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Rationale:Both insufficient and excessive respiratory effort during mechanical ventilation are associated with lung and diaphragm injury, and poor outcome. The characteristics of respiratory effort under MV has not been systematically described. The expiratory occlusion pressure (Pocc) is a non-invasive technique to estimate effort and lung-distending pressure from spontaneous breathing during MV. We set out to describe the frequency and magnitude of effort and lung-distending pressure in patients receiving MV. Methods:In a retrospective cohort study, we collected data from charts of patients receiving invasive MV at Toronto General Hospital from July 2019 to June 2021. Pocc is routinely measured once daily in every patient on MV. Data on patient demographic characteristics and ventilator settings was collected in a registry of ventilated patients in Toronto. For each day, we calculated the proportion of patients in whom effort was absent (Pocc = 0), low (Pocc -1 to -5 cm H2O), moderate (-5 to -15 cm H2O), high (-16 to -30 cm H2O), and very high (< -30 cm H2O). Excessive dynamic transpulmonary driving pressure was defined as estimated ΔPL,dyn was >20 cm H2O. Results:We included 854 patients who received invasive MV for at least 1 day. Of 577 patients in whom Pocc was measured on day 1 (within 24 hours of initiation of MV), effort was absent in 434 (75%) patients, moderate in 70 (12%), and high or very high 43 (7%). Of 328 patients in whom Pocc was measured on day 5, effort was absent in 127 (39%) patients, moderate in 80 (24%) patients and high or very high in 91 (28%). Among spontaneously breathing patients (Pocc <0 cm H2O), estimated dynamic transpulmonary driving pressure exceeded 20 cm H2O in 49/116 (42%) on day 1 and 77/150 (51%) on day 5. On patient-days on which estimated dynamic transpulmonary driving pressure exceeded 20 cm H2O, on average the ventilator contributed 62% (SD 24%) of total lung-distending pressure and the patient contributed 38% (SD 24%) of total lung-distending pressure. Over days 1 through 10, respiratory efforts were more vigorous in patients with COVID-19 pneumonia compared to those without (mean Pocc -12 cm H2O vs -7 cm H2O, p= <0.01). Conclusions:Respiratory effort is frequently absent or excessive during MV. Patients frequently exhibited excessive lung-distending pressures during spontaneous breathing. COVID-19 pneumonia was associated with higher respiratory effort. (Figure Presented).
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Apart from the physical effects of Covid-19, psychological effects are seen as well in the general population. In pregnant females, psychological impact leads to adverse pregnancy and neonatal outcomes. Due to limited data, the mental health of COVID-19 positive pregnant patients is not clear especially in relation to isolation in hospital, treatment, time and mode of delivery. Objective: To determine and compare frequency of anxiety and depression in pregnant women with and without COVID-19. Material and Methods: It was a comparative cross-sectional study that was conducted in the department of Obstetrics and Gynaecology, SGRH, Lahore. 60 pregnant females were enrolled and underwent nasopharyngeal swab for PCR and had HRCT to determine Covid-19 status. HADS was applied on all pregnant females to assess depression and anxiety and findings were subjected to statistical analysis. Results: The mean age, gestational age, anxiety scores and depression scores were 29.93±4.15, 31.1±6.28, 10.56±3.29 and 10.02±2.72 respectively. There were 60% Covid positive pregnant females, depression was present in 31.7% and anxiety was present in 65% females. Comparison of pregnant females with or without Covid infection in terms of depression and anxiety using independent T-test revealed that anxiety was significantly associated with Covid positive status (p=0.032), however, no significant association was seen between depression and covid status (p=0.641) (table 3). Conclusion: Covid-19 was frequently seen in pregnant females and was significantly associated with high frequency of anxiety. Depression was less commonly seen and was not significantly associated with Covid-19 infection.
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Aim: To determine the psychological and social impact of lockdown due to COVID-19 and to determine the associated factors like anxiety, depression and psycho social stressors. Methodology: It was a cross-sectional online survey conducted by Department of Psychiatry, Shaikh Zayed Hospital, Lahore, 500 random participants were enrolled. A pretested questionnaire was used and information was collected from a sample of 500 clients, selected via Google Class Room, Social Media (WhatsApp and Facebook). Results: The mean age of the participant's was 24.83±5.245. Depression and anxiety scores on HADS were 6.88±2.791 and 8.42±4.09. As many as 22.2% individuals were affected financially by lockdown and 10.2% were affected badly. Due to lockdown, the bonding of individuals with their partners was affected positively in 22.2% cases and negatively in 18%. Bonding with the parents/children was affected positively in 23.8% cases and negatively, in 61.8%. Depression was reported by 43.6% individuals and anxiety was reported by 55.3% individuals. Conclusion: Significant psychosocial issues have emerged as a result of lockdown imposed because of Covid-19 pandemic in Pakistan. The high rates of psychosocial issues have been found to be associated with depression and anxiety.
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Purpose Citizen journalism practices through social networking sites are increasingly becoming an imperative source of public opinion formation. Given the increase in the volume of information sharing on social media during COVID-19, this study aims to grasp the largely unknown interaction of the individual's trust in citizen journalism practices and public perception formulation. Drawing on this idea, the study has twofold objectives: first, to examine the influence of user-generated information about economic policies of government during COVID-19 as the antecedent of public perception about government performance and second, to identify the moderating role of trust in citizen journalism practices during COVID-19 through social networking sites. Design/methodology/approach The study used a survey method and a sample of 464 adults were collected through an online administrated questionnaire. Findings The findings specify that user-generated content that is pro-government economic policies during COVID-19 positively influenced the perception of government performance. On the other hand, user-generated information that criticized government economic policies had a negative influence on public perception. Originality/value This study seeks to intensify the understudied phenomenon of how nature and source of the information could interact to influence one's information processing during a crisis such as pandemic COVID-19. Furthermore, only a little research has been conducted in this area focusing on two mechanisms, namely;citizen journalism and trust in social media user-generated information about prevailing economic insecurities during crisis provided through citizen journalism.
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Non-technical summary Urban density is erroneously regarded as the main factor in the spread of COVID-19 in cities. A review of extant literature and findings from our case study of Karachi, Pakistan indicate that inequalities in income, healthcare, and living conditions play a key role in the spread of contagions along with government responsiveness to the pandemic. Moving forward, urban policies need to address these inequalities through changes in housing policies and decentralized governance systems. Cities must adapt to sustainable modes of travel, reduce digital inequalities, and encourage people friendly urban planning to become resilient in the face of pandemics. Technical summary COVID-19 has changed how urban residents relate to their cities. Urban centers have become epicenters of disease, which has raised questions about the long-term sustainability of high-density settlements and public transport usage. However, the spread of COVID-19 in cities is incorrectly attributed to urban density. Using the case study of Karachi, Pakistan, we find that inequality of income, healthcare, and living conditions is a major contributing factor to the spread of COVID-19. Data on positive COVID-19 cases, density, and socioeconomic status were obtained at the Union Council level from administrative districts of Karachi, Pakistan between March 2020, and July 2020. Despite low population densities, low-to-middle income neighborhoods in Karachi had a higher proportion of positive cases. Further, the experience of dense cities such as Hanoi in Vietnam and New York in the US differs regarding the spread of COVID-19. Hence, the government's response to the pandemic is also a major factor in containing the outbreak. Our findings suggest that a crisis in a city is exacerbated by its inability to take advantage of its density, inequality in the distribution of resources, lack of inclusiveness, and centralized governance mechanisms that make it difficult to respond quickly to situations. Thus, urban planning scholarship and practice should take an interdisciplinary approach to make cities equitable, inclusive, and adaptive. Social media summary Cities in the developing world have an opportunity for more resilient renewal in the post-COVID world. Copyright © The Author(s), 2021. Published by Cambridge University Press.
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Objective: To assess the level of anxiety among doctors and paramedical staff working in a tertiary care Hospital during COVID-19-Pandemic. Study Design: Cross-sectional study Place and Duration of Study: This study was conducted at the Abwa Hospital & Research Centre attached with Abwa Medical College, Faisalabad for the period of three months i.e. May, 2020 to July, 2020. Materials and Methods: Total 55 participants including 11 doctors & 44 paramedics serving specifically COVID-19 patients were selected to assess the level of anxiety and its associated factors. Results: Out of total 55 participants, the level of anxiety was higher among medical doctors (mean score =6.91+7.0) as compared to paramedical staff (mean score3.25+4.68) where 31.7% of frontline health workers reported anxiety on BAI. 20 % (n=11) mild symptoms, a single worker only reported moderate anxiety 7.2% reported severe anxiety. Conclusion: During the pandemic of COVID-19 disease, among health care workers of ABWA hospital, medical doctors reported anxiety problems to a greater extent as compared to paramedical staff although intensity of anxiety was disproportionately higher in paramedical group. Considering this, there is a need of implementing programs of mental health being for health care professionals as an essential component of every epidemic at both national and international level.