Pandemic Of COVID-19 Infection Research Articles

#4312 CHANGES OF PATIENT CARE DURING THE COVID 19 PANDEMIC AND ITS IMPACT ON THE ADVANCED STAGE OF CKD PATIENTS

Abstract Background and Aims With the COVID-19 pandemic from the end of 2019, due to the tightening of medical care resources and intermittent lockdowns, CKD patients could not receive the full patients care or educations. However, on CKD management, patient care and education by the nephrologist and multiple professions are known to be important, especially for the late stage of CKD patients. We assessed changes of CKD patients’ management during the COVID-19 pandemic and clarify its impact on their medical conditions. Method Retrospective single center cohort study was conducted. From 2018 to 2021, CKD stage 4 to 5, non-dialyzed patients, who were followed in CKD out-patients clinic in St. Luke's International Hospital, Tokyo, Japan, were included. We definite the pre post pandemic periods as: pre-pandemic: Pre-C, from January 2018 to December 2019, and post-pandemic; Post-C, January 2020 to December 2021. The following data was compared between the 2 periods: Number of nephrology visits per patient; Rate of using telemedicine; Rate of receiving multidisciplinary educational support; Rate of drop-out patients; and Number of patients who initiate renal replacement therapy, newly. Clinical information and laboratory data were obtained from hospital medical record, eGFR were calculated according to MDRD formula modified for Japanese. This study was approved by research ethics committee in St. Lukes’ International hospital. Results Two hundreds and eighty nine individual patients were eligible for the analysis. The baseline data were as follows: mean age 67.9±14 years, 63.5% male, mean eGFR 22.2±5.9 ml/min and 40.2% comorbid DM. The number of nephrology visits and receiving multidisciplinary support was decreased in Post-C periods: Nephrology visits; Pre-C: 9.8±5.1 visits/year, Post-C 7.7±5.2 visits/year, P<0.001, Multidisciplinary support; Pre-C: 78%, Post-C 32%, P<0.001. Multi professional educational support was provided mainly for CKD stage 5 patients during the Post-C. More, the rate of using telemedicine and dropout increased in Post-C. Especially, the dropout rate of elderly patients over 70 years old was significant: 8% in Pre-C and 17% in Post-C, P<0.001. On the other hand, clinical indicators such RRT initiation rate remained unchanged. More, there were no difference of RRT initiation rate, between on-visit and telemedicine patients. Conclusion Frequency of nephrology visits and multidisciplinary educational care has been decreased with COVID-19, there was no difference in the short-term prognosis of CKD patients, from our study. During the pandemic of COVID-19 infection, human conversation or contact, was restricted to prevent its spread, in all over the world. In Japan, a national survey reported that the number of outpatient hospital visits in 2020 was on average 70% of those in 2019. Our clinic also recognized the phenomenon. Some patients switched their visit to telemedicine. Telemedicine has some evidence which has equivalent value to face to face education. From our study, needs for more IT-based, contact-less device-based medical treatment and care in the future was suggested. On the other hand, the dropout rate in the elderly was increased, and these population could no easily use telemedicine. The prognosis of these patients needs to be followed up and verified.

Covidophobia: Psychiatric and addict ION impacts in patients in the psychiatry department of Toamasina Madagascar University Hospital

Introduction: The Covid-19 pandemic changes radically the modalities of care for almost worldwide hospitals, such as in the Psychiatry Department of the University Hospital of Analankininina Toamasina Madagascar. Phone exchanges reduced the transferal dimension of care approach, which is so important for patients treated in Psychiatric Department. The objective of this study is to describe the psychiatric and addictological impacts of the pandemic in patients in the Psychiatry Department Hospital of Toamasina Madagascar. Methods: This is a single-center descriptive prospective study conducted in the Psychiatric Département of Analankinina Toamasina University Hospital, which is the only hospital reference for mental disorders in the eastern region of Madagascar. The population studied were made up of outpatients and those hospitalized from September 01st to October 31st, 2021, more specifically, after the first pandemic of Covid-19 infection and after the first Lock-down period. Were included patients having or not a Covid-19 infection and who presented psychological disorders, a depressive mood, anxiety disorders, obsessive-compulsive disorders or a delusional state, with or without psychiatric and addiction past. Were excluded patients whose authorizatipn was not obtained. Questionnaires translated into the local dialect were used. Results: Thirty patient cases were included with Male-Female equitability. The average age was 42 years old. The study showed the predominance of psychiatric disorders in low-income patients (56.66%), who had mainly moderate forms of Covid-19 infection (66.67%). The majority of them (93.33%) presented significant psychological disorders according to the Mental Health Inventory-5 (MHI-5) Scale. Depression mood was found in 26.67% of cases according to the Hospital Anxiety and Depression Scale. A significant proportion of patients (90%) presented pathologic anxiety according to the same scale. Post-Traumatic Stress Disorder was observed in 46.66% of patients, according to the PTD Check List DSM5 (PCL-5) Scale. An increase of alcohol and cigarettes addiction and heroin withdrawal precisely due to financial problems have been noticed. Conclusion: Despite health restrictions due to spread of Covid-19 infections, contact and touch should always be at the heart of medical practice because according to traditional Malagasy belief, touch is synonymous of healing.

Functional Disorders of the Gastrointestinal Tract During the Pandemic of a New Coronavirus Infection

Aim. To analyze the literature data devoted to the study of the features of functional gastrointestinal diseases (FGID) during the pandemic of a new coronavirus infection.Key findings. Measures taken in connection with the pandemic of COVID-19 infection (introduction of lockdown, social isolation) leads to an increase in the level of depression and anxiety and, as a consequence, to an increase in the frequency and prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), as well as an increase in the severity of clinical symptoms of these diseases. In turn, the overcoming of COVID-19 infection contributes to an increase in the permeability of the mucous membrane of the gastrointestinal tract and the occurrence of its inflammatory changes, which lead to the development of postinfectious (postcovid) FD and postinfectious (postcovid) IBS.Conclusion. The problem of functional gastrointestinal diseases during the pandemic of a new coronavirus infection is very important and requires further research.

Sex difference in hospitalized patients with COVID-19 infection

The pandemic of COVID-19 infection is rapidly progressing to one of the most severe threats to human health. The different responses of the immune system in females and males to a range of infectious and inflammatory stimuli were investigated. We aimed to explore the association of sex with the course of infection among the hospitalized COVID-19 patients. This Comparative cross-sectional study was conducted on RT- PCR positive COVID-19 patients. Severe and critical patients who required hospital or ICU admission were included in the study. The total number of patients was 150 (75 males and 75 females) with mean age of 57Y±14.7. There was a statistical significance in age between both groups [mean ± SD: males 60.5 (12.2), females 54 (15.3) (p=0:0.007)]. The prevalence of diabetes mellitus, hypertension, chronic kidney disease and ischemic heart disease was higher among males but without statistical significance. Consolidation was significantly more prevalent in female group (85.3% vs 61.3% in male group). The need of mechanical ventilation was higher in men, but with no statistical significance (44% Vs 32%, p=0.302). Also, mortality rate was higher (48%) in males than in females (37.3%), but with no statistical significance (p=0.262). During the COVID-19 infection, the risk factors of severe disease and progression to the need of mechanical ventilation support in addition to mortality rate are more prevalent among males. However, radiological patterns apart from consolidation, distribution of radiological abnormalities and CT severity score in both groups did not show significant sex difference.

Predisposing Factors Promoting COVID-19 Infection and Mortality

The pandemic of COVID-19 infection has had an untold adverse impact on patients living with chronic disease, across various ethnicity/race, age and gender. Underlying hypertension, cardiovascular disease, diabetes and respiratory illness are key risk factors for the development of severe COVID-19 pneumonia and systematic inflammation. Patients who are immunosuppressed by virtue of their chronic disease, age or a therapy have been identified as susceptible groups. The redirection of healthcare services towards the increasing numbers of COVID-19 patients has compromised the healthcare delivery to patients with chronic illness. Movement restriction measures as approach to curb the spread of the infection have also compromised the metabolic health of many patients who need enhanced physical activity to improve their health. Media publications on COVID-19 infection and restrictions may have also contributed to the poor mental health of some individuals, especially patients with underlying mental conditions or its risk factors. The inadequate or availability of quality health care system across low income and developing regions especially, those with older age groups, has further accelerated the spread and death rate from COVID-19. Future research should be directed towards protecting vulnerable groups from possible waves of COVID-19 as a measure to reduce the negative impact of the pandemic on these individuals.

Aplikasi K-means cluster untuk pengelompokan unit kerja yang beresiko Covid-19 pada industri layanan kesehatan

The pandemic of COVID-19 infection is an epidemic that is of major concern now more than the dengue epidemic that continues to occur today. The focus of risk, especially on medical and non-medical personnel working specifically in health services, is very high because it deals directly with co-19 patients or other patients who are likely to suffer but have not been detected with other illnesses. Related to this, the human resources working in the health service are affected as well as the health conditions and habits that are carried out daily that affect the level of risk that might occur. Covid-19 positive patients who must be hospitalized usually have acute respiratory distress which can be fatal. Identification of patients with Covid-19 infection is usually obtained after laboratory examinations which in less than half are based on congenital (comorbid) diseases such as diabetes, hypertension and those related to the heart and blood vessels.