non-COVID Patients Research Articles

Decreased hospital length of stay and intensive care unit admissions for non-COVID blunt trauma patients during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic overwhelmed hospitals, forcing adjustments including discharging patients earlier and limiting intensive care unit (ICU) utilization. This study aimed to evaluate ICU admissions and length of stay (LOS) for blunt trauma patients (BTPs). MethodsA retrospective review of COVID (3/19/20-6/30/20) versus pre-COVID (3/19/19-6/30/19) BTPs at eleven trauma centers was performed. Multivariable analysis was used to identify risk factors for ICU admission. Results12,744 BTPs were included (6942 pre-COVID vs. 5802 COVID). The COVID cohort had decreased mean LOS (3.9 vs. 4.4 days, p = 0.029), ICU LOS (0.9 vs. 1.1 days, p < 0.001), and rate of ICU admission (22.3% vs. 24.9%, p = 0.001) with no increase in complications or mortality compared to the pre-COVID cohort (all p > 0.05). On multivariable analysis, the COVID period was associated with decreased risk of ICU admission (OR = 0.82, CI 0.75–0.90, p < 0.001). ConclusionsBTPs had decreased LOS and associated risk of ICU admission during COVID, with no corresponding increase in complications or mortality.

The Saga of Non-COVID Patients in COVID Times: Our Experience in a Secondary Care Hospital in Hilly Terrain, Northern India

Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in the diversion of all the resources, attention, and energy of the medical personnel and administration towards the management of COVID-19 patients. This resulted in unforeseen difficulties and hazards for non-COVID-19 patients in accessing healthcare professionals and facilities. Objectives: The objective of this study was to analyze the impact of the COVID-19 pandemic and repeated lockdowns on the non-COVID patients; to understand the social, psychological, and medical issues faced by them; and propose solutions for difficulties faced by this specific cohort of patients. Methods: We conducted a retrospective observational study on all non-COVID patients reporting for non-COVID-19 illnesses. We conducted the data analysis by comparing the trends for 15 months each in the pre-pandemic (1 January 2019 to 31 March 2020) and pandemic periods (1 April 2020 to 30 June 2021). Results: There was a 65.92% decrease in Out Patient Department (OPD) attendance, a 56.05% decrease in admissions, and a 90.33 % decrease in elective surgical procedures in non-COVID-19 patients. However, there was a significant increase in emergency surgeries by 62.16%. Conclusion: There has been a significant albeit much-needed diversion of time, energy, and resources to manage COVID-19 patients in recent times. This has led to a paucity of care opportunities for non-COVID-19 patients, which has been further compounded by the frequent lockdowns. We attempted to understand the impact of the pandemic on non-COVID-19 patients, particularly in peripheral hospitals in Hilly Terrains. We propose the solutions to tackle these issues and describe our experience with them.

QCovSML: A reliable COVID-19 detection system using CBC biomarkers by a stacking machine learning model

The reverse transcription-polymerase chain reaction (RT-PCR) test is considered the current gold standard for the detection of coronavirus disease (COVID-19), although it suffers from some shortcomings, namely comparatively longer turnaround time, higher false-negative rates around 20–25%, and higher cost equipment. Therefore, finding an efficient, robust, accurate, and widely available, and accessible alternative to RT-PCR for COVID-19 diagnosis is a matter of utmost importance. This study proposes a complete blood count (CBC) biomarkers-based COVID-19 detection system using a stacking machine learning (SML) model, which could be a fast and less expensive alternative. This study used seven different publicly available datasets, where the largest one consisting of fifteen CBC biomarkers collected from 1624 patients (52% COVID-19 positive) admitted at San Raphael Hospital, Italy from February to May 2020 was used to train and validate the proposed model. White blood cell count, monocytes (%), lymphocyte (%), and age parameters collected from the patients during hospital admission were found to be important biomarkers for COVID-19 disease prediction using five different feature selection techniques. Our stacking model produced the best performance with weighted precision, sensitivity, specificity, overall accuracy, and F1-score of 91.44%, 91.44%, 91.44%, 91.45%, and 91.45%, respectively. The stacking machine learning model improved the performance in comparison to other state-of-the-art machine learning classifiers. Finally, a nomogram-based scoring system (QCovSML) was constructed using this stacking approach to predict the COVID-19 patients. The cut-off value of the QCovSML system for classifying COVID-19 and Non-COVID patients was 4.8. Six datasets from three different countries were used to externally validate the proposed model to evaluate its generalizability and robustness. The nomogram demonstrated good calibration and discrimination with the area under the curve (AUC) of 0.961 for the internal cohort and average AUC of 0.967 for all external validation cohort, respectively. The external validation shows an average weighted precision, sensitivity, F1-score, specificity, and overall accuracy of 92.02%, 95.59%, 93.73%, 90.54%, and 93.34%, respectively.

A Comparative Study of &lt;em&gt;Acinetobacter&lt;/em&gt; Infections in COVID and Non-COVID Patients

<em>Acinetobacter</em> species are associated with high mortality, with <em>A. baumannii</em> being associated with a significant number of hospitals acquired infections worldwide. Multidrug resistance makes it challenging to control or treat these infections. Aim of this study is to evaluate the risk factors and compare the clinical outcomes of <em>Acinetobacter</em> infections in a tertiary care hospital, in COVID and non COVID patients.

The impact of anxiety level on decision to seek medical care of non-COVID cardiac patients during the pandemic outbreak-single-center experience in Israel.

Coronavirus disease 2019 (COVID-19) has significantly the delivery of healthcare all around the world. In part, an abnormal and unexplained high non-COVID-related cardiovascular mortality rate was reported during the outbreak. We assess the correlation between anxiety level and decision to seek medical care (DSMC) during the COVID-19 pandemic. We recruited patients with cardiovascular complaints admitted to the emergency department in a single institute in Israel between February and September 2020. Anxiety level was measured using available questionnaires. DSMC was assessed with a newly designed questionnaire (DM-19). Two-hundreds seventy patients were included in the study. The mean age was 52.6 ± 14.9 (females represent 36.2%). 23.6% of the patients had at least moderate cardiovascular risk. High anxiety levels were (HAL) reported in nearly half of the patients (57.1% and 49.8% for General Anxiety Disorder Assessment [GAD-7] and Beck Anxiety Inventory [BAI], respectively). It was more prevalent in old, married, and unemployed patients (significant p-value for all in both questionnaires). Age was an independent factor (χ2 = 6.33, p < 0.001, odds-ratio: 4.8) and had a positive correlation on anxiety level (r = 0.81, p < 0.001 and r = 0.62, p < 0.001, for GAD-7 and BAI, respectively). The DM-19 revealed a strong and positive correlation of seeking medical care with anxiety level (R2 linear = 0.44, r = 0.70, p < 0.001 and R2 linear = 0.30, r = 0.58, p < 0.001 for GAD-7 and BAI, respectively) and results in deferring medical care for several days than patient with low anxiety level (p = 0.02). We observed an abnormal prevalence of a high level of anxiety among non-COVID patients with cardiovascular complaints, which affected the patient's likelihood to seek medical care and resulted in an unreasonable postponement of medical treatment. Our results may explain cardiovascular mortality trends during the outbreak and should be considered in health crisis management. Future studies will involve multi-institutional efforts to address reproducibility of our findings across geographic regions in the state of the global impact. Additionally, it is imperative to understand the effects of the coronavirus vaccine on patient consideration to seek medical care.

Complement Activation via the Lectin and Alternative Pathway in Patients With Severe COVID-19.

Complement plays an important role in the direct defense to pathogens, but can also activate immune cells and the release of pro-inflammatory cytokines. However, in critically ill patients with COVID-19 the immune system is inadequately activated leading to severe acute respiratory syndrome (SARS) and acute kidney injury, which is associated with higher mortality. Therefore, we characterized local complement deposition as a sign of activation in both lungs and kidneys from patients with severe COVID-19. Using immunohistochemistry we investigated deposition of complement factors C1q, MASP-2, factor D (CFD), C3c, C3d and C5b-9 as well as myeloperoxidase (MPO) positive neutrophils and SARS-CoV-2 virus particles in lungs and kidneys from 38 patients who died from COVID-19. In addition, tissue damage was analyzed using semi-quantitative scores followed by correlation with complement deposition. Autopsy material from non-COVID patients who died from cardiovascular causes, cerebral hemorrhage and pulmonary embolism served as control (n=8). Lung injury in samples from COVID-19 patients was significantly more pronounced compared to controls with formation of hyaline membranes, thrombi and edema. In addition, in the kidney tubular injury was higher in these patients and correlated with lung injury (r=0.361*). In autopsy samples SARS-CoV-2 spike protein was detected in 22% of the lungs of COVID-19 patients but was lacking in kidneys. Complement activation was significantly stronger in lung samples from patients with COVID-19 via the lectin and alternative pathway as indicated by deposition of MASP-2, CFD, C3d and C5b9. Deposits in the lung were predominantly detected along the alveolar septa, the hyaline membranes and in the alveolar lumina. In the kidney, complement was significantly more deposited in patients with COVID-19 in peritubular capillaries and tubular basement membranes. Renal COVID-19-induced complement activation occurred via the lectin pathway, while activation of the alternative pathway was similar in both groups. Furthermore, MPO-positive neutrophils were found in significantly higher numbers in lungs and kidneys of COVID-19 patients and correlated with local MASP-2 deposition. In conclusion, in patients who died from SARS-CoV-2 infection complement was activated in both lungs and kidneys indicating that complement might be involved in systemic worsening of the inflammatory response. Complement inhibition might thus be a promising treatment option to prevent deregulated activation and subsequent collateral tissue injury in COVID-19.

The dark price that non-covid patients are paying to covid pandemic: the "chinese boxes" of the public health crisis.

In Italy, as in the other Western countries, during the different pandemic surges, the health care systems have undergone an unprecedented imbalance between health care resources demand and supply due to the huge number of patients affected by covid-19. In this dramatic scenario the access to the necessary hospital care for non-covid patients has been limited or precluded. Delays in diagnostic procedures or in caring for many acute or chronic diseases can result in a dangerous increase in their severity with a consequent increase in short and long-term related mortality. This is evident both with regard to time-dependent acute diseases, such as coronary artery syndromes or cerebrovascular diseases, and chronic degenerative diseases such as neoplasms. In this case the natural consequence of the interruption of the screening activities will require more complex treatments with a lower probability of a good outcome and higher mortality. Developing policies to promote healthcare access for non-covid patients population is an urgent task for governmental bodies and all decision makers to prevent a health crisis of unpredictable proportions. This narrative review is firstly aimed to set out the findings regarding the comparison between the trends of hospital admissions, surgical interventions, diagnostic and screening procedures for cardiac, cerebrovascular and oncological diseases before and during pandemic around the world; secondly, some public health policies are put forward in order to begin the restoration of medical services for non-covid patients.

Tele-robotic recommendation framework using multi-dimensional medical datasets on COVID-19 classification

The development of robotic partners to take care of daily human life has been expanded recently. Mobile robots have spread their presence within the public environment to assist people in a variety of problematic activities. Mobile Robots are developed with the underlying artificial intelligence technology. Adequate training is provided to the mobile robots under the classifications of supervised learning. The interaction of robots is very important to practice everything that is told to the robotic systems from domestic robots to high-risk work environments that threaten the health of the spinal cord, which focuses on robotic support during the COVID-19 epidemic. In the present research work, a mobile agent is trained using Computerized Tomography (CT) scan reports and X-rays under VGG-16 processing standards for classifying covid and non-covid patients. A hybrid model is designed using Deep Learning Network (DNN) and Convolutional Neural Network (CNN). CNN is trained using images collected using a camera and thermal camera with RGB values ranging from 0 to 255. The advantage of the proposed model in training the mobile agent is making use of CT scan and X-ray images and providing recommendations to the victim about the criticality of being affected by covid. In addition to that, the Machine Learning Algorithm like Decision Tree and Random Forest is constructed and achieved a classification accuracy of 95%. The proposed technique has efficiently provided a reliable recommendation system based on ReLu activation. The other evaluation parameters used to estimate the performance of the proposed model are precision, recall, F1-score. The proposed model achieves 0.84 Precision over the inception technique with 0.79 precision. The reason behind the improvement of accuracy in the present work is the filter used to extract the features.

Pulmonary embolism severity and in-hospital mortality: An international comparative study between COVID-19 and non-COVID patients

ObjectiveTo compare the severity of pulmonary embolism (PE) between patients with and without COVID, and to assess the association between severity and in-hospital-mortality. MethodsWe performed an analysis of 549 COVID (71.3% PCR-confirmed) and 439 non-COVID patients with PE consecutively included by 62 Spanish and 16 French emergency departments. PE-severity was assessed by size, the presence of right ventricular dysfunction (RVD), and the sPESI. The association of PE-severity and in-hospital-mortality was assessed both in COVID and non-COVID patients, and the interaction of COVID status and PE severity/outcome associations was also evaluated. ResultsCOVID patients had PEs of smaller size (43% vs 56% lobar or larger, 42% vs. 35% segmental and 13% vs. 9% subsegmental, respectively; p = 0.01 for trend), less RVD (22% vs. 16%, p =0.02) and lower sPESI (p =0.03 for trend). Risk of in-hospital death was higher in COVID patients (12.8% vs. 5.3%, p < 0.001). PE-severity assessed by RVD and sPESI was independently associated with in-hospital-mortality in COVID patients, while PE size and sPESI were significantly associated with in-hospital-mortality in non-COVID. COVID status showed a significant interaction in the association of PE size and outcome (p =0.01), with OR for in-hospital mortality in COVID and non-COVID patients with lobar or larger PE of 0.92 (95%CI=0.19–4.47) and 4.47 (95%CI=1.60–12.5), respectively. Sensitivity analyses using only PCR-confirmed COVID cases confirmed these results. ConclusionCOVID patients present a differential clinical picture, with PE of less severity than in non-COVID patients. An increased sPESI was associated with the risk of mortality in both groups but, PE size did not seem to be associated with in-hospital mortality in COVID patients.

Outcomes of Extubated COVID and Non-COVID Patients Receiving Awake Venovenous Extracorporeal Membrane Oxygenation.

Cessation of continuous analgesia and sedation in patients with acute respiratory distress syndrome (ARDS) receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO) facilitates early extubation, family, patient and provider engagement, and mobility. Outcomes associated with an awake ECMO strategy have not been well described in the literature. The purpose of this study was to evaluate outcomes in patients receiving this strategy. This was a retrospective review of ARDS patients receiving awake VV ECMO. The primary outcome was survival to hospital discharge. Secondary outcomes included days requiring ECMO, time from cannulation to extubation, complications, patients requiring tracheostomy, hospital and intensive care unit (ICU) length of stay (LOS), and discharge disposition. In a subgroup analysis, outcomes were compared between non-COVID and COVID ECMO patients. Sixty-two patients were included with a survival to hospital discharge of 85.5%. Days requiring ECMO was 33.0 (0.0-75.0) and cannulation to extubation was 6.0 (4.0-11.0). Three patients received a tracheostomy (4.8%). Bleeding and infection were reported in 80.6% and 82.3% of patients, respectively. Intensive care unit length of stay was 46.0 days (29.0-90.0) and hospital LOS was 51.0 days (32.0-91.0). Over half of the patients (51.6%) were discharged to an acute rehabilitation facility and 27.4% were discharged home. There was similar survival to hospital discharge between the COVID and non-COVID awake ECMO patients (85% in both groups, p = 1.000). This study highlights the impact of an awake ECMO approach on survival to hospital discharge. Future studies are needed to evaluate this approach as compared to current practice to determine if this should become the standard.

Virus related acute pancreatitis and virus superinfection in the ‘Dual disease’ model of acute pancreatitis and SARS-Co-V2 infection: A multicentre prospective study

BackgroundSARS-CoV-2 can cause acute pancreatitis (AP) and SARS-CoV-2 superinfection can occur in patients with AP during prolonged hospitalisation. Our objective was to characterize SARS-CoV-2 related AP and study the impact of SARS-CoV-2 superinfection on outcomes in AP. MethodsIn this multicentre prospective study, all patients with AP and SARS-CoV-2 infection between August 2020 and February 2021 were divided into two groups: SARS-CoV-2-related AP and superadded SARS-CoV-2 infection in patients with AP. The two groups were compared with each other and the whole cohort was compared with a non-COVID AP cohort. ResultsA total of 85 patients with SARS-CoV-2 and AP (SARS-CoV-2-related AP; n = 18 and AP with SARS-CoV-2 superadded infection; n = 67) were included during the study period. They had a higher mortality [28 (32.9%) vs. 44 (19.1%), aOR 2.8 (95% CI, 1.5–5.3)] than 230 propensity matched non-COVID AP patients. Mortality in SARS-CoV-2 and AP patients was due to critical COVID. SARS-CoV-2-related- AP (n = 18) had a higher but statistically insignificant mortality than SARS-CoV-2 superinfection in AP [8/18 (44.4%) vs 20/67 (29.8%), p = 0.24]. On multivariable analysis, infection with SARS-CoV-2 (aHR 2.3; 95% CI, 1.43.7) was a predictor of in-hospital mortality in addition to organ failure (OF) in patients with AP. ConclusionPatients with AP and SARS-CoV-2 infection had a higher mortality than matched non-COVID AP patients which was largely attributable to the severity of COVID-19. SARS-CoV-2 related AP had higher OF and in-hospital mortality.

Respiratory system compliance at the same PEEP level is similar in COVID and non-COVID ARDS

BackgroundThe comparison of respiratory system compliance (Crs) between COVID and non-COVID ARDS patients has been the object of debate, but few studies have evaluated it when considering applied positive end expiratory pressure (PEEP), which is one of the known determinants of Crs itself. The aim of this study was to compare Crs taking into account the applied PEEP.MethodsTwo cohorts of patients were created: those with COVID-ARDS and those with non-COVID ARDS. In the whole sample the association between Crs and type of ARDS at different PEEP levels was adjusted for anthropometric and clinical variables. As secondary analyses, patients were matched for predicted functional residual capacity and the same association was assessed. Moreover, the association between Crs and type of ARDS was reassessed at predefined PEEP level of 0, 5, 10, and 15 cmH2O with a propensity score-weighted linear model.Results367 patients were included in the study, 276 patients with COVID-ARDS and 91 with non-COVID ARDS. The association between Crs and type of ARDS was not significant in both the complete cohorts (p = 0.17) and in the matched cohorts (p = 0.92). This was true also for the propensity score weighted association at PEEP 5, 10 and 15 cmH2O, while it was statistically significant at PEEP 0 (with a median difference of 3 ml/cmH2O, which in our opinion is not clinically significant).ConclusionsThe compliance of the respiratory system is similar between COVID ARDS and non-COVID ARDS when calculated at the same PEEP level and while taking into account patients’ anthropometric characteristics.

The Outcome of Catheter-Directed Thrombolysis in COVID-19-Associated Deep Vein Thrombosis.

IntroductionPublished evidence of venous thrombotic complications of COVID-19 is lacking from India. This case series consists of twenty-nine adult patients who were COVID -19 positive and treated for Deep Vein Thrombosis (DVT) during the second wave of the COVID-19 pandemic, in India. The study was aimed at analyzing patient demographics of patients with DVT and the outcome of Catheter-Directed Thrombolysis (CDT) in COVID positive patients. Material and Methods: Patients who developed DVT while or after being COVID positive were managed between February and April 2021 at the institution of the first two authors and were included in this retrospective study. Demographic, clinical data, laboratory data, and treatment given were analyzed. All patients were followed up for 3 months with a Villalta score. Results: There were a total of 29 patients (12 male and 17 female) included in the study with a mean age of 47 ± 17 years. The average time of presentation from being COVID positive was 17.8 ± 3.6 days and one patient developed DVT after becoming Covid negative. All but one patient had lower limb involvement, with 42.8% having proximal and 57.2% distal DVT. All patients with Iliofemoral and two with Femoropopliteal DVT were treated with catheter-di thrombolysis and the other 15 patients were managed with anticoagulation alone. No re-thrombosis was observed in the thrombolysis group. Overall average Villalta score at 3 months was 10.7 ± 2.1 with a score of 10.58 ± 2.1 in the anticoagulation-only group and 10.85 ± 2.3 in the CDT group. Conclusion: COVID-19 seems to be an additional risk factor in the development of DVT. The outcome of such patients, treated by thrombolysis appears to be similar to non-COVID patients. In this, observational experience of the authors suggests that CDT could be offered to COVID positive patients with symptomatic Iliofemoral DVT with good outcomes and an acceptable post-intervention Villalta score.

Impact of COVID-19 Pandemic on the Care of Non-COVID Pediatric Patients

Background: Coronavirus disease 2019 (COVID-19) pandemic-related refocusing of healthcare along with needs for social distancing, complete or partial lockdowns, and burgeoning economic crisis has created immense barriers to the access of healthcare services by the non-COVID patients. Aim: We aimed to assess the perspectives of Indian healthcare workers taking care of pediatric patients on the barriers to healthcare delivery to pediatric non-COVID illnesses. Methods: Indian healthcare workers, working in both public and private sectors, taking care of pediatric patients were surveyed using a predesigned pretested online questionnaire over a period of 1 month (May 2020). The impact on healthcare delivery was graded using a Likert scale. Results: Of the total of 356 responses obtained, 75.3% reported a significant negative impact of the COVID-19 pandemic on delivery of healthcare to non-COVID pediatric patients. Respondents of government and COVID hospitals reported a significantly worse impact than private (P = 0.0002) and non-COVID hospitals (P = 0.01), respectively. Significant decline in number of non-COVID patients attending outpatient department (86.2%), admitted in wards (71.6%), number of routine (81.7%) and emergency surgeries (60.5%), number of diagnostic procedures (61.2%), and scheduled therapies (50.2%) was reported by the surveyed healthcare workers. Most important factors for disrupted healthcare delivery were restricted travel (78.3%) and fear of contracting COVID-19 (68.8%). Telemedicine (67.4%) was the commonest alternate strategy deployed for continuing care of patients. Conclusion: Several challenges exist to maintain the continuity of healthcare services to pediatric non-COVID patients especially in those with chronic diseases, poor financial background, and follow-up in COVID government hospitals. Use of telemedicine, strategic preplanning, strengthening peripheral healthcare, and optimal resource reallocation may help reduce the broader health impact of the COVID-19 pandemic.

Postoperative Outcomes of Cardio-Thoracic Surgery in Post-COVID versus Non-COVID Patients - Single-Center Experience

Objective: The aim of this study is to investigate the postoperative outcomes in post COVID versus non-COVID patients undergone cardiac surgery. Materials and Methods: A retrospective cohort study to analyze the impact of COVID-19 in patients undergoing elective or emergency cardiac surgeries. A total of 512 patients were included in the study over a period of 6 months. The study consists of 35 post-COVID patients and 477 non-COVID patients. All data were collected from previous medical records and hospital database. The clinical outcomes and mortality of post-COVID patients were compared with a cohort of non-COVID patients. The endpoints were compared using t-test or Chi-squared test. Results: Among the post-COVID patients, 54.3% (19) of the post-COVID patients were under COVID category A followed by category B 28.6% (10) and category C 17.1% (6). About 50% of post-COVID patients had complications, especially pneumonia and myocardial infarction following COVID-19. Around 43% of patients showed fibrotic changes in computed tomography (CT) Thorax at the time of admission for surgery. 63% showed CT score in between 1 and 5. The mean COVID antibody titer was 158 U/ml. Majority of the surgeries were coronary artery bypass graft and significant difference was observed in the requirement of intra-aortic balloon pump in post-COVID patients (P &lt; 0.0001). No postoperative mortality reported in post-COVID patients. The postoperative outcomes and survival rates were almost similar in both groups. Conclusion: In our study, the post-COVID patients were recover in a similar way as non-COVID patients after cardiac surgery.

Thrombocytopenia in the ICU before and during the pandemic of the new coronavirus infection COVID-19: a comparative retrospective cohort study

INTRODUCTION: Thrombocytopenia is common in critically ill patients. Its development is associated with a high risk of bleeding and other complications, including adverse outcomes. ОBJECTIVE: To analyze the incidence, severity, predictive significance of thrombocytopenia in critically ill patients before and during coronavirus infection. MATERIALS AND METHODS: The observational study included patients from intensive care units of a multidisciplinary hospital at different periods: before the COVID-19 and during the period when the hospital was operating as a СOVID hospital. Patients from all intensive care units, excluding the hematology unit, were analyzed. RESULTS: Non-infectious period. Among 314 patients, 91 cases of thrombocytopenia were identified, representing 29 %. Severe thrombocytopenia among them was noted in 35 % (n = 32). The main etiological causes: performing extracorporeal procedures, liver disease, ischemic stroke, acute coronary syndrome. The infectious period. Thrombocytopenia occurred more frequently than in non-COVID patients (in 209 of 396 patients — 52.8 %) and was more uniform in severity. The most frequent cause of thrombocytopenia was a combination of sepsis, acute liver injury, performance of extracorporeal procedures and specific drug therapy of COVID-19 infection. CONCLUSIONS: According to our data, thrombocytopenia in the intensive care units of a multidisciplinary hospital (non-infectious period) occurred in one-third of critically ill patients. COVID 19 infection demonstrated an increased incidence of thrombocytopenia in critical patients (in the presented study up to half of the patients). Severe thrombocytopenia is more common in patients of non-infectious period (35 % vs 20%). In patients with coronavirus infection, thrombocytopenia was more frequently associated with a bleeding clinic (6.2 % vs 2.2 %), with less prognostic value as a criterion for adverse outcome: the presence of thrombocytopenia increased the risk of death by 5.5 times (95 % CI 2.979–10.031) in noninfectious and by 1.54 times (95 % CI 1.3–1.82) in COVID-19 infection.

Impact of COVID on management of urological cases in a tertiary care non-COVID institute: A patient-centered study

Background: Health-care systems across the globe have been overwhelmed by coronavirus disease-19 (COVID 19). It has affected non-COVID patient management as well. While service, hospital-oriented data on effect of the pandemic on urological diseases have been published, there is scarce data on patient-centered issues in urology, particularly from India. Hence, we planned this study to determine the impact of COVID on management of urological cases.Materials and Methods: This is a prospective observational single-center study conducted at Indira Gandhi Institute of Medical Sciences, Patna, from April 2020 to November 2020. Consecutive non-COVID adult patients presenting to the indoor, outdoor, and telemedicine services of the urology department of our institute were included. Patients who were moribund, having altered sensorium, severe cardiorespiratory illness, unable to understand and respond, and those unwilling to participate were excluded from the study. A questionnaire-based data were collected. The same interviewer explained the questionnaire to patients in their own language (English/Hindi/Bhojpuri) either in person or telephonically and recorded the findings.Results: Two hundred consecutive patients were screened. One hundred and fifty were included in the study. Mean age of patients was 50 ± 3.2 years. One hundred and five patients were male. Thirty-eight patients had comorbid conditions. One hundred and thirty-seven patients reported delay to consult an urologist since development of the first urological symptom. The average delay was 68 ± 20 days. Thirty-two patients suffered COVID-19 disease during the urological illness. One hundred and twelve were advised for urology consultation after the first evaluation at a local health-care center. The reasons cited for delay by these patients (n = 112) were lock-down and reduced/unavailable public transport (n = 20) and fear of contacting corona infection (n = 10), both (n = 56), suffered COVID-19 (n = 18), and others (n = 8). The distance of patients' residence from the hospital was median 50 km, with interquartile range of 5–254 km. One hundred and three patients received definitive treatment and 47 were still undergoing delays due to various reasons. Sixty-two patients were advised surgery. 25 of these 62 were found to have complications due to delay.Conclusion: Delay in all aspects of management of urological illness, including consultation, work up, and definitive treatment was observed. Of all who were advised surgery, about 40% were found to have complications due to delay in surgery.

The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review.

BackgroundItaly has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy.MethodsA PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19.ResultsOf the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine.ConclusionsOur work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.

Working in hospitals during a pandemic: investigating the resilience among medical staff during COVID-19 outbreak through qualitative and quantitative research.

Medical staff in hospitals were faced with great stress as a result of COVID-19's sudden and severe occurrence, which makes investigating their resilience essential. Using qualitative and quantitative research methods, this research studied medical staff (n = 403) working in a hospital during the COVID-19 pandemic and followed four main goals: First was evaluating the psychometric properties of the Persian version of Adult Resilience Measure-Revised (ARM-R). The second goal was investigating the personal, relational, social, and organizational issues facing the medical staff during the COVID-19 using semi-structural interviews. The third goal was to determine predictive effects of demographic and work-related variables on resilience using stepwise regression analysis. And the fourth was comparing resilience of three groups of the medical staff (coronavirus group consisted of the medical staff in direct contact with COVID-19 patients; emergency group who work in the emergency department who deal with both COVID and non-COVID patients; and non-coronavirus group who had no contact with COVID-19 patients) using one-way ANOVA. Results showed that internal reliability/consistency, content, and face validity of the Persian version of the ARM-R are acceptable. The construct validity of the test was also verified using exploratory factor analysis and indicated the two factors of personal and relational resilience. The content of the interviews was analyzed using manifest content analysis, and the results were divided into 27 subcategories and 3 main categories including personal, organizational, and family categories. Moreover, regression analysis revealed that the marital status and age of children can explain resilience variance in some medical staff groups. The results of ANOVA and post hoc test also showed that the total resilience of the non-coronavirus group was greater than the coronavirus and emergency groups; the relational resilience of the coronavirus and non-coronavirus groups was greater than the emergency, and non-coronavirus group's personal resilience was greater than the emergency group.

THE IMPACT OF COVID-19 PANDEMIC ON DIAGNOSIS AND TREATMENT IN OTORHINOLARYNGOLOGY PATIENTS IN CROATIA.

COVID-19 pandemic resulted in a decrease in the number of diagnostic and therapeutic procedures in most ENT departments. We performed a survey among ENT specialists in Croatia aiming to assess how the pandemic influenced their practice, and consequently the patient diagnosis and treatment. The majority of the 123 participants who completed the survey stated that there was a delay in diagnosis and treatment of ENT diseases, which they expected to have negative effects on patient outcomes. Since the pandemic is still ongoing, there is the need for improvement at different levels of the healthcare system to minimize the consequences of the pandemic in non-COVID patients.