Non-invasive predictors of ICU admission and mortality in initially asymptomatic COVID-19 patients

Background Coronavirus disease 2019 (COVID-19) can present with pulmonary and non-pulmonary manifestations, or it may be asymptomatic. Asymptomatic patients have a major impact on transmission of the disease, and prediction of their outcome and prognosis is challenging. We aim to identify the predictors of intensive care unit (ICU) admission and mortality in hospitalized COVID-19 patients with initially asymptomatic presentation. Methods This was a prospective multicenter study using cohort data that included all admitted patients aged 21 years and above, with different clinical presentations other (than pulmonary manifestation) and were discovered to have COVID-19. Demographic data, clinical data and progression were reported. Univariate analysis and logistic regression analysis were performed to predict ICU admission and mortality during hospitalization. Results One hundred forty-nine consecutive patients, 92 (61.7% males) were included in our study, Median age (IQR) was 59.00 (43–69]. Only 1 patient (0.7%) had a contact with a confirmed case of COVID-19. 58 patients (39%) were admitted to ICU and 22 patients (14.8%) have died. High ferritin level (more than 422.5), low oxygen saturation (less than 93%), and in need of non-invasive ventilation (NIV) have 3.148, 8.159 and 26.456 times likelihood to be admitted to ICU, respectively. Patients with high CO-RADS, low oxygen saturation (less than 92.5%), and in need for mechanical ventilation (MV) have 82.8, 15.9, and 240.77 times likelihood to die, respectively. Conclusion Initially asymptomatic hospitalized patients with COVID-19 have a great impact on health system with high ICU admission and mortality rate. We identified the predictors that may help in early management and improving prognosis. Trial registration Trial was registered in Clinicaltrials.gov, registration number is NCT05298852, 26 March 2022, retrospectively registered.

Development, Validity, and Reliability of the Perceived Telemedicine Importance, Disadvantages, and Barriers (PTIDB) Questionnaire for Egyptian Healthcare Professionals.

BACKGROUND: This study aimed to develop and investigate the psychometric properties of the Perceived Telemedicine Importance, Disadvantages, and Barriers (PTIDB) questionnaire for healthcare professionals (HCPs) in Egypt. This study was conducted in three phases: (1) development of the questionnaire, (2) preliminary testing of the questionnaire, and (3) investigation of its validity and reliability using a large survey. METHODS: A cross-sectional survey was conducted over two months. A convenience sample of 691 HCPs and clerks from 22 governorates accessed the online survey. The construct validity was assessed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and internal reliability. RESULTS: The initial Eigenvalues showed that all 19 items of the questionnaire explained 56.0% of the variance in three factors. For Factor 1 (importance), eight items were loaded on one factor, with factor loading ranging from 0.61 to 0.78. For Factor 2 (disadvantages), seven items were loaded on one factor with factor loading ranging from 0.60 to 0.79. For Factor 3 (barriers), four items were loaded on one factor, with factor loading ranging from 0.60 to 0.86. The CFA showed that All loadings ranged from 0.4 to 1.0, with CFI = 0.93 and RMSEA = 0.061. All the factors had satisfactory reliability; 0.87 for ''Importance'', 0.82 for ''Disadvantages'', and 0.79 for ''Barriers''. CONCLUSION: The PTIDB questionnaire has an acceptable level of validity and internal consistency, at a readability level of 12th grade. The retest reliability, however, still needs to be tested.

Healthcare Providers' Perspective about the Use of Telemedicine in Egypt: A National Survey.

Incorporation of telemedicine in general clinical practice is becoming a compelling need nowadays in the context of COVID-19 pandemic and its consequent burdens on the healthcare systems. Though telemedicine appears to be appealing and carries a lot of advantages, yet it is still faced by many challenges and barriers especially in developing countries. Our aim was to explore the impression of healthcare providers about telemedicine and its applicability in clinical practice in Egypt. A cross-sectional study was conducted among healthcare providers from different Egyptian governorates through a web-based survey. The survey gathered information about demographic, socioeconomic features of the enrolled healthcare participants; their knowledge, previous experience, impression about telemedicine, advantages of telemedicine over traditional medical services, barriers that may face telemedicine, and additional services that can be provided by telemedicine were also explored. Our study enrolled 642 healthcare providers from all over Egypt, 43.77% were females, of which 55.5% were physicians, 27.3% were nurses, 6.1% were technicians, 7.6% were administrative clerks, and 3.6% were medical directors. Sixty-four percent of participants reported that they have never used telemedicine. Smartphones were the most commonly used mean in the group who used telemedicine (65%), and smartphone applications were the favorable telemedicine service for about 50% of participants. Participants assumed that the use of telemedicine might not have a negative effect on the doctor-patient relationship but raised some concerns regarding the privacy and security of patients' data. Despite the fact that telemedicine appears to be appealing and widely accepted by healthcare providers, yet still, its implementation is confronted by some obstacles. Precise organizational guidelines need to be developed to clearly figure out the exact role of each healthcare provider to minimize their doubtfulness about telemedicine and to facilitate its adoption.

Predictors for Severity of SARS-CoV-2 Infection Among Healthcare Workers.

BACKGROUND: Healthcare workers (HCWs) are still at higher risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections than the general population. Identifying risk factors associated with severe SARS-CoV-2 infections is of paramount importance to protect HCWs and the non-infected patients attending different healthcare facilities. PURPOSE: To recognize the predictors for severity of SARS-CoV2 infection among HCWs working in either COVID-19 or non-COVID-19 healthcare settings. Also, to assess compliance of HCW to standard precautions of infection control and explore the possible risk factors for SARS-CoV-2 infection among HCWs. METHODS: A cross-sectional study was conducted among HCWs with suspected or confirmed SARS-CoV-2 infection, from different Egyptian governorates. They were asked to fill in a web-based self-reporting questionnaire. The questionnaire assessed the demographic and socio-economic characteristics of participants, compliance of HCWs to standard precautions of infection control and COVID-19 presentation. RESULTS: Our study enrolled 204 HCWs (52.3% physicians). Infection of SARS-CoV-2 was confirmed in 61.3% by RT- PCR; 35.8% were admitted to hospital, and of these, 3.9% were admitted to the intensive care unit. While 30.4% had mild disease, 48.5% had moderate disease, 17.2% had severe disease and 3.9% had critical disease. Regression analysis for variables predicting COVID-19 severity among study healthcare workers showed that associated chronic diseases and management at home were the main independent variables predicting severity of their SARS-COV-2 infection, while the variables age, sex, residence, occupation or drug history of immunosuppressives had no role in severity prediction. CONCLUSION: Associated chronic diseases and management at home were the main independent variables predicting severity of SARS-COV-2 infection among HCWs. So, HCWs with chronic diseases should not work in COVID-19 designated hospitals, and there should be a screening strategy for their infection with SARS-COV-2. HCWs must not be negligent in adhering to strict precautions of infection control. HCWs infected with SARS-COV-2 must be managed in hospital not at home.

Knowledge, Applicability, and Barriers of Telemedicine in Egypt: A National Survey.

OBJECTIVES: The study is aimed at evaluating knowledge, attitude, and barriers to telemedicine among the general population in Egypt. METHODS: A questionnaire-based cross-sectional design was carried out among the general Egyptian population. A convenience sampling method was used to approach the eligible participants from University Teaching Hospitals of eight governorates from May to July 2020. RESULTS: A total of 686 participants filled the questionnaire (49.4% were males, mean age 36.7 ± 11.2 years old). Half of the participants stated that they previously used a telemedicine tool, mainly to follow up laboratory results (67.3%). Video or phone calls (39.3%) and mobile applications (23.7%) were the most commonly recognized telemedicine tools by the participants. The included participants exhibited a high level of knowledge and attitude towards telemedicine. On the other hand, 21.9% stated that telemedicine services could jeopardize patient privacy. 32.8% reported that telemedicine service could lead to disclosing medical information to people who are not authorized to do so. Almost half of the participants agreed to strongly agreed that telemedicine service could increase medical errors. 60.80% of the participants said that they are more likely to prefer telemedicine than traditional ways. However, 13.70% stated that telemedicine is more likely to be challenging to use. CONCLUSION: The Egyptian population has high knowledge about the applications of telemedicine. In addition, the vast majority of Egyptians appear to perceive the benefits of telemedicine positively and are willing to use it. However, some barriers that have been found must be taken into consideration to adopt telemedicine successfully, especially for people who are old, are low educated, and live in remote areas. Future studies should address the utility of telemedicine in improving the quality of healthcare and patient's health outcome and quality of life.

Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt.

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic has affected routine endoscopy service across the gastroenterology community. This led to the suspension of service provision for elective cases. AIM: To assess the potential barriers for resuming the endoscopy service in Egypt. METHODS: A national online survey, four domains, was disseminated over a period of 4 wk in August 2020. The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s). RESULTS: A hundred and thirteen Egyptian endoscopy centers participated in the survey. The waiting list was increased by ≥ 50% in 44.9% of areas with clusters of COVID-19 cases (n = 49) and in 35.5% of areas with sporadic cases (n = 62). Thirty nine (34.8%) centers suffered from staff shortage, which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis. In multivariate analysis, the burden of cases in the unit locality, staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice (P = 0.029, < 0.001 and 0.02, respectively) and Odd's ratio (0.15, 1.8 and 0.16, respectively). CONCLUSION: The COVID-19 pandemic has led to restrictions in endoscopic volumes. The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery. Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.