Evaluation of patient safety culture as perceived by nurses during the COVID-19 pandemic

Objectives: A good patient safety culture (PSC) is linked to a reduced risk of patient problems and minimal undesirable occurrences. This study investigated the PSC levels from nurses' perspectives during the COVID-19 pandemic. Methods: A descriptive cross-sectional design was applied. The Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was administered to 315 nurses working at 2 major hospitals in Jeddah, Saudi Arabia. The data were analyzed using descriptive statistics, a t-test, and a one-way ANOVA test. The statistical significance of the correlation was determined at the 0.05 level. Results: PSC was rated as medium overall according to the nurses, with a weighted mean of 2.88-0.76 and a relative weight of 57.57%. In addition, all PSC composites were rated from medium to high, except organizational learning, which was rated low. The correlation between sociodemographic variables as well as PSC levels was investigated using the t-test and one-way ANOVA test. The association is statistically significant when P ≤ 0.05. The findings revealed a statistically significant correlation between nurse nationality (t = -4.399, P = 0.000), age (F = 7.917, P = 0.000), experience in years (F = 3.760, P = 0.024), and hospital (t = -0.401, P = 0.689). Conclusions: The nurses in this study had a medium overall PSC level, and all PSC composites ranged from a medium to a high level, except organizational learning, which had a low level. In addition, the findings showed that there is a significant relationship between PSC levels, nurses' nationalities, experience in years, and the hospital itself. © 2023 Anood M. Alabbasa et al., published by Sciendo.

In silico analysis of Osciallatoria sp. for SARS-CoV-2 protease inhibiting bioactive compounds

SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) was first reported in Hubei Province of the People's Republic of China, during a pneumonia outbreak in late 2019. COVID-19 became a viral pandemic causing higher mortalities across the globe. Increasing mutations in the spike proteins led to increased severity and speedy transmission. Since its appearece, the scientific world has been trying to develop an effective drug to treatment COVID-19. Main protease responsible for viral replication is found to be potent target irrespective of SARS-CoV-2 mutations. So, this investigation focuses on evaluating the protease inhibiting capabilities of Oscillatoria sp. derived bioactive compounds through in silico processes. The bioactive compounds with potential activities were identified, analysed and retrieved from database of KNApSAck. Binding sites of the target protein was examined using Cast P online server. Total of 29 bioactive compounds from Osciallatoria sp. were subjected to molecular docking against protease of SARS-CoV-2. From the analysis, 5 compounds showed binding energy (>-7 kcal/mol) and significant interactions on binding aminoacid residues. PASS prediction showed all the compounds have probable antiviral activity. Therefore, it was concluded that, the compounds Anabaenopeptin F, Oscillamide Y, Raocyclamide A, Anabaenopeptin B and Largamide A can be utilised for development of effective drugs in the treatment of COVID-19 infection.

SARS-CoV-2 protease inhibiting phytocompounds from Datura metel L.: An in silico investigation for potential drugs unaffected by viral mutations against COVID-19

Viral mutations can become more common as a result of natural selection, random genetic drift or recent epidemiological trends. Even more difficult is to determine whether a single mutation will affect the fate of an illness or a pandemic. World Health Organization designated the latest strain of SARS-CoV-2, the Omicron, as a "variant of concern" as more countries are reporting cases, and it contains a unique mix of mutations that might help it spread faster. Mutations in the SARS-CoV-2 strains at the high rates lead to the in effectiveness of vaccines and developed drugs. As the mutations occur only on the spike proteins of the viral particles, targeting other vital enzymes, i.e., proteases for drug discovery paves way for potential drug candidate irrespective of the mutations. So, the present study focuses on identifying the phytocompounds from Datura metal L. inhibiting the SARS-CoV-2 proteases. The druglikeness, PASS predictions and ADMET properties of the selected compounds were performed. 31 compounds were identified from the KNApSAck database and subjected to molecular docking studies. From the analysis, 7 compounds. Withametelin I, Withametelin J, Withametelin K, Withametelin L, Withametelin M, Withametelin N and Withametelin O showed significant binding energies and ADMET values. Therefore, these compounds can be further utilized for development of novel drugs for treatment of SARS-CoV-2 infections.

Mask-wearing Behaviours among the Public in Saudi Arabia during the COVID-19 Pandemic: A Cross-sectional Study

Introduction: Public behaviour involving the wearing of face masks are influenced by a host of interdependent demographic, economic, and educational factors, therefore, mask-wearing behaviours among the public vary not only in different countries but also from region to region within a country. Aim: To assess mask-wearing behaviours among the public in Saudi Arabia during the Coronavirus Disease 2019 (COVID-19) pandemic. Materials and Methods: This cross-sectional study was conducted among the general public of Saudi Arabia who could communicate in Arabic, from 9th August 2021 to 12th October 2021, after approval from Taif University. To collect as many respondents as possible, convenience sampling was used. A social media platform was used for the data collection. Descriptive statistics and a logistical regression model were employed for data analysis. Results: A total of 481 participants consented to take part in the current research, with 56.8% being male and 43.2% being female. Most individuals showed poor compliance (67.6%). Female participants, participants who had graduate degree, and people who worked in a confined environment, including a hospital, restaurant or similar place, reported better compliance with the use of a face mask (χ2=13.29;p-value < 0.001), (χ2= 8.26;p-value= 0.041), and (χ2=16.84;p-value < 0.010), respectively. Regression analysis defined three characteristics linked with good compliance ie., sex, level of education and present work/living situation. Conclusion: Most people did not comply with public behaviour concerning the use of face masks. Female participants were more likely to wear a face mask.

ACUTE PULMONARY EMBOLISM AND MYOCARDIAL INJURY IN COVID-19 PATIENT

SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Corona Virus Disease (COVID-19) main presenting feature is hypoxia which coincidentally is a feature of Pulmonary Embolism (PE) that can be life-threatening if not diagnosed early. COVID-19 causes excessive inflammation that can induce expression tissue factors, which is a major coagulation activator1,2. Therefore, PE should also be a consideration for those presenting with COVID-19 with worsening hypoxia. CASE PRESENTATION: 79-year-old a man with non-ischemic cardiomyopathy with Ejection Fraction (EF) 45- 50% presented with worsening shortness of breath, dry cough, and bilateral lower limb edema for 2 weeks. On presentation, he was afebrile normotensive with tachypnea, tachycardia, and hypoxia. On physical examination, he was in respiratory distress with faint bilateral crackles and bilateral lower limb edema. Lab Investigations showed elevated Brain Natriuretic Peptide to 1830 pg/ml (normal range 0-100 PG/ml), troponin level to 6.89 ng/ml (normal range 0.00-0.03 ng/ml) and the D-dimer level was >20.00 UG/ml FEU (normal range 0.00-0.40 UG/ml FEU). Viral PCR confirmed COVID-19. No ischemic changes noted in EKG. Echocardiography (Echo) revealed EF (Ejection Fraction) at 10-15%, dilated right ventricle with reduced function, and left ventricular thrombus. In CT chest with contrast noted to have acute segmental right middle lobe pulmonary arterial embolus. He was therapeutically anti-coagulated with enoxaparin. He received antibiotics, systemic steroids, and diuresis On day 3 of admission, he had worsening hypoxia and dyspnea while on 100% oxygen therapy. The patient opted for no escalation in care with ventilation or resuscitation. As he had no clinical improvement, the family agreed on comfort care. He died on day 5 of admission. DISCUSSION: We described a case of COVID-19 complicated by PE, which is found among 13% of COVID-19 patients in a study done in Netherland1. Studies showed that elevated D-dimer levels can correlate with risk for pulmonary embolism. In this case, D-dimer found to be elevated which is consistent with prior cases 3. The patient found to have cardiomyopathy with ejection fraction at 15% during presentation despite prior Echo done about 6 months earlier revealed an EF 45%. Evidence of myocardial injury was found in previous articles from China as found in 19.7% of patients (total 416) with evidence of cardiac injury including elevated troponin and reduced ejection fraction. It was noted to be independently associated with a higher risk of mortality 4. CONCLUSIONS: Diagnosis of pulmonary embolism in COVID19 patients may represent a diagnostic challenge as hypoxia is arguably the feature of COVID19 that could be explained by a viral lung infection. Thus, it is necessary to have a lower index of suspicion and CT chest to be considered in patients with worsening hypoxia so as to evaluate for pulmonary embolism especially among patients with an elevated D- dimer level. Reference #1: Klok, F. A., Kruip, M. J. H. A., van der Meer, N. J. M., Arbous, M. S., Gommers, D. A. M. P. J., Kant, K. M., … Endeman, H. (2020). Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research. https://doi.org/10.1016/j.thromres.2020.04.013 Reference #2: Goeijenbier, M., van Wissen, M., van de Weg, C., Jong, E., Gerdes, V. E. A., Meijers, J. C. M., … van Gorp, E. C. M. (2012). Review: Viral infections and mechanisms of thrombosis and bleeding. Journal of Medical Virology, 84(10), 1680–1696. https://doi.org/10.1002/jmv.23354 Reference #3: J. Chen, X. Wang, S. Zhang, et al., Findings of acute pulmonary embolism in COVID-19 patients, The Lancet Infectious Diseases (3/1/2020), https://doi.org/10.2139/ ssrn.3548771 (preprint. Available at SSRN), https://ssrn.com/abstract=3548771. DISCLOSURES: No relevant relationships by Musaab Alfaki, source=Web Response No relevant relationships by Nia Flemming, source=Web Resp nse No relevant relationships by Janeen Grant, source=Web Response No relevant relationships by Fausto Lisung, source=Web Response No relevant relationships by Rani Sittol, source=Web Response

SADDLE UP! A CASE OF COVID-19-ASSOCIATED SADDLE PULMONARY EMBOLISM

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The novel COVID-19 virus has been found to be associated in a wide variety of complications most commonly involving the lungs namely by pneumonia with resultant ARDS. We present a case of COVID19 related extensive pulmonary emboli. CASE PRESENTATION: A previously well 47-year-old male presented with an 8 day history of fever, cough & dyspnea. He tested positive for COVID-19 as an outpatient. Four days later, he developed left sided pleuritic chest pain & presented to hospital. On examination, blood pressure was 119/89mmHg, HR 124beats/min & RR 44breaths/min. Despite this, he was saturating 93% on room air. On examination, he had diminished breath sounds and faint crackles bilaterally. Significant laboratory investigations revealed, leucocytosis of 18 (4.00 -11.00 K/ul), troponin of 3.13 (0.00 - 0.03ng/ml), C-reactive protein was 236 (<10mg/l), D-dimer was >20 UG/ml FEU (0.00-0.04 ug/ml) and BNP of < 5 (0-100pg/ml). Electrocardiogram revealed sinus tachycardia with no ST segment changes. Plain chest radiograph had subsegmental airspace disease in the left lower lobe. CT pulmonary angiography revealed a saddle pulmonary embolus with filling defects throughout right upper middle and lower lobe and left upper and lower lobe pulmonary arteries, and evidence of right heart strain. There were airspace opacities in the left and right lungs. A transthoracic echocardiogram study confirmed right heart strain. He underwent emergent catheter directed thrombolysis and was placed on heparin infusion. Two days later, an IVC filter was placed. He was discharged on day 7 with a six month course apixaban. He received five days of hydroxychloroquine, thiamine, vitamin C and zinc. He was also given 5 days of ceftriaxone. At 2 month follow up, he continues to do well and no longer has any respiratory symptoms or further hypoxia DISCUSSION: COVID-19 causes excessive inflammation that can induce initiation and progression of both venous and arterial thromboembolism. The exact pathophysiology is unknown but it is hypothesized that the virus induces the expression of tissue factor which is a major coagulation activator. Therefore, pulmonary emboli (PE) should be a consideration in COVID-19 patients with acutely worsening respiratory symptoms. Interestingly, it has been highlighted that those with a d-dimer of greater than 1ug/ml have an odds ratio increased by 18 times for mortality. Despite this, our patient continues to do well on anticoagulation, presumably because of his age, health, as well as early intervention and anticoagulation. Data from China indicate that those who received heparin had a 20% survival rate. Apixaban maybe an acceptable long term therapy, but further study is needed. CONCLUSIONS: This case demonstrates that even though dyspnea and hypoxia are key presenting symptoms of COVID-19, one must be vigilant for acute worsening and consider other differentials such as pulmonary emboli. Reference #1: Gronagle Dennis, O’Donnell James S, Sharif Kassem, Emery Paul, Bridgewood Charles, Immune mechanism of pulmonary intravascular coagulopathy in COVID19 pneumonia, The Lancet Rheumatology, May 2020, https://doi.org/10.1016/ S2665-9913(20)30121-1 Reference #2: Ning Tang Huan Bai Xing Chen Jiale Gong Dengju Li, Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy, Journal of thrombosis and haemostasis, March 2020, https://doi.org/10.1111/jth.14817 Reference #3: Oudkerk Matthijs, Büller Harry R, Kuijpers Dirkjan, van Es Nick, Oudkerk Sytse F, McLoud Theresa C et al, RSNA Radiology, April 2020, ttps://doi.org/10.1148/radiol.2020201629 DISCLOSURES: No relevant relationships by Musaab Alfaki, source=Web Response No relevant relationships by Nia Flemming, source=Web Response No relevant relationships by Latoya Gayle, source=Web Response No relevant relationships by Janeen Grant, source=Web Response No relevant elationships by Fausto Lisung, source=Web Response No relevant relationships by Jason Lofters, source=Web Response No relevant relationships by Gene Otuonye, source=Web Response No relevant relationships by Ro-Kaye Simmonds, source=Web Response No relevant relationships by Rani Sittol, source=Web Response

CORONAVIRUS UNCOVERS MYSTERIOUS MEDIASTINAL MASS: A DIAGNOSTIC AND MANAGEMENT DILEMMA

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: As worldwide incidence of COVID-19 increases, so too does the heterogeneity of patients affected. This includes those with underlying neuromuscular disorders. Myasthenia gravis (MG) & myasthenic crises (MC) in the presence of SARS-CoV-2 is a relatively unknown entity. Herein we present such a case. CASE PRESENTATION: A previously well 35-year-old female health care worker presented with 5-days of fever, malaise & dyspnea. She had been in contact with COVID-19 positive patients. Her BP was 117/65mmhg, HR 104 beats/min, RR 22 breath/min, T 98.2°F & O2 sat 87% on 5L nasal cannula. At that time examination was solely significant for dullness to percussion & decreased air entry on the right lung zones. Only significant labs were WBC 18.47 & Hb 10.5. CT chest showed right lower lobe consolidation, air bronchograms, bilateral alveolar infiltrates & a 7.6x4 x10.7cm right anterior mediastinal mass concerning for thymoma or lymphoma. There were no pulmonary emboli. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) PCR was positive. Within 24 hours her tachycardia, tachypnea & O2 sat worsened. Repeat examination revealed bilateral ptosis, no neck control & grade 2 power in all limbs. ABG showed pH 7.39, pCO2 35.4, pO2 52.9, HCO3 21.3. She was emergently intubated. A significant amount of blood was noted in the endotracheal tube which resolved with nebulized tranexamic acid. There was consideration of a new diagnosis of MG as well as diffuse alveolar hemorrhage. She received IV methylprednisolone, hydroxychloroquine, thiamine, vitamin C & zinc in addition to inhaled epoprostenol and intermittent proning. Antibodies for acetylcholine receptors were positive & IVIG was started. Her oxygenation subsequently improved & she was extubated on day 16 of admission. She was discharged on pyridostigmine, prednisone & apixaban with planned outpatient thymectomy. DISCUSSION: Over 5 million cases of COVID-19 have been reported. The infection stimulates a robust inflammatory cascade & may result in respiratory failure. The presence of concurrent comorbidities worsens prognosis. It is well known that MC may be triggered by infectious processes. In this case, a new diagnosis of MG was uncovered during SARS-CoV-2 infection. MC is the initial presentation for 20% of patients with MG with only 1/3 surviving. IVIG is recognized treatment for severe MG. Although there is no consensus on definitive COVID-19 therapy, there are reports of patients with severe ARDS due to COVID-19 improving with IVIG. We opine that this patient’s condition may have improved due to a combination of corticosteroid use and IVIG. At minimum, it did not worsen her outcome. The mechanism behind this is unclear and further study is needed to determine an association with improved outcome. CONCLUSIONS: IVIG may be a valid treatment modality for COVID-19, especially with concurrent autoimmune disease. Further study is required. Reference #1: Barth D, Nabavi Nouri M, Ng E, Nwe P, Bril V. Comparison of IVIg and PLEX in patients with myasthenia gravis. Neurology 2011;76:2017-2023 Reference #2: Moeinzadeh F, Dezfouli M, Naimi A, Shahidi S, Moradi H1. Newly Diagnosed Glomerulonephritis During COVID-19 Infection Undergoing Immunosuppression Therapy, a Case Report. Iran J Kidney Dis. 2020 May;14(3):239-242. Reference #3: Shi H1, Zhou C2, He P2, Huang S3, Duan Y3, Wang X3, Lin K3, Zhou C3, Zhang X4, Zha Y5.Successful treatment of plasma exchange followed by intravenous immunogloblin in a critically ill patient with 2019 novel coronavirus infection. Int J Antimicrob Agents. 2020 Apr 13:105974. doi: 10.1016/j.ijantimicag.2020.105974. [Epub ahead of print] DISCLOSURES: No relevant relationships by Musaab Alfaki, source=Web Response No relevant relationships by Samarth Beri, source=Web Response No relevant relationships by Latoya Gayle, source=Web Response No relevant relationships by Janeen Grant, source=Web Response No re evant relationships by Fausto Lisung, source=Web Response No relevant relationships by Gene Otuonye, source=Web Response No relevant relationships by Rani Sittol, source=Web Response