ABSTRACT
Background: Personal protective equipment (PPE) guidelines serve to protect health care providers and patients from harmful biohazards. With the rise of COVID-19, many institutions have mandated strictly enforced endoscopic PPE guidelines. We currently do not know how practitioners perceive these mandates or how they will influence their practice in the long term. We aimed to study the PPE practices among endoscopists across Canada and compare their perceived differences in practice between the pre- and postpandemic eras. Methods: A 74-item questionnaire was emailed from June 2020 to September 2020 to all members of the Canadian Association of Gastroenterology and the Canadian Association of General Surgeons through monthly newsletters. The survey was created by expert consensus and distributed using REDCap. Survey questions collected basic demographic characteristics of Canadian endoscopists and differences between PPE practices before and after the COVID-19 pandemic. Results: A total of 77 respondents completed the survey, with the majority of respondents aged 40-49 years (34 [44.2%]) and identifying as gastroenterologists (54 [70.1%]). There was an even split in terms of sex: (38 women [49.4%], 39 men [50.6%]). In the prepandemic era, the majority of endoscopists wore gowns (91.0-93.9%) and all endoscopists wore gloves (100%). However, the majority of endoscopists did not wear surgical masks (20.9%-31.3%), N95 respirators (1.5%-3.2%), face shields (13.4%-33.9%), eye protection (13.4%-21.3%) or hair protection (11.1%-12.5%). In the postpandemic era, endoscopists reported a plan to dramatically change their prepandemic practices and adopt current PPE mandates. Overall, the top 3 PPE changes endoscopists reported implementing were increasing routine use of surgical masks (50.6%-61.0%), face shields (32.5%-46.8%) and hair protection (32.5%-36.4%). Endoscopists also reported a plan to change gowns more frequently (13.0%-19.5%). Conclusion: The COVID-19 pandemic has changed the attitudes of many endoscopists regarding future PPE use in routine endoscopy. Ongoing studies comparing the rates of transmission of hospital-acquired infections in the setting of endoscopy are needed to develop a new postpandemic PPE consensus.
ABSTRACT
Background: Patients with lupus nephritis (LN) are known to be at higher risk for severe infections due to both an underlying immune dysfunction and as a consequence of immunosuppressive therapy (IS). We sought to investigate the impact of COVID-19 pandemic in patients with LN. Methods: A total of 95 patients with LN actively monitored in our department between 26th February 2020, when the first case of COVID-19 was diagnosed in Romania, and 1st May 2021 were included in the study. Demographics, comorbidities, clinical and laboratory characteristics, current IS therapy, COVID-19 symptoms and outcome were collected. A COVID-19 diagnosis was made if clinical symptoms were accompanied by a positive SARS-CoV-2 PCR. Results: Fifteen patients (15.8%) were diagnosed with COVID-19 at a median 279 days (IQR:218-341) since the first case was diagnosed in Romania. The majority of infections were mild (73.3%), moderate infections being encountered in the remaining patients (26.7%), while none has developed a severe infection. The most common (53.3%) and fever (46.7%). Overall, 40% of patients were hospitalized for a median of 11.5 days (IQR:3.75-14). Of these, 2 patients needed supplemental oxygen and 1 patient non-invasive ventilation. There were no COVID-19-related deaths during the study period. Of the clinical variables associated with infection development, fewer patients with COVID-19 were on hydroxychloroquine (66.7% vs. 89%, p=0.04) or were on clinical remission during the study period (40% vs. 67.5%, p=0.04), while the median maintenance oral corticosteroid dose was significantly higher in those with SARS-CoV-2 infection compared to those without [16 mg (IQR:7-21) vs. 6 mg (IQR:4-10), p=0.007]. In multivariate Cox regression analysis, use of hydroxychloroquine (HR, 0.23;95%CI, 0.04-1.26) and oral corticosteroid dose (HR, 1.11;95%CI, 1.01-1.22) remained the most important predictors of COVID-19. Conclusions: The burden of SARS-CoV-2 infection in patients with LN seems to be low. Use of hydroxychloroquine seems to be associated with a lower risk for COVID-19, while from different immunosuppressive agents corticosteroid dose was identified as an independent risk factor for infection development.