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BACKGROUND: COVID-19 caused healthcare systems to significantly alter processes of care. Literature on the pandemic's effect on healthcare processes and resulting surgical outcomes is lacking. This study aims to determine outcomes of open colectomy in patients with perforated diverticulitis during the pandemic. METHODS: Using CDC data, the highest and lowest COVID mortality rates were calculated and used to establish 9-month COVID-heavy (CH) and COVID-light (CL) timeframes, respectively. Nine-months of 2019 were assigned as pre-COVID (PC) control. Florida AHCA database was utilized for patient-level data. Primary outcomes were length of stay (LOS), morbidity, and in-hospital mortality. Stepwise regression with 10-fold cross-validation determined factors most impacting outcomes. A parallel analysis excluding COVID-positive patients was performed to differentiate COVID-infection from processes of care. RESULTS: There were 3862 patients in total. COVID-positive patients had longer LOS, more intensive care unit admissions, and higher morbidity and mortality. After excluding 105 COVID-positive patients, individual outcomes were not different per timeframe. Regression showed timeframe did not affect primary outcomes. DISCUSSION: Outcomes following colectomy for perforated diverticulitis were worse for COVID-positive patients. Despite increased stress on the healthcare system during the pandemic, major outcomes were unchanged for COVID-negative patients. Our results indicate that despite COVID-associated changes in processes of care, acute care surgery can still be performed in COVID-negative patients without increased mortality and minimal change in morbidity.
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Objectives: Organizational skills training (OST) for youth with ADHD is an efficacious treatment that addresses impairments at home and in school. Modifications of OST were conducted to treat children with or without ADHD, to reduce treatment barriers, and to respond to changes in school demands during the COVID-19 pandemic. Method(s): After an initial RCT documenting OST efficacy, 3 further studies involved: 1) an open replication of the original RCT confirming improvements in organization, time management, and planning (OTMP) in children diagnosed with ADHD (N = 15) using twice-weekly in-person visits;2) a subsequent open trial investigating children with deficient organizational skills with or without ADHD and altering delivery to involve a combination of in-person and virtual meetings (N = 29);and 3) a third study with subjects with low OTMP skills who do not necessarily have ADHD, receive treatment with combined in-person and virtual delivery or, in response to COVID-19 restrictions, fully virtual delivery (N = 27, thus far), and, in response to remote school delivery, have altered OST content to fit varied school instruction demands (eg, use of electronic documents instead of papers) while adhering to the principles of OST. Change was measured on the Children's Organizational Skills Scales (COSS). Result(s): 1) Improvements in OTMP skills (parent ratings d = 3.73;teacher ratings d = 1.12) in the first open study were comparable to the initial RCT findings. 2) In study 2, parents also reported substantial improvements (d = 3.04), and teachers reported large changes (d = 0.88) in pre-post comparisons. 3) In the ongoing RCT, subjects who received treatment immediately were reported to have large changes by parents (d = 2.17) and moderate changes by teachers (d = 0.47) when compared to waitlist controls. Conclusion(s): Initial analyses indicate that OST leads to OTMP improvements in children struggling with disorganization with and without ADHD diagnosis. Improvements are found when treatment is delivered fully in-person, delivered in hybrid in-person and virtual meetings, or delivered fully virtually. OST could help children with or without ADHD improve behavioral and emotional adjustment at home and in school, when treatment delivery is modified to increase treatment availability, and when school demands are varied. ADHD, CBT, EBP Copyright © 2022
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Systemic inflammation is a hallmark of severe coronavirus disease-19 (COVID-19). Anti-inflammatory therapy is considered crucial to modulate the hyperinflammatory response (cytokine storm) in hospitalized COVID-19 patients. There is currently no specific, conclusively proven, cost-efficient, and worldwide available anti-inflammatory therapy available to treat COVID-19 patients with cytokine storm. The present study aimed to investigate the treatment benefit of oral colchicine for hospitalized COVID-19 patients with suspected cytokine storm. Colchicine is an approved drug and possesses multiple anti-inflammatory mechanisms. This was a pilot, open-label randomized controlled clinical trial comparing standard of care (SOC) plus oral colchicine (colchicine arm) vs. SOC alone (control arm) in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. Colchicine treatment was initiated within first 48 hours of admission delivered at 1.5 mg loading dose, followed by 0.5 mg b.i.d. for next 6 days and 0.5 mg q.d. for the second week. A total of 96 patients were randomly allocated to the colchicine (n=48) and control groups (n=48). Both colchicine and control group patients experienced similar clinical outcomes by day 14 of hospitalization. Treatment outcome by day 14 in colchicine vs control arm: recovered and discharged alive: 36 (75.0%) vs. 37 (77.1%), remain admitted after 14-days: 4 (8.3%) vs. 5 (10.4%), ICU transferred: 4 (8.3%) vs. 3 (6.3%), and mortality: 4 (8.3%) vs. 3 (6.3%). The speed of improvement of COVID-19 acute symptoms including shortness of breath, fever, cough, the need of supplementary oxygen, and oxygen saturation level, was almost identical in the two groups. Length of hospitalization was on average 1.5 day shorter in the colchicine group. There was no evidence for a difference between the two groups in the follow-up serum levels of inflammatory biomarkers including C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), ferritin, interleukin-6 (IL-6), high-sensitivity troponin T (hs-TnT) and N-terminal pro b-type natriuretic peptide (NT pro-BNP). According to the results of our study, oral colchicine does not appear to show clinical benefits in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. It is possible that the anti-inflammatory pathways of colchicine are not crucially involved in the pathogenesis of COVID-19.
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COVID-19 Drug Treatment , Humans , SARS-CoV-2 , Cytokine Release Syndrome/drug therapy , Colchicine/therapeutic use , Hospitalization , Anti-Inflammatory Agents/therapeutic use , Treatment OutcomeABSTRACT
Aim: To compare the predictive accuracy of raised ALT/AST ratio in diabetic patients for survival and myocarditis due to COVID- 19 pneumonia. Study design: It was a cross-sectional study, conducted at Department of Medicine, Services Hospital, Lahore for about 6 months (March 2020 to September 2020) Methods: A cross-sectional study was conducted for six months at Services Hospital in Lahore (March 2020 to September 2020). A total of 350 patients' ALT and AST levels will be tested in blood. Patients' survival rates will be tracked. Patients with myocarditis and ALT/AST ratios below 0.90 had a dismal prognosis. Results: The average female age was 47.87.15.82. There were 142 men (40%) and 208 women (59.4%). There were 131 light (36.4%), 77 moderate (22%), 83 severe (23.7%), and 59 serious cases (16.9%). Mean ALT/AST was 0.89 0.33. 58 patients (16.6%) had myocarditis, and 66 (18.9%) died in the hospital. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the ALT/AST ratio for predicting diabetic patient survival were 56.1%, 39.1%, 17.6%, 79.3%, and 42.3%. The ALT/AST ratio's sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 78%, 42.9%, 20%, 91.3%, and 48.3% for predicting the survival of diabetic patients with COVID-19 pneumonia-related myocarditis. Conclusion: This study found that ALT/AST ratio is not a strong predictor of mortality in diabetic patients with COVID-19-related myocarditis.
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Healthcare workers (HCWs) are at increased risk of mental health issues when faced with the challenges associated with pandemics. This study was conducted to assess the psychological impact of pandemic o n HCWs working in tertiary care hospitals of Khyber-Pakhtunkhwa province of Pakistan. This cross-sectional study was conducted between April & June 2020. By convenience sampling an electronic form of Goldberg General Health Questionnaire was distributed among HCWs of the private sector and public tertiary care hospitals. Data were analyzed using SPSS version 22. Inferential analysis was done. The significant level was considered at p=< 0. 05. Total of 186 HCWs among which 105 (56.5%) males and 81 (43.5%) females participated in the survey, a mean age of 37.6 +/- 9.28 years. The highest prevalence was found for social dysfunction 184 (97.8%) followed by somatization, 169 (92.8%). Significance of difference was found between age group and anxiety (p=0.018), specialty of HCWs with somatization and social dysfunction (p=0.041 and 0.037 respectively). Pandemic poses a significant risk for the mental health of HCWs. During pandemics at its peak, proper mental health support program, personal and family protection assurance is highly recommended for provision of quality care by HCWs.
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Health is not merely the absence of disease but a state of complete physical, mental and social wellbeing. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being globally. The World Health Organisation (WHO) as the global leader in public health is responsible to ensure public health globally. Every member states of the United Nation (UN) have developed own healthcare infrastructure and medical services to ensure citizen’s health. The unprecedented health crisis aroused due to the Covid-19 pandemic has proved the healthcare infrastructure and medical services exist in India and abroad insufficient. The Pandemic has affected the socio-economic febric of the world and forced the people to face new challenges. The study investigates the constitutional and legal position of right to health and medical care in India and the impacts of Covid-19 thereupon. The study critically examines the working of the WHO in the time of Covid-19 pandemic. Doctrinal method of research is applied in this study.
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BACKGROUND: Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)- ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care. METHODS: This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included. RESULTS: A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality. CONCLUSIONS: The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start.
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Background: The purpose of this study was to estimate the effect of social distancing (days since the imposition of a lock-down) and the number of daily tests conducted per million population on the daily growth rate of COVID-19 cases. Methods: After excluding the first 30 days since the announcement of an index case in a country, relevant data for the next forty days was collected from four countries: Belgium, Italy, South Korea and United Kingdom. Two online databases: Our World in Data and worldometer were used for the collection of data which included the number of new COVID-19 cases and the number of tests conducted on a given day. The acquired figures were transformed into per million population of the given country. The growth rate of daily COVID-19 cases was derived and was used as the regress and in a multiple linear regression with the number of tests per million population per day and the number of days since a lock-down was imposed as the regressors. Results: It was found that the growth rate of daily COVID-19 cases decreased by .051% when the number of daily tests conducted per million population increased by 1. A .532% decrease in the growth rate of daily COVID-19 cases was observed with each passing day of a lock-down, which essentially represented the most effective form of social distancing. A significant regression was calculated (F (2, 155) = 35.191, p=.014), with an R2 of .054. Neither the daily number of tests conducted per million population nor the number of days of maintaining social distancing (lock-down) was individually significant contributors to the prediction of the growth rate of daily COVID-19 cases (p=.267 and p=.554 respectively). Conclusion: An extensive and rapid increase in the daily number of testing capacity and maintaining social distancing can decrease the growth rate of daily COVID-19 cases. Depending on the availability of the required resources, timely implementation of these measures can lead to better outcomes for a given population.