ABSTRACT
Objective: To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit (HDU) in relation to invasive vs. non-invasive mode of ventilation. Methods: In this study, the patients required either non-invasive [oxygen ≤10 L/min or >10 L/min through mask or nasal prongs, rebreather masks and bilevel positive airway pressure (BiPAP)] or invasive ventilation. For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen, Kaplan Meier and log rank analyses were used. In the end, independent predictors of survival were determined by Cox regression analysis. Results: Invasive ventilation was required by 15.1% patients while 84.9% patients needed non-invasive ventilation. Patients with evidence of thromboembolism, high inflammatory markers and hypoxemia mainly required invasive ventilation. The 30-day in hospital mortality was 72.7% for the invasive group and 12.9% for the non-invasive group (1.8% oxygen 10 L/min, 3.6% rebreather mask and 4.5% BiPAP). The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group (P<0.05). Age, presence of co-morbidities, number of days requiring oxygen, rebreather, BiPAP and invasive ventilation were independent predictors of outcome. Conclusions: Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury. Thus, protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.
ABSTRACT
Background: There is paucity of research based information regarding the dermatology learning needs and their fulfilment in primary care physicians
Objective: To determine skin diseases burden in the community AND adequacy of preparedness of Primary Care Physicians to deal with skin diseases
Methodology: This was a cross sectional study conducted from 1[st] January 2015 to 31[st] December 2016 at Dermatology Outpatient Department of Sheikh Zayed Medical College/Hospital [SZMC/H], Rahim Yar Khan, for burden of skin diseases and feedback from Primary Care Physicians of both SZMC/H and Primary Health Care setups [BHUs and RHCs] of District Rahim Yar Khan regarding adequacy of their preparedness to deal with skin disease patients. Records from a tertiary care teaching hospital was sought from OPD to assess skin disease burden and Primary Care Physicians from tertiary care hospital and BHU and RHC of district were surveyed regarding content AND teaching adequacy of undergraduates through their dermatology curriculum. Data was entered and analyzed by using SPSS version 20
Results: A total of 356 doctors participated in this study. Of these 233 [65.4%] were males. It was found that 10% of patients attending OPD in Sheikh Zayed Hospital [A tertiary care teaching hospital] suffered from skin disease. Frequencies of "Common skin diseases" in the community were; eczema 12.9%, scabies 10.8%, fungal infection 9%, bacterial infection 8% and acne 7%. Of all participants, 274 [77%] reported that <10% of their patients suffered from skin disease and only 30 [8.4%] of them were fully confident while treating skin disease patients and only 36 [10.1%] reported that most of their patients were cured. It was noted that 145 [40.7%] participants could name only 1-3 of the common skin diseases in the community, 182 [51.1%] named 4-6 while only 12[3.4%] could name 7 or more and 17[4.8%] had no knowledge of even a single common skin disease in the community. Only 92[25.8%] participants rated that their undergraduate training was adequate while 264[74.2%] rated it to be inadequate
Conclusion: This study concluded that primary care physician were not adequately prepared for managing common skin diseases during their undergraduate training. Appropriate exposure and adequate teaching in dermatology throughout undergraduate medical curriculum is essential because skin presentations manifest throughout all aspects of medicine, and most often dermatological problems are dealt with exclusively by non-dermatologists