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Introduction: Literature states a higher self-contamination rate among healthcare workers (HCWs) while doffing personal protective equipment (PPE). During the COVID-19 pandemic, onsite trained observers were not always available to monitor PPE compliance. The remote audio-visual doffing surveillance (RADS) system has the potential to overcome this limitation [1, 2]. We aimed to compare the efficacy of this real-time RADS system against the onsite buddy system for monitoring the doffing of PPE. Method(s): This prospective, observational study was conducted at our tertiary care centre in northern India. Study was registered in the clinical trial registry India (CTRI/2020/11/038172). 200 HCWs who cared for COVID-19 patients in the intensive care units were included. Group A included HCWs who performed doffing with the help of an onsite trained observer and group B included HCWs who performed doffing with the RADS system. An independent observer noted the error at any step using the CDC doffing checklist, in both groups. An online questionnaire to analyse the level of satisfaction post-doffing was also surveyed. Result(s): The proportion of errors committed during doffing was significantly lower in group B compared to group A with a low relative risk of 0.34 (95% CI 0.22-0.51) (p < 0.001) (Fig. 1). In both groups, there was no difference in HCWs feedback regarding the ease of the system and fear of committing an error. Though the perceived quality of monitoring was felt better with onsite buddy, the overall confidence rating of being safe after doffing was better with the RADS system. Conclusion(s): Real-time RADS system may be more effective than the onsite buddy system for ensuring the safety of HCWs during doffing PPE. HCWs level of satisfaction related to the ease and anxiety with the monitoring systems were comparable. RADS system can reduce reliance on HCW resources and can integrate well into existing healthcare systems.
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Aim and background: The high mortality associated with the thrombotic events in hospitalised COVID-19 patients resulted in the usage of anticoagulants in varying doses. Whether the high-dose anticoagulants have led to better outcomes or higher incidence of clinically significant bleeding events is still debatable. Objectives: To find the incidence of clinically significant bleeding events in moderate to severe COVID-19 patients on therapeutic anticoagulation and the factors influencing these events. Materials and methods: In our retrospective, single-centre, cohort study of 155 critically ill COVID-19 patients we observed the incidence of clinically significant bleeding. Multivariate regression models were used to evaluate the association between anticoagulant regimen, coagulation, and inflammatory markers with the incidence of bleeding and thrombotic events. Results: The incidence of Clinically Relevant Non-Major Bleeding (CRNMB) was 33.5% (26.17-41.46%,) and major bleeding was 9.03% (5.02-14.69%). The anticoagulation intensity at baseline had a very high odds of major bleeding when Enoxaparin and dual antiplatelet therapy were used together (adjusted OR of 434.09 [3.81-49502.95], p < 0.05). At admission, bleeders had a poorer P/F ratio with more patients on invasive ventilation. At the time of bleeding, the bleeders had a higher d-dimer, ferritin, CRP, and procalcitonin. The subhazard ratio (SHR) for death in bleeders was 3.35 (95% CI, 1.97-5.65;p < 0.001). Conclusion: The incidence of bleeding in critically ill COVID-19 patients on therapeutic anticoagulation increases with the severity of the disease as well as with concurrent use of dual antiplatelets. Major bleeding may also contribute to higher mortality.
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Aim and background: Efficacy of therapeutic vitamin D3 supplementation for ICU outcomes in severe COVID-19 is sparingly studied. Objective: Effect of single high-dose vitamin D3 supplementation on sequential organ failure assessment (SOFA) score in patients with moderate to severe COVID-19 disease. Materials and methods: A single centre, randomized, doubleblind, placebo-controlled study was carried out among 90 patients with moderate to severe COVID-19 ARDS defined by PaO2/FiO2 <200. Participants received 0.6 million IU vitamin D3 (oral nanoformulation) (intervention) or placebo (equal volume, oral). SOFA score on day-3, -7, -10, and -14 was measured. The primary outcome was a change in day-7 SOFA score from admission. Pre-specified secondary outcomes were day 10 and day-14 SOFA score, change in PaO2/FiO2 ratio, in-hospital all-cause mortality, and inflammatory cytokine levels. Results: A total of 358 patients were screened and 90 patients (45 in each group) were included. 25(OH)D3 levels were 12.0 (10.0-16.0) and 12.7 (12-18) ng/mL (p = 0.059) at study entry;60 (54.40 to 65.59) ng/mL and 3.8 [1.05 to 6.55] at day-3 in the intervention and placebo group, respectively. The SOFA score on day-7 was better in the treatment group [intergroup difference was -2 (95% CI, -3.99 to -0.01, p = 0.009) with effect-size of r = 0.35 (95% CI, 0.09-0.55). The all-cause mortality with intervention was 24.4% compared to 44.4% (p = 0.046) in the control group. A significant improvement in the day-7 PaO2/FiO2 ratio [200.50 (101.01-291.30) and 110.70 (66.20-166.50), p = 0.003;intergroup difference -98.6 (40.70 to 156.49)], a decrease in CRP [-48.63 (-80.78 to -16.48) and 5.4 (-17.62 to 28.42), p = 0.042)], ferritin [-412.3 (-736.29 to -88.31) and 41.5 (-293.68 to 376.68), p = 0.018] was observed in the intervention and placebo groups, respectively. Conclusion: Single high-dose oral cholecalciferol supplementation to increase vitamin D3 >50 ng/mL improves the SOFA score and reduces in-hospital mortality in vitamin-D deficient patients with severe COVID-19.
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Introduction: COVID-19 pneumonia is a recently discovered, rapidly spreading acute respiratory syndrome. Chest CT has a 97% sensitivity for the diagnosis of COVID-19 pneumonia after a mean interval of 5 days. The typical chest CT findings in COVID-19 pneumonia are bilateral, peripheral, and basal predominant GGOs with or without consolidation and Broncho vascular thickening. The chest CT severity score of lung inflammation and clinical parameter analysis can assess COVID-19 disease and its severity. Aims: Authors evaluated correlation of biochemical parameters with Chest CT Score for diagnosis and prognosis of COVID-19 pneumonia patients. Materials and Methods: A total of 350 Patients diagnosed with COVID-19 pneumonia were included in the present study. We collected clinical and laboratory data for analysis, derived from an electronic medical record system, from June 2020 to July 2021 of patients who were diagnosed with COVID-19 infection by RT - PCR as well as chest HRCT scan. All the patients D-Dimer, LDH, Procalcitonin and ferritin levels were also collected. The statistical analysis was performed by using SPSS 21.0. Results: A significantly elevated levels of D-Dimer (1346±124.60), LDH (768±58.74), Procalcitonin (9.89± 0.97) and Ferritin (567±47.19) observed in all the subjects. The D-Dimer, LDH, Procalcitonin and ferritin was found to be positively correlated with CT severity score (p<0.0001). Conclusion: This study concluded that chest CT severity score can aid in predicting COVID-19 disease outcome, when CT Score is correlated with laboratory investigations useful for diagnosis as well as prognosis of COVID-19 pneumonia.
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The unprecedented COVID-19 pandemic has set a massive impact on the tourism industry through border closures, lockdowns and collapse of air travel. This conceptual research focuses on how tourism destinations strive to manage the health crisis and promote tourism amidst COVID-19. To achieve this, it analyses health crisis management in previous pandemic like situations, through the measures and problems that were dealt with as lessons learnt;highlights the impacts of COVID-19;identifies current practices and challenges of selected countries such as USA, Italy, Singapore, Japan, Greece, China, and Spain. Countries chosen for this research are either reliant on tourism or have dealt with the pandemic in many ways resulting in altered numbers of cases and deaths. The study adopts a qualitative approach, in analysing data derived from different sources such as official websites, social media campaigns, news and destination press releases on governmental actions of different countries and literature related to crisis management. Firstly, by identifying responses and measures taken to plan, support and promote tourism amidst COVID-19. Followed by thematically analysis using pre-decided themes of ‘good practices and challenges’ for tourism. The findings indicate the different good practices adopted by governments in assisting to manage this crisis and promoting the destinations through several campaigns to revive. It highlights challenges in planning, development and promotion amidst COVID-19 and proposes an integrated strategy for better crisis management. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Siddha's system of medicine is the effective one to reduce the symptoms of many viral illnesses. Siddha's system of medicine in asymptomatic, mild to moderate Covid-19 Positive patients, will make them recognize its effectiveness, reduce the symptoms, and move into the traditional approach towards the deadliest pandemic disease Covid-19. The objective of this study is to evaluate the acceptance and benefit of integrative Siddha management among the mild, moderate and asymptomatic COVID patients through a feedback questionnaire in TPEC COVID Care Center, Vellore, Tamil Nadu (TPECThanthai Periyar Engineering College). 74 asymptomatic, mild to moderate Covid-19 Positive patients were observed 7 days from 14.07.2020 to 30.07.2020 in TPEC COVID Care Center, Vellore, Tamil Nadu. During this period, Siddha medicines were administrated along with Western medicine. At the end of the period, validated feedback questionnaires were used to collect information from 74 participants for evaluating the acceptance and benefit of integrative Siddha management.In the 74 patients of TPEC COVID Care Center, Vellore, 100% were taken the given Siddha drug properly. 82.4% had the most common symptoms and 52.7% had less common symptoms. 16.2% of cases developed gastric acidity and 1.3% developed mild dyspnea as an ADR. 91.8% were recommended the Siddha system to others. 93.2% reported excellent disease progress. 90.7% of Siddha doctors quoted for 'Excellent' service on covid patients. This feedback report explores the three important significance. (a) Siddha medicine having significant effectiveness (b) Siddha medicines have safety in covid-19 patients (c) overall services of Siddha doctors are appreciatable by the patients and Siddha system is recommended to others. This analysis report helps to provide the possibility of the Siddha system for further or future clinical trials.
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Peripartum services are indispensable notwithstanding the COVID-19 pandemic. Providing safe and quality obstetric anesthesia is quite demanding as most signs and symptoms of COVID-19 are non-specific and overlap with the constitutional signs of pregnancy. Overloaded viral testing facilities, urgency of caesarean delivery, limited resources, capricious evidence-base, and potential exposure risk to healthcare providers further add to the challenge imposed by COVID-19. In this discourse we attempt to provide a summary of the current evidence and recommendations concerning the practice of obstetric anesthesia and analgesia.