pregnancy

Background: Despite the fact that, ferritin is commonly regarded as a representation of total body iron reserves; its predictive value is also connected to COVID-19 severity. COVID-19 disease can manifest itself in pregnant women in a variety of ways. Comorbid conditions have a significant impact on the progression of COVID-19 severity. Several studies have showed that, serum ferritin level was associated with severity of COVID-19 infection. So, we conducted this study to evaluate the comparison of mean serum ferritin levels between non-severe and severe COVID-19 infection groups during third trimester of pregnancy. Objectives: The aim of this study is to compare the mean serum ferritin levels between non-severe and severe COVID-19 infection groups in third trimester of pregnancy. Methods: This cross-sectional study was carried out in Department of Obstetrics and Gynaecology, COVID-19 Unit, BSMMU and DMCH. Sampling method was purposive. Total 154 cases were included in this study after matching eligibility criteria. After collecting intravenous blood, serum ferritin level was measured. Results: Among 154 cases, 24.7% cases were asymptomatic, 40.3% cases were mild, 24.7% cases were moderate and 10.4% cases were severe COVID-19 infection during third trimester of pregnancy. The non-severe COVID-19 infection group consisted of 100 cases of asymptomatic and mild COVID-19 infected patients, with a mean serum ferritin level of 51.48 ng/ml. The severe COVID-19 infection group consisted of 54 cases of moderate and severe COVID-19 infected patients, with a mean serum ferritin level of 478.37 ng/ml. The independent samples t-test revealed a p-value of ≤0.05 (0.0000000002), when comparing the mean values of these two groups. Conclusion: Serum ferritin level rises significantly in severe COVID-19 infection during third trimester of pregnancy.

The Effect of Music on Care Behaviors and Burnout Levels of Nurses Working in COVID-19 Units

Studies indicate that during the COVID-19 pandemic, most of the nurses have experienced burnout, affecting their caring behavior. It is important that nurses be provided with physical and mental health support. Therefore, music may be useful for these frontline nurses. The aim of this study was to assess the effect of music on care behaviors and burnout levels of nurses working in COVID-19 units. This was a self-controlled intervention study. The study included 38 daytime nurses in a public hospital in Ankara, Türkiye. Data were collected using the Caring Behaviors Inventory-24 (CBI-24), and the Maslach Burnout Inventory (MBI). Music was played for 30 minutes every day over eight weeks. After the music intervention, mean CBI-24 subscores significantly increased (P

COVID-19 pneumonia in older patients: clinical features and outcomes of a 400 case series

Background Since late 2019, COVID-19 has been a major health issue worldwide. Older patients seemed more susceptible to severe forms and complications with higher mortality rates. This study aimed to identify the clinical features and outcomes of SARS-Cov-2 pneumonia in elderly patients. Methods Retrospective monocentric study in the internal medicine Covid-19 unit of the Ben Arous regional hospital, enrolling admitted patients with confirmed SARS-CoV-2 pneumonia, aged 65 years and above from September 2020 to September 2021. Results The study group counted 222 women (55.5%). The mean age was 74 years. At least one chronic disease was found in 84.75% of patients. The most common comorbidities were high blood pressure (55.75%), and diabetes mellitus (50%). The most frequent symptoms were dyspnoea (69.8%), fatigue (66.8%) and dry cough (65.8%). Corrected Qt interval was prolonged in 24.2% of cases. Chest computed tomography were performed in 277 cases (69.3%). Ground glass opacities (93.86%), consolidations (73.3%) and crazy paving (36%) were the main findings. Assessment of pulmonary extent found important involvement (41.87%), sever lesions (23.82%), moderate involvement (21.29%) and critical involvement (1.8%). C-reactive protein (CRP) was elevated in 94.25% of patients. Elevated D-dimer levels were common (68.8%). Antinuclear antibodies were positive in 22.85% cases, and lupus anticoagulant in 35.41%. Acute kidney failure was noted in 25% of patients. The incidence of pulmonary embolism in the current study was 12.99%. The death rate was 8%. According to multivariate logistic regression: older age (odds ratio:1.11, 95% CI: 1.058-1.167; P P&lt; .005), elevated C-reactive protein levels (odds ratio: 1.008, 95% CI: 1.003-1.013; P&lt; .005) and duration of hospital stay (odds ratio: 1.131, 95% CI: 1.062-1.204; P&lt; .005) were predictive factors of mortality. Conclusions Clinical presentation of covid-19 pneumonia in elderly patients is particular due to pre-existing comorbidities and frailty. Mortality risk factors are age, elevated CRP and length of hospitalization.

Proximal tubular dysfunction as a predictor of AKI in Hospitalized COVID-19 patients.

High concentration of Angiotensin converting enzyme receptors in the proximal tubules make kidneys an early target in COVID-19. Proximal tubular dysfunction (PTD) may act as an early predictor of acute kidney injury (AKI) and more severe disease. This prospective observational study was conducted in the COVID unit, Bangabandhu Sheikh Mujib Medical University. 87 COVID-19 patients without known kidney disease were screened for 6 markers of PTD on admission-hyperuricosuria, normoglycemic glycosuria, proteinuria, renal phosphate leak, sodium leak and potassium leak. Positivity of 2 of the first 4 markers was considered as PTD. 35 patients with PTD and 35 without PTD were followed up throughout their hospital stay. 52.9% had PTD on admission. The most prevalent markers were renal sodium leak (67%), followed by proteinuria (66.7%), hyperuricosuria (42.5%), potassium leak (32.2%), phosphate leak (28.7%) and normoglycemic glycosuria (20.7%). Mean age was 55.7 years. 32.9% patients developed AKI. PTD group had higher odds of developing AKI (odds ratio 17.5 for stage 1, 24.8 for stage 2 and 25.5 for stage 3; p<0.0001). The mean duration of hospital stay was 9 days higher in the PTD group (p<0.001). PTD group also had higher odds of transferring to ICU (OR = 9.4, p = 0.002), need for mechanical ventilation (OR = 10.1, p = 0.002) and death (OR = 10.3, p = 0.001). 32.6% had complete PTD recovery during follow-up. Proximal tubular dysfunction is highly prevalent in COVID-19 patients very early in the disease and may act as a predictor of AKI, ICU transfer, need for mechanical ventilation and death.

Performance of chest X-ray scoring in predicting disease severity and outcomes of patients hospitalised with COVID-19 in Bangladesh.

Evaluation of potential outcomes of COVID-19-affected pneumonia patients using computed tomography scans may not be conceivable in low-resource settings. Thus, we aimed to evaluate the performance of chest X-ray scoring in predicting the disease severity and outcomes of adults hospitalised with COVID-19. This was a retrospective chart analysis consuming data from COVID-19-positive adults who had chest X-ray availability and were admitted to a temporary COVID unit, in Bangladesh from 23rd April 2020 to 15th November 2021. At least one clinical intensivist and one radiologist combinedly reviewed each admission chest X-ray for the different lung findings. Chest X-ray scoring varied from 0 to 8, depending on the area of lung involvement with 0 indicating no involvement and 8 indicating ⩾75% involvement of both lungs. The receiver operating characteristic curve was used to determine the optimum chest X-ray cut-off score for predicting the fatal outcomes. A total of 218 (82.9%) out of 263 COVID-19-affected adults were included in the study. The receiver operating characteristic curve demonstrated the optimum cut-off as ⩾3 and ⩾5 for disease severity and death, respectively. In multivariate logistic regression analysis, a chest X-ray score of ⩾3 was found to be independently associated with disease severity (aOR: 8.70; 95% CI: 3.82, 19.58, p < 0.001) and a score of ⩾5 with death (aOR: 16.53; 95% CI: 4.74, 57.60, p < 0.001) after adjusting age, sex, antibiotic usage before admission, history of fever, cough, diabetes mellitus, hypertension, total leukocytes count and C-reactive protein. Using chest X-ray scoring derived cut-off at admission might help to identify the COVID-19-affected adults who are at risk of severe disease and mortality. This may help to initiate early and aggressive management of such patients, thereby reducing their fatal outcomes.

Mucormycosis in COVID-19 Pandemic

Background Coronavirus disease-2019 (COVID-19) has been associated with a wide range of opportunistic fungal infections. Many countries have seen an unprecedented rise in cases of COVID-19-associated mucormycosis (CAM). The purpose of this study is to identify the correlation between the COVID-19 epidemic and mucormycosis. Our study also provides details on factors causing CAM. Methods A retrospective study from November 2020 to February 2022 includes four cases of COVID-19-associated rhino-orbital mucormycosis treated at Habib Thameur Hospital’s ENT Department. Results The mean age of patients was 67.5-years, 75% were males, and the most frequent underlying conditions were diabetes mellitus (100%). The median time interval between the diagnosis of COVID-19 and the first evidence of mucormycosis infection was 15-days; two patients required hospitalization in a COVID unit, and two patients received oxygen therapy at home. All patients received corticosteroid therapy at a dose of 1 mg/kg/d for an average of 10-days. Treatment using antifungals and surgery was described in all the patients. Amphotericin B deoxycholate was used in 75% and lipid formulation in 25%. Two patients presented renal insufficiency due to amphotericin B; the doses were adapted with good evolution. In that report, the case fatality rate was 75%. Conclusion Mucormycosis is a fatal fungal infection that usually affects patients with altered immunity. Several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide. Diabetes mellitus (DM), steroid overdose, immunosuppression, and high iron levels, combined with other factors such as prolonged hospitalization, unhygienic conditions, and the use of ventilators, combine to create an ideal environment for contracting mucormycosis. Lastly, there is a need to create awareness about fungal diseases among clinicians in order to help identify early symptoms and restrict the spread of lethal fungal diseases. A collaborative team of otolaryngologists, ophthalmologists, anesthesiologists, and resuscitators will be required in hospitals to accelerate optimal management.

Regional moderate hyperthermia for mild-to-moderate COVID-19 (TherMoCoV study): a randomized controlled trial.

BackgroundTo prevent COVID-19 progression, low-cost alternatives that are available to all patients are needed. Diverse forms of thermotherapy have been proposed to prevent progression to severe/critical COVID-19.ObjectiveThe aim of this study is to evaluate the efficacy and safety of local thermotherapy to prevent disease progression in hospitalized adult patients with mild-to-moderate COVID-19.MethodsA multicenter, open-label, parallel-group, randomized, adaptive trial is used to evaluate the efficacy and safety of local thermotherapy to prevent disease progression in hospitalized adult patients with mild-to-moderate COVID-19. Eligible hospitalized adult patients with symptoms of COVID-19 with ≤5 days from symptom onset, meeting criteria for mild or moderate COVID-19, were randomly assigned to the intervention consisting of local thermotherapy via an electric heat pad in the thorax (target temperature range 39.5–42°C) continuously for 90 min, twice daily, for 5 days, or standard care. The main outcome was the proportion of patients who progressed to severe-to-critical COVID-19 or death. Patients were randomized in a 1:1 ratio through a centralized computer-generated sequence of minimization with a random component of 20%. Participants and medical staff were not blinded to the intervention.ResultsOne-hundred and five participants (thermotherapy n = 54, control n = 51) with a median age of 53 (IQR: 41–64) years were included for analysis after the early cessation of recruitment due to the closure of all temporal COVID-19 units (target sample size = 274). The primary outcome of disease progression occurred in 31.4% (16/51) of patients in the control group vs. 25.9% (14/54) of those receiving thermotherapy (risk difference = 5.5%; 95%CI: −11.8–22.7, p = 0.54). Thermotherapy was well tolerated with a median total duration of thermotherapy of 900 (IQR: 877.5–900) min. Seven (13.7%) patients in the control group and seven (12.9%) in the thermotherapy group had at least one AE (p = 0.9), none of which were causally attributed to the intervention. No statistically significant differences in serum cytokines (IL-1β, IL-6, IL-8, IL-10, IL-17, and IFN-γ) were observed between day 5 and baseline among groups.ConclusionLocal thermotherapy was safe and well-tolerated. A non-statistically significant lower proportion of patients who experienced disease progression was found in the thermotherapy group compared to standard care. Local thermotherapy could be further studied as a strategy to prevent disease progression in ambulatory settings.Clinical Trial registration: www.clinicaltrials.gov, identifier: NCT04363541.

Physical and psychological repercussions on Nursing workers’ health in COVID-19 units: A mixed-methods research study

Objetivo: analisar como os trabalhadores de enfermagem de unidades hospitalares COVID-19 percebem as repercussões físicas e psicológicas do trabalho em sua saúde e os fatores associados à sua percepção. Método: estudo de métodos mistos paralelo-convergente realizado com 359 trabalhadores lotados em unidades COVID-19 de sete hospitais. Para a coleta de dados quantitativos foram utilizados um questionário contendo variáveis sociodemográficas, laborais e relacionadas às percepções de repercussões físicas e psicológicas e, para a qualitativa, entrevistas semiestruturadas. Para a análise utilizou-se estatística inferencial e análise temática de conteúdo. Resultados: trabalhadores diurnos, que tinham mais de um vínculo empregatício e trabalhavam mais de 41 horas/semana perceberam as repercussões físicas como mais moderadas/intensas, devido à sobrecarga e déficit de folgas. Enfermeiros e celetistas perceberam as repercussões psicológicas mais moderadas/intensas, atribuindo-as à sobrecarga gerencial e insatisfação trabalhista. Mulheres apresentaram 97% mais chance de perceberem repercussões físicas e três vezes mais chance de perceberem repercussões psicológicas, quando comparadas aos homens, referindo sobrecarga doméstica e familiar. Conclusão: sobrecargas laborais e familiares, intensificadas pelo contexto pandêmico, foram associadas à intensidade com a qual os trabalhadores da enfermagem perceberam repercussões físicas e psicológicas.

Repercussões físicas e psicológicas na saúde de trabalhadores de enfermagem em unidades COVID-19: pesquisa de métodos mistos

Objective: to analyze how Nursing workers in COVID-19 hospital units perceive the physical and psychological repercussions of work on their health, as well as to identify the factors associated with their perceptions. Method: a parallel-convergent mixedmethods study conducted with 359 Nursing workers from COVID-19 units in seven hospitals. For the collection of quantitative data, a questionnaire containing sociodemographic and labor variables and related to perceptions of physical and psychological repercussions were used, and for qualitative data, semi-structured interviews were used. For the analysis, inferential statistics and thematic content analysis were used. Results: daytime workers, who had more than one employment contract and worked more than 41 hours/week perceived more moderate/intense physical repercussions, reporting overload and time off deficits. Nurses and CLT workers perceived psychological repercussions more moderately/intensely, mentioning managerial overload and job dissatisfaction. Women were 97% more likely to perceive physical repercussions and three times more likely to perceive psychological repercussions when compared to men, reporting household and family overloads. Conclusion: work and family overloads, intensified by the pandemic context, were associated with the intensity with which Nursing workers perceived physical and psychological repercussions.

Hypothalamic-Pituitary-Adrenal Axis Activity in SARS-CoV-2 Infected Noncritically Ill Hospitalized Patients.

This study determined the baseline hypothalamic-pituitary-adrenal axis hormonal levels and their associated factors in noncritically ill hospitalized patients with coronavirus disease 2019 (COVID-19). This cross-sectional study was carried out in 91 noncritical RT-PCR-confirmed COVID-19 patients (aged 18 to 65 years) recruited consecutively from the COVID unit of two tertiary care hospitals over a period of six months. After the screening, relevant history and physical examinations were done, and blood was drawn between 07:00 am to 09:00 am in a fasting state to measure serum cortisol and plasma adrenocorticotropic hormone (ACTH) by chemiluminescent microparticle immunoassay. Of 91 patients, 54, 26, and 11 had mild, moderate, and severe COVID-19, respectively. Median values of serum cortisol (p = 0.057) and plasma ACTH (p = 0.910) were statistically similar among the severity groups. Considering a cortisol cut-off of 276 nmol/L (<10 μg/dL), the highest percent of adrenal insufficiency was present in severe (27.3%), followed by mild (25.9%) and least in the moderate (3.8%) COVID-19 cases. Using the cortisol/ACTH ratio >15, only 6.6% had enough reserve. The adrenocortical response was compromised in a significant percentage of noncritically ill hospitalized patients with COVID-19, with the highest percentage of adrenal insufficiency present in severely infected cases. The HPA axis parameters of serum cortisol, plasma ACTH and cortisol/ACTH were similar across the severity of noncritical patients with COVID-19.

Management of COVID-19 during the second wave at a tertiary care public hospital in Eastern India: An experience from the administrative control room.

Though many arrangements had been made during the first wave, multiple complaints were reported regarding the arrangements made for COVID patients. The control room was set up as a 24 × 7 administrative coordination center to attend to issues after the initial setup of COVID units. To identify the major problems reported to the control room during the second wave of COVID-19 and find the related cause for the same. Issues reported to the control room were recorded from April to June (2021). The control room residents were asked to allocate each problem into six categories. Next, the residents allotted a frequency score to each of the problems depending on how regularly it was reported. Secondary data from various reports were also considered. Data were analyzed using MS Excel software. Various administrative issues were identified to be due to issues in communication and coordination (23%), policy and procedures (22%), human resource and training (16%), administration and implementation (15%), infrastructure (14%), and HMIS and IT (10%). Most frequent problems reported to the control room were related to infrastructure, policy implementation, and manpower training. After the initial implementation of new processes, there was a requirement for regular follow-up and coordination. This model of setting up an administrative control room and evidence-based approach will serve as a template for public hospitals to ensure coordination of hospital operations.

From uncertainty to the experience of collective care: Immersion in a hospital COVID-19 unit during the ‘first wave’ of the epidemic in Marseille, France

Social and psychological risks are weighed against biological risks and addressed by healthcare workers responding to health crises. This article examines the transformation of biosecurity protocols in one hospital in Marseille, France as the beginning of the COVID-19 pandemic and how they were adapted to meet changing needs. Based on ethnographic methods that included active observation alongside caregivers, nurses, and medical doctors during their professional activities, as well as interviews with healthcare professionals and administrators, we analyze some of the key strategies used by these staff to negotiate challenges related to the uncertainty provoked by the emerging virus and changing protocols. We examine the strategies of health professionals through the lens of ‘collective care’ and shared decision-making to show how collaborative work practices allowed these individuals to mitigate challenges provoked by the health crisis while supporting the needs of the individuals in their care. A key recommendation that emerges from this study is the importance of favoring the cognitive, relational, and organizational aspects of collective care.