ABSTRACT
BACKGROUND AND AIMS: Despite the lungs are the major targets of COVID-19, other organs such as the kidneys are also affected. Renal complications of COVID-19 are not yet well studied. We aimed to study the prevalence of acute kidney injury (AKI) among positive COVID-19 cases that were managed in the intensive care unit (ICU) in a single isolation hospital during the pandemic, and to explore its impact on patient outcome. METHOD: This retrospective study included 616 patients with COVID-19 who were managed in the ICU in a single isolation hospital in Kuwait during the pandemic, from February to December 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Of the 616 patients, 40.2% developed AKI (group 1, n = 248) and were compared with the patients without AKI (group 2, n = 368). RESULTS: Most of cases in the two groups were males (73% versus 70.7%), aged (60.8 ± 14 versus 51.7 ± 16 years), respectively. The two groups were comparable regarding chronic kidney disease (2% versus 0.8%) and chronic pulmonary disease. Other factors were significantly predominating among group 1 as diabetes mellitus (63.7 versus 40.5%), hypertension (74.2% versus 40.5%) and ischemic heart disease (26.2% versus 12.5%) (P < .05). Fever, cough, shortness of breath and dehydration were significantly more frequent presentations among patients of group 1, and had radiological findings that were synchronized with COVID-19 (89.5% versus 50.8%) (P < .05). Moreover, sepsis, volume depletion, shock, arrhythmias and ARDS predominated among the AKI group (P < .05). The number of cases who were managed by therapeutic anticoagulation was significantly higher in AKI patients (89.9% versus 51.9%);also, cases who received supportive vasopressors and convalescent plasma transfusion as well as steroid were significantly higher in the same group (P < .05). Other therapeutic modalities such as antivirals, tocilizumab and hydroxychloroquine were comparable in both groups. We found that acute respiratory failure requiring mechanical ventilation was significant among the AKI group (66.8% versus 29.4%), and the overall mortality rate was significantly higher in the same group (62.5% versus 32.8%). CONCLUSION: The prevalence of AKI in patients with COVID-19 was 40.2%, and it was associated with poor prognosis among ICU COVID-19 positive cases.
ABSTRACT
Background: Cancer care is heavily centered in health care facilities due to the requirements of providing complex multidisciplinary care with multiple testing and interventions. We describe our experience in implementing a new model of care to minimize cancer patients visit to health care facilities and to reduce the risk of infections and to decrease the pressure on the health care system. Methods: In response to the COVID-19 pandemic, we reengineered the cancer care process to reduce patients visit to the hospital by the implementation of a Care Near Home (CNH) Model, which comprises offour components: Virtual clinic, laboratory testing near home, shipping medications and supplies, and involving local health care facilities. The effectiveness and acceptance of this new model has been assessed by the delivery of timely care successfully and assessing the satisfaction patients and healthcare providers. Results: On March 18, 2020, we launched the virtual clinics followed by different components of the model. The number of virtual clinic visits has increased significantly from 399 visits in March to 1107 in April 2020. More the 90% of physicians and patients who responded to the survey expressed their acceptance and satisfaction with the virtual clinic services. Medications were shipped to total of 603 patients. Of those, 578 (96%) patients received their medications (378 patients outside city, 200 patients inside city of which, 95% received medications within 24 hours). Only 25 (4%) patients did not receive their medications and we arrange for alternative solutions. Laboratories in various regions were set up to perform the tests for our patients and to communicate the results through our electronic healthcare records system. The process of ordering and performing the test were piloted with success and now we are at the scaling up phase. Conclusions: Although the implementation of CNH Model was driven by COVID-19 pandemic, it will be integrated in our work process and utilized as a long term approach to manage many of our patients because it is more convenient to them and more cost effective to the health care system.
ABSTRACT
Background: Saudi Arabia is one of the nations impacted by the epidemic of COVID-19. Objectives: To address psycho-behavioral problems to the pandemic of COVID-19 in the whole population of Saudi Arabia, namely: 1) obstacles to infection control measures against COVID infections;2) adverse responses to COVID-19;and 3) fear among the general population in Saudi Arabia. Methods: An electronic population based cross sectional survey using a validated electronic questionnaire was performed between 23 July and 1 August 2020. Among the whole estimated target population of COVID-19 patients in Saudi Arabia. Using multi-stage random sampling technique all over the governorates. The six-item variant of the State-Trait-Anxiety-Stock (STAS-6) was used to measure rates of anxiety. Estimated target population of 67,000 Covid-19 patients according to last national report of MOH. A multi stage sampling from different affected governorates. Sample size was calculated using Steven Sampthon formula to be 2230 patient. Sample was collected from MOH electronic registries approved by the ethical committee of KSUMC # (78/82/KSUMC/IRB-COVID-3792). Results: A total of 1,800 full replies have been received. Almost 60 percent reported having trouble wearing a face mask to guard against COVID infection. The mean and standard deviation (SD) for the overall avoidance obstacle value was 35.8 (SD +/- 7.1;scale 18 to 68) out of a maximum 72. Male respondents [odds ratio (OR) = 1.25;95 % confidence interval (CI) 1.03 to 1.51] and many respondents who regarded their health condition as poor / fair (OR = 1.49;95 % CI 1.31 to 1.82) were indicators of Strong obstacles to avoidance. Negative feelings such as anxiety (74.6%), accompanied by sadness (43.4%) and stigma (23.0%) correlated with SARS-CoV-2 infection has been identified. The addressing groups that their wellbeing was viewed as poor / fair (OR = 2.19;95 % CI 1.57 to 3.04) and a higher risk was recorded to get more depressive feelings. Anxiety rating results showed 68.0 per cent (95 per cent CI 65.8 to 65.8 per cent). (70.1) mild to extreme anxiety recorded. Participants who see their well-being as poor / fair (OR = 3.46;95% CI 12.22 to 5.40) and who were female (OR = 1.91;95 % CI 1.55 to 2.36) were female;predictors with mild to extreme fear. Conclusion: Psycho behavioral measures are expected to promote the management and monitoring of the epidemic of COVID-19.