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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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In recent decades, the COVID-19 pandemic is the biggest social and economic crisis that has influenced all aspects of human life. The main purpose of this research paper is to yield a bibliometric analysis in terms of research papers regarding the influence of the SARS-CoV-2 virus on the international economy. Accordingly, the findings will reveal the papers written in the domains of economics, business and business finance, management, hospitality, leisure, sport and tourism. Thus, current areas of research were examined and future study may be proposed. The analysis shows key information concerning the authors, journals, countries and keywords. It may be acknowledged that the COVID-19 pandemic was of utmost importance for the worldwide researchers. Our judgments and recommendations are supposed to act as a framework to possible research opportunities and conspicuous implications for the economic area. © 2022, Bucharest University of Economic Studies. All rights reserved.
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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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In order to highlight the impact of the pandemic phenomenon, especially on the wide use of antibiotics and biocides on bacterial communities, 3 Romanian interest regions were studied during 2019-2020. Every year, three wastewater sampling campaigns were organized from Covid-19 hospitals and WWTPs. The effluents were subjected to quantitative analysis for the determination of fecal coliform bacteria by the MPN (Most Probable Number) method using Colilert-18 medium (Idexx). The positive control (Escherichia coli ATCC25922, Citrobacter freundii ATCC 8090 and Enterobacter aerogenes ATCC 13048) and the negative one (Enterococcus faecalis ATCC 29212) were tested. In the same time, a blank control with sterile distilled water was analyzed. Hospital effluents did not show high densities of coliform bacteria at the beginning of the pandemic, but the values of these indicators were high (an average of over 5x105 CFU/100mL) in the WWTP. With the evolution of the pandemic, the treatment plants have streamlined their treatment processes, so that by the end of 2019 the densities of coliform bacteria remained around 5x104 CFU/100mL. While in mid-2020 the density of coliform bacteria decreased in hospital effluents, an increase can be observed in WWTP. In conclusion, the inversely proportional distribution of the densities of coliform bacteria in the hospital compared to WWTP, could be explained by the action of biocides and antibiotics on the microorganisms in the hospital environment that determined their decrease in wastewater.
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COVID-19 treatment includes both antiviral agents and immunosuppressive and immunomodulatory medication for moderate and severe disease, which decrease systemic inflammation. Our objective was to evaluate tocilizumab, anakinra and corticosteroid effectiveness in a cohort of COVID-19 patients hospitalized in a tertiary care unit from Bucharest, Romania, during the second and third SARS-CoV-2 pandemic waves, by assessing the prediction variables for the length of hospital stay (LHS). We enrolled 330 consecutive patients, with a mean age of 58.2 +/- 14.8 years, 119 females (mean age 61.4 +/- 14.1 years) and 211 males (mean age 56.4 +/- 15 years). The prediction parameters for LHS were the treatment approach, older age and the presence of COPD, but were not associated with other significant comorbidities for COVID-19, such as obesity, diabetes, chronic renal failure or active malignancy. We found a significant difference in the mean LHS between patients who received tocilizumab and standard of care and patients treated with anakinra plus standard of care. Still, this difference was only seen in patients who required high concentration oxygen therapy (more than 5 L O-2/min). We suggest that, especially in non-critically-ill patients with a high oxygen therapy requirement, the administration of tocilizumab and standard of care is associated with a reduced length of hospital stay compared to the anakinra standard of care regimen.
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Background: Influenza is an acute infection affecting all age groups;however, elderly patients are at an increased risk. We aim to describe the clinical characteristics and the circulation of influenza virus types in elderly patients admitted for severe acute respiratory infection (SARI) to a tertiary care hospital in Bucharest, Romania, part of the I-MOVE+ hospital network. Methods: We conducted an active surveillance study at the National Institute for Infectious Diseases “Prof. Dr Matei Balș,” Bucharest, Romania, during three consecutive influenza seasons: 2015/16, 2016/17, and 2017/18. All patients aged 65 and older admitted to our hospital for SARI were tested for influenza by PCR. Results: A total of 349 eligible patients were tested during the study period, and 149 (42.7%) were confirmed with influenza. Most patients, 321 (92.5%) presented at least one underlying condition at the time of hospital admission, the most frequent being cardiovascular disease, 270 (78.3%). The main influenza viral subtype circulating in 2015/16 was A(H1N1)pdm09, followed by A(H3N2) in 2016/17 and B influenza in 2017/18. Case fatality was highest in the 2015/16 season (3.7%), 0% in 2016/17, and 1.0% in 2017/18. Vaccination coverage in elderly patients with SARI from our study population was 22 (6.3%) over the three seasons. Conclusions: Our study has highlighted a high burden of comorbidities in elderly patients presenting with SARI during winter season in Romania. The influenza vaccine coverage rate needs to be substantially increased in the elderly population, through targeted interventions. © 2020 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.
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Background: The severe manifestations of the coronavirus disease 2019 (COVID-19) are linked to viral hyper-inflammation, cytokine release syndrome and subsequent coagulation disturbances. The most common coagulation abnormality observed in COM-19 patients is the elevation of the plasma levels of D-dimers. The aim of this study was to evaluate the characteristics of COVID-19-associated inflammatory syndrome and coagulopathy, in correlation with disease severity. Methods: We performed a cross-sectional study, enrolling all consecutive COVID-19 patients treated in the Adulti 3 Department of the Prof Dr. Matei Bals National Institute of Infectious Diseases, Bucharest, Romania, between 1st march and 30th September 2020. We recorded clinical and epidemiological characteristics, inflammatory markers, coagulation abnormalities and lymphocyte count. The severity of lung involvement was assessed using native Computed Tomography examination. Results: We included 106 patients with SARS-COV2 infection, 50 males (47.2%) and 56 females (52.8%), age range 14-91 years. All markers of inflammation were increased in our study in patients with severe disease, as were lactate dehydrogenase, monocyte distribution width, and neutrophil-to-lymphocyte ratio. An elevated level of serum D-dimers was observed in approximately half of our subjects and was associated with disease severity. Our best linear regression model for predicting COVID-19 coagulopathy (manifested as abnormal D-dimer levels) included age, fibrinogen, and lymphocyte count. Conclusion: Our findings emphasize the association between COVID-19 coagulopathy and the presence of systemic inflammation. A significant proportion of patients with moderate and severe disease had coagulation abnormalities and these were linked with the presence of inflammation and older age..