Facteurs predictifs de mortalite chez les patients hospitalises pour une pneumonie a COVID-19

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Predictors of mortality in hospitalized COVID-19 patients in a Tunisian university hospital

Introduction: Mortality rates of coronavirus disease 2019 (COVID-19) continue to rise across the world. The predictors of mortality in COVID- 19 patients are under study. Objectives: we aim to evaluate the risk factors associated with the death of patients with COVID-19 pneumonia. Methods: We analysed data of laboratory confirmed hospitalized patients at the COVID-19 unit of a university hospital in the Tunisian center, between September 2020 and January 2021.Patients' characteristics, comorbidities, and laboratory abnormalities were recorded. Potential predictors of in-hospital mortality were identified by multivariable Cox regression model. Results: A total of 256 patients were included.Mean age was 66 years (SD, 14 years) and 62% (n = 158) patients were males. Forty-eight percent (n = 123) of patients had at least two co-morbidity with hypertension and diabetesas the most common comorbidities.Severe cases accounted for 52% of the study population.The overall in-hospital mortality rate was 29% (n = 72). multivariate analysisrevealed that Age > = 60 years (HR 5.87, p < 0.001);The presence of coronary heart disease (HR 2.47, p = 0.027) and leukocytes ≥ 10,000 (HR 2.25, p = 0.012),were independently associated with increased in-hospital mortality. Conclusion: Predictors could assist clinicians to identify patients with a poor prognosis at an early stage to reduce the Covid-19-related mortality and rationalize the use of limited medical resources.

[Quality of "crisis communication" media during the COVID-19 pandemic in the Great Maghreb countries]. / Qualité des supports de communication de crise lors de la pandémie de la COVID-19 au Grand Maghreb.

OBJECTIVE: To objectively assess the quality of "crisis communication" media, during the COVID-19 pandemic, in the three Greater Maghreb countries (Tunisia, Algeria, Morocco). METHODS: A compliance audit for press releases and epidemiological bulletins was analyzed against a quality benchmark, which had been specifically designed by the authors. This framework, made up of five dimensions and 50 items, graded (0/1), was applied by two researchers in preventive medicine. Multiplying the scores by a coefficient of two resulted in a partial score of 20 points for each dimension and a total score of 100 points for the checklist taken as a whole. The quality of the communication media was considered to be good when exceeding the thresholds of 15/20 for the different dimensions and 75/100 for the entire grid. RESULTS: A total of 141 information media were included in this audit (Tunisia: 60; Algeria: 60; Morocco: 21). The overall median quality score for these media was only 56/100 (IIQ: [46-58]), without major variability between countries. The most appreciated dimension was "maintaining the confidence of the population", with an overall median score of 14/20 (12/20 for epidemiological bulletins and 16/20 for press releases). The most poorly rated dimension was "strengthening community participation", with a median score of only 4/20 (6/20 for epidemiological bulletins and 4/20 for press releases). CONCLUSION: The quality of the Maghreb crisis communication media during COVID-19 was insufficient in most of its dimensions and items, particularly from a psychosocial standpoint. Reinforcement of the capacities of communication officers to develop information material and supports during health crises is indispensable and should be considered as an urgent matter.

Effectiveness of hand hygiene in an epidemic context. Systematic review

Objective: To assess the effectiveness of Hand Hygiene (HH) in preventing infections and the transmission of pathogens, in an epidemic context, in community and hospital settings. Method: It is a systematic review of the literature based on a document request, conducted on PubMed, using the following search equation: «(« Hand Hygiene «[All Fields] OR» Hand Disinfection «[All Fields]) AND («Epidemics» [All Fields] OR «Pandemics» [All Fields]) «. All publications related to the effectiveness of the preventive intervention for HH in an epidemic setting were Included. Results: A total of 16 publications were included, of which the majority proved the effectiveness of HH and its promotion in reducing infections during an epidemic. In a clinical trial, promoting HH in an intervention group significantly reduced the prevalence of infections (24.4% vs. 11.1%). Two systematic reviews have shown the effectiveness of HH in preventing the transmission of germs with ORs between 0.52 and 0.62. Four case-control studies and three cross-sectional studies concluded with the protective effect of HH with ORs varying between 0.06 and 0.71. A cohort study showed that low adherence to HH recommendations was associated with a higher infection rate (77.5% vs 95%;p = 0.02). A single systematic review did not conclude that HH was effective in the epidemic setting. Conclusion: The effectiveness of HH in the fight against epidemics has been demonstrated. It is dependent on the engagement and the active participation of the different intervenient. Hence the need to increase accessibility to different methods of HH and to promote the importance of this prevention strategy could be assured through education and awareness.